The American Journal of Tropical Medicine and Hygiene

This cross-sectional study assessed hygienic practices, microbial contamination, and associated factors among street food vendors in Mymensingh City, Bangladesh, from August 2024 to February 2025. Using purposive sampling, 300 vendors were evaluated through structured questionnaires, observational assessments, and laboratory analysis of food samples (n = 300) for bacterial load (log-transformed Total Viable Count, log_TVC). Results revealed that 87.33% (95% CI: 83.6-91.1) of vendors practiced poor hygiene: 90.7% (95% CI: 87.4-94.0) did not cover food, 7% (95% CI: 4.1-9.9) used disinfectants, and 81.00% (95% CI: 76.6-85.4) reused ingredients beyond one day. Knowledge gaps were stark, with 89.7% (95% CI: 86.3-93.1%) demonstrating insufficient basic hygiene knowledge and 90.7% (95% CI: 87.4-94.0%) lacking understanding of hygienic food processing. Education significantly influenced practices; secondary-educated vendors exhibited markedly better hygiene awareness (65.0% vs. 2.89% in uneducated groups). Bacterial loads varied across food types, with Velpuri showing the highest mean log_TVC (8.00, 95% CI: 7.65-8.35) and fast food the lowest (7.69, 95% CI: 7.34-8.03). Significant correlations emerged between hygiene knowledge and practices: vendors aware of foodborne diseases were more likely to use gloves (Spearman's r = 0.199, p = 0.001) and cover food (r = 0.118, p = 0.041). Challenges included financial constraints (62.25% [95% CI: 56.1-68.4] among uneducated vendors), knowledge gaps, and time limitations. The study underscores systemic issues in street food safety, driven by low education and economic barriers. Interventions targeting vendor education, affordable hygiene solutions, and stricter enforcement of ingredient freshness protocols are urgently needed to mitigate foodborne disease risks in urban Bangladesh.

Background: Dengue emerged as a new public health threat in the Rohingya refugee camps in Coxs Bazar, Bangladesh, in 2021 and expanded into large-scale upsurges in subsequent years. Evidence on dengue epidemiology and clinical presentation in protracted refugee settings remains limited, despite the need for stronger outbreak preparedness and case management in these contexts. Objectives: To describe the epidemiological, clinical, and diagnostic characteristics of the dengue upsurge among Rohingya refugees and surrounding host communities in Coxs Bazar, Bangladesh, and to identify predictors of inpatient admission and diagnostic positivity patterns. Methods: This retrospective observational study used anonymized surveillance data from the International Organization for Migration (IOM) dengue patient database. Rapid diagnostic test (RDT)-confirmed dengue cases identified across 36 IOM-supported health facilities in Ukhiya and Teknaf between 1 October 2021 and 31 December 2024 were included. Demographic, epidemiological, clinical, and laboratory variables were summarized using descriptive statistics. Weekly incidence was aggregated by epidemiological week and calendar year, and epidemic growth and decay phases were modelled using phase-specific Poisson regression. Multivariable logistic regression was used to identify predictors of inpatient admission and to examine associations between delay in presentation and RDT positivity patterns, adjusting for age and sex. Results: A total of 35,581 RDT-confirmed dengue cases were reported, of which 90.2% occurred among Rohingya refugees. The median age was 17 years (IQR 7-30), and 46.0% of cases were among children aged 0-14 years. Annual caseload increased from 1,011 in 2021 to 11,752 in 2022, 10,669 in 2023 and 12,149 in 2024, with seasonal peaks during the monsoon period and progressively later peaks and longer epidemic tails over time. Poisson models showed decreasing growth rates across years (r=0.449 in 2021 to r=0.091 in 2024) with increasing doubling times, while decay rates remained broadly comparable (halving time ~4.4-6.0 weeks). Overall, 8.0% of cases required inpatient admission, 1.3% were referred, and four deaths were reported (case fatality <0.1%). In multivariable analysis, inpatient admission was associated with older age ([&ge;]60 vs 0-14: aOR 2.31), delayed presentation (aOR 1.06 per day), refugee status (aOR 1.39), presence of any World Health Organization (WHO) warning sign (aOR 26.60), low systolic BP (aOR 2.84) and chronic co-morbidity (aOR 6.07). In addition, males had lower odds of admission than females (aOR 0.88). NS1 antigen alone was positive in 62.1% of cases, IgM alone in 33.6%, and dual positivity in 4.3%. Longer delay from symptom onset to presentation was strongly associated with IgM-only positivity compared with NS1-only positivity (adjusted models controlling for age and sex). Conclusion: Sustained dengue preparedness is required in Coxs Bazar, including strengthened surveillance, community-based early referral, targeted monitoring of high-risk groups, environmental vector control, and phase-appropriate use of NS1 and IgM/IgG diagnostics to reduce missed diagnoses and prevent progression to severe disease. These findings highlight the need for a policy shift from episodic outbreak response toward sustained dengue preparedness in humanitarian settings, including strengthened surveillance systems, integrated diagnostic strategies, community-based early referral, and coordinated vector control interventions.

Background Approximately 59,000 cases and 1700 deaths were reported during the 2022-2023 cholera outbreak in Malawi. In response, the Ministry of Health implemented Oral Cholera vaccination campaigns (OCV) as one of the interventions. Four series of single-dose reactive OCV campaigns were conducted in 21 health districts between May 2022 and September 2023. OCV survey report of 2023 estimated a coverage of 55.40%. It was barely known how a single dose of OCV interrupts community transmission. This study was conducted to provide evidence on the use of a single-dose strategy and its contribution towards reducing the risk of cholera infection. Method A cross-sectional quantitative analysis was conducted to assess the effectiveness of OCV in reducing cholera incidence, severity, and mortality during the 2022-2023 cholera outbreak in Malawi. A national cholera line-list was used for analysis. Results Oral cholera vaccination coverage was at 2.0% of 28,920 suspected cholera cases. The effectiveness of a single dose of OCV towards reducing cholera infections was 98.00%. and associated with lower odds of severe dehydration (OR = 0.50; 95% CI: 0.39-0.64), with OCV effectiveness at 50%(95% CI: 36-61) Case fatality rate among vaccinated was 1.20 (95% CI: 0.54; 2.6, p = 0.025) and among unvaccinated it was 2.80% (95% CI: 2.6; 3.0, p = 0.025). Conclusion A single dose of the OCV campaign conducted during the 2022-2023 cholera outbreak in Malawi contributed to the reduction of cholera incidence. The intervention complemented other long-term interventions such as Water, Sanitation and Hygiene Oral Dehydration Points, Case Area Targeted Intervention, and Risk Communication and Community Engagements.

Abstract Background In many countries, particularly in sub-Saharan Africa, medical pluralism and utilization of multiple therapeutic approaches for managing diseases, including malaria, are common. Ghana's antimalarial medicine policy has recommended herbal medications for treating uncomplicated malaria. While this is in line with complementary and alternative medicine (CAM) use for the treatment of malaria, exploring CAM for malaria prevention could be an important consideration for public health initiatives towards malaria elimination efforts. This study assessed the prevalence, perceptions, and attitudes on CAM use for malaria prevention in the general population and associated factors. Methods A community-based cross-sectional analytic survey was conducted among 3064 adult residents sampled between September and November 2023. A multi-stage sampling method was used to select participants from 18 sub-districts drawn from 6 districts and 6 regions in Ghana. Data on CAM use for malaria prevention, attitudes about CAM, perceptions about malaria, and sociodemographic factors were collected. The primary outcome was reported CAM use for malaria prevention within the 12months preceding the survey, measured as a binary outcome. Multiple logistic regression analyses were performed to identify the predictors of CAM use for malaria prevention. Results A total of 3,064 household respondents were involved in the analysis, with 51.2% (n=1,570) females and a median age of 31 years (IQR: 24-42 years). The use of CAM for malaria prevention in the last 12 months was 31.6% (95% CI: 30.0-33.3%). The most common types of CAM used included botanical/herbal medicine (21.8%), vitamin supplements (12.3%), mineral supplements (10.7%), and spiritual healing/prayers (9.6%). Increased CAM use for malaria prevention was associated with education and perceptions, such as concerns and consequences about malaria. Factors associated with decreased odds of CAM use included formal employment and having a skeptical and indifferent attitude about CAM. Conclusion Over a third of the population used CAM for malaria prevention in the last year, highlighting its role in public health. Integrating herbal medicine into prevention strategies could enhance community acceptance and help with efforts toward malaria elimination. However, further research is needed to validate clinical efficacy, establish potential drug-herb interactions, and isolate lead compounds for optimized malaria prevention therapy.

Background: Malaria remains a major global health threat, with 249 million cases and 609,000 deaths reported in 2022. The Ashanti Region of Ghana bears a disproportionate burden, with severe malaria accounting for 24% of hospital admissions in 2021, above the national average of 19%. Despite intensified control efforts, inpatient mortality patterns remain poorly understood. This study identifies key determinants of severe malaria mortality among hospitalized patients in the Ashanti Region. Methods: We analyzed inpatient surveillance data from the District Health Information Management System 2 (DHIMS2) for severe malaria admissions from 2018 to 2022. Descriptive statistics, bivariate analyses with robust survey estimation (accounting for design effects), and multivariable Firth penalized logistic regression were used to identify mortality predictors. Survey-adjusted logistic regression served as a sensitivity analysis to validate findings. Results: Among 54,544 severe malaria admissions, females comprised 51.1% and children under five 39.4%. The case fatality rate was 0.4% (200 deaths). Mortality was significantly associated with age, occupation, insurance status, facility ownership, admitting department, length of stay, and comorbidities. Males had 1.4 times higher mortality odds than females. Compared to children under five, patients aged 5 to 17 years had 44% lower odds of mortality (aOR = 0.56, 95% CI: 0.33, 0.94). Active NHIS membership had lower mortality odds by 67% (aOR=0.33, 95% CI: 0.25, 0.45) compared to inactive membership. Admissions to faith-based facilities showed lower mortality odds (aOR=0.38, 95% CI: 0.23, 0.65) than government facilities, while medical wards had higher odds (aOR=2.38, 95% CI: 1.48, 3.84) than paediatric wards. Stays of 3 to 5 days were associated with lower mortality odds (aOR=0.67, 95% CI: 0.47, 0.97) compared to stays <3 days. Those with comorbidities had twice the mortality odds versus those without. Sensitivity analysis confirmed consistent direction and significance. Conclusion: Age, comorbidities, insurance coverage, facility type, and admission practices strongly influence severe malaria mortality in Ashanti. Strengthening NHIS enrollment, extending inpatient monitoring beyond three days, and adopting best practices from paediatric and faith based facilities could improve survival. Integrating comorbidity screening and management into malaria protocols is essential to reducing preventable deaths.

Background: Household insecticides are widely used for domestic pest control, yet exposure patterns in traditionally underserved populations remain poorly characterized. In the Brazilian Amazon, data on use patterns among older adults living in riverine communities are particularly scarce. Objective: To describe the prevalence, frequency, duration, application practices, and types of household insecticides used by older adults living in near-urban riverine insular communities in the Brazilian Amazon. Methods: Cross-sectional, population-based door-to-door survey conducted from August 2022 to July 2025 in four islands (Cotijuba, Mosqueiro, Outeiro, and Combu) in the city of Belem, Brazil. All residents aged 60 years or more registered in the primary care system were invited to participate. Trained interviewers administered an in-person standardized questionnaire to participants on current household insecticide use, frequency, duration, self-application, protective equipment, insecticide types, and product brands. Results: Among 1,101 screened individuals, 1,084 were included (median age at evaluation: 68 years). Overall, 78.4% reported current use of household insecticides. Weekly or more frequent use was reported by 58.9%, and 33.4% reported use for more than 5 years. Self-application was common (57.5%), whereas use of protective equipment was rare (8.2%). Aerosol sprays were the most frequently reported type (39.4%). Commonly recalled aerosols contained pyrethroid mixtures including cypermethrin, imiprothrin, prallethrin, and transfluthrin. A substantial proportion of participants reported using unregulated products and veterinary-only insecticides for household purposes. Conclusions: Household insecticide use is highly prevalent and frequent in Amazonian riverine communities, with minimal use of protective equipment and substantial irregular practices, underscoring the need for targeted risk communication and surveillance.

Background Malaria remains a critical global health challenge, with over 68% of Ethiopias population living in at-risk areas. While Long-Lasting Insecticidal Nets (LLINs) are a cornerstone of prevention, their effectiveness depends on consistent use. This study aimed to assess LLIN ownership and utilization patterns and identify socio-behavioral and physical determinants of their effectiveness in endemic communities. Methods A community-based, cross-sectional survey was conducted from October 2024 to January 2025 across 11 administrative regions in Ethiopia. Using a two-stage stratified cluster sampling technique, data were collected from 9,222 households (34,427 individuals) through face-to-face interviews and direct physical observations. Data analysis was performed using the SPSS Complex Samples module and hierarchical multivariable logistic regression. Results The survey found a household LLIN ownership rate of 71.5%, while the proportion of sufficient LLINs for every two people was 58.3%. Among those who owned nets, the overall utilization rate was 59.9%, with significantly higher rates in rural areas (72.7%) than in urban areas. Vulnerable groups achieved higher usage levels, specifically pregnant women (78.5%) and children under five (67.2%). Multivariable analysis indicated that age and pregnancy status were the strongest predictors of LLIN use, with ORs of 0.258 (p < 0.001) and 0.662 (p < 0.001), respectively. Major barriers identified included a 60.5% lack of confidence in hanging nets (p < 0.001) and a widespread misconception (64.1%) that malaria risk is restricted to the rainy season. Conclusion Although Ethiopia has made strides in LLIN ownership and prioritized protection for vulnerable demographics, overall utilization remains below the 80% threshold required for community-wide protection. To bridge the gap between ownership and consistent use, national strategies should transition toward skill-based interventions and targeted communication to address practical barriers and seasonal misconceptions.

Protracted conflict in Sudan since April 2023 has severely disrupted routine immunization services, particularly in the Darfur region, resulting in widespread vaccine stockouts, declining coverage, and increased risk of vaccine-preventable disease outbreaks. Traditional national supply routes became largely inaccessible, exacerbating inequities in immunization access for conflict-affected and displaced populations. This paper examines the design, implementation, and outcomes of a cross-border vaccine deployment strategy implemented in 2025 through Chad to restore vaccine availability in Darfur. Using programmatic data, shipment records, coverage reports, and partner monitoring outputs, the study assessed the operational feasibility, partnership arrangements, and public health impact of the intervention on routine immunization and outbreak response. In 2025, nearly 20 million doses of vaccines were successfully delivered to the five Darfur states through cross-border operations, supporting routine immunization services and outbreak response campaigns. Average coverage for the first dose of a DPT-containing vaccine (DPT1) increased from 22.6% in 2024 to 83.2% in 2025, while DPT3 and MCV1 coverage rose to 55.4% and 50.4%, respectively. Oral cholera vaccine campaigns achieved 90.4% coverage among targeted populations, and polio outbreak response campaigns exceeded 100% administrative coverage, reflecting both successful reach and uncertainties in target population estimates due to population displacement. Investments in cold chain infrastructure and strengthened coordination among government, UNICEF, Gavi, and implementing partners were critical to these outcomes. The findings demonstrate that cross-border vaccine deployment can serve as a viable and effective mechanism for restoring immunization availability and support recovery of immunization service delivery in a highly constrained conflict setting. While not a substitute for functional national systems, such approaches are essential life-saving interventions during acute crises and should be integrated into preparedness planning for fragile and conflict-affected contexts.

BackgroundAnimal bites represent a significant public health concern due to the risk of injuries and transmission of zoonotic diseases such as Rabies, particularly in low and lower- middle-income countries (LMICs). Understanding the epidemiological characteristics of animal bite incidents is essential for improving the prevention and control strategies. This study aimed to characterize the epidemiological patterns and characteristics of animal bite cases in Sylhet, Bangladesh. Methodology/Principal findingsWe conducted a retrospective analysis of 6,565 animal bite cases reported between January 1 and December 31, 2024, in Sylhet, Bangladesh. Data on demographic characteristics, type of biting animal, site of bite, and exposure category were collected and analyzed to determine associations using correlation analyses and chi-square tests. Among the victims, 3,917 (60%) were male and 2,648 (40%) were female and young adults aged 20-39 years comprised the largest group (39% of cases). The majority of cases (88.1%) originated from urban areas within Sylhet City Corporation. Cats were the leading cause of bites (56.6%), followed by dogs (35.0%) and monkeys (7.5%), suggesting a shift from the traditional dog-dominated pattern. The most frequently affected anatomical sites were the legs (50.3%) and hands (40.9%). Most exposures were classified as World Health Organization (WHO) Category II (98.2%). Bite incidents showed moderate seasonal variation, with peaks in spring and early autumn. A significant declining temporal trend was observed for monkey bites (R = -0.59, p = 0.044), whereas cat and dog bite patterns remained relatively stable throughout the year. Significant associations were identified between bite site and age group, as well as between biting animal and demographic characteristics (p < 0.05). Conclusion/SignificanceThese findings highlight the epidemiological patterns of animal bites in Sylhet and emphasize the need for strengthened public awareness, surveillance, and preventive strategies to reduce animal bite incidents and associated zoonotic disease risks. SynnopsisO_LIA large-scale retrospective analysis of 6,565 animal bite cases revealed a cat-dominant bite pattern (56.6%), contrasting with the traditional dog-dominant paradigm in South Asia. C_LIO_LIYoung adults (20-39 years) and males (60%) were disproportionately affected, reflecting occupational and behavioral exposure risks. C_LIO_LIUrban residents (88.1%) accounted for the majority of cases, highlighting the growing public health burden of animal bites in rapidly urbanizing settings. C_LIO_LIThe most frequently affected anatomical sites were the legs (50.3%) and hands (40.9%). Bite incidents showed moderate seasonal variation, with peaks in spring and early autumn. C_LIO_LICategory II exposures (98.2%) predominated, indicating a high burden of seemingly minor injuries that may be underestimated in rabies prevention strategies. C_LI

Background: Dengue is rapidly emerging in parts of Europe. How households value vector control attributes, and whether inferences depend on decision models or message framing, is unclear. Methods: We conducted a split-ballot online experiment among adults in Italy and France, as well as a hotspot subsample from Marche, Italy. National samples included 1,505 respondents in Italy and 1,501 in France; 183 respondents were recruited in Marche. Participants were randomised to a discrete choice experiment (random utility maximisation) or a regret-based choice experiment (random regret minimisation) and to one of three pre-task messages (control, loss aversion, community values). Each respondent completed 12 choice tasks comparing two dengue control programmes and an opt-out. We estimated mixed logit and mixed random-regret models with random parameters and treatment effects. Results: Across frameworks, nearby cases and high mosquito prevalence were the dominant drivers of programme uptake, whereas cost and operational burden were secondary. In pooled analyses, loss-aversion messaging increased the weight on high mosquito prevalence in both models (from 0.483 to 0.547 in the utility model; from 0.478 to 0.557 in the regret model). Cost effects were small nationally but larger in the hotspot subsample. Conclusions: Risk salience dominates preferences for dengue vector control in these European settings. Random utility and random regret models yield consistent rankings of attributes but differ in behavioural interpretation and some secondary effects; messaging effects were modest and context dependent.

ABSTRACT Background: Malaria remains a leading public health burden in sub-Saharan Africa, disproportionately affecting children under five years. In response, Kenya introduced the RTS,S/AS01 malaria vaccine in selected regions, including Siaya County where malaria transmission is endemic. Despite this milestone, uptake has been inconsistent, with hesitancy emerging as a significant barrier. Objective: This study aimed to determine factors associated with malaria vaccine hesitancy among caregivers of children 6-59 months in Ugenya Subcounty, Siaya County. Methodology: A cross-sectional mixed methods design was employed involving 425 caregivers and 15 healthcare workers and County health officials between January to February 2025. Quantitative data were collected using structured questionnaires and analyzed in Stata version 17 through descriptive statistics, bivariate analysis at 20% significance threshold, and multivariable logistic regression at 5% level to determine key factors associated with malaria vaccine hesitancy. Qualitative data from 15 key informant interviews were transcribed verbatim and thematically analyzed using NVivo. Thematic analysis, guided by a predefined codebook, was used to identify recurring patterns and extract key themes, which were illustrated with direct quotations from participants Results: Overall, 42.9% of caregivers (n=181; 95% CI: 38.9%-47.3%) reported hesitancy. Significant predictors included caregiver age, marital status, family size, access to health facilities, and vaccine availability. Single caregivers, those from smaller households, and those facing health facility access challenges were more likely to be hesitant to malaria vaccine. Despite high levels of knowledge, misconceptions and misinformation about vaccine safety, often spread via social media persisted. Conversely, caregivers relying on healthcare workers and mainstream media showed greater acceptance of malaria vaccine. Conclusion and Recommendations: Malaria vaccine hesitancy remains significant at 42.9%, driven by demographic factors such as younger age, single status, and smaller household size. Structural barriers including limited vaccine availability and poor access to health facilities further contribute to reluctance. Although knowledge and awareness were high, misinformation, particularly from social media, persisted, while information from healthcare workers improved acceptance. Addressing these gaps through targeted community engagement, improved access, and trusted communication channels is essential to increase uptake of malaria vaccine.

Background Nigeria has experienced its largest recorded diphtheria outbreak since late 2022, centred on Kano State, where facility-based surveillance documented over 25,000 confirmed cases. The true community burden remains unknown. We conducted a population-based household survey to estimate community attack rates, mortality, vaccination coverage, and determinants of infection and death. Methods We performed a retrospective household survey (September-October 2024) using spatially randomised cluster sampling (65 clusters, ~15 households each; recall period January 2023 to interview). Survey-weighted analyses, multivariable logistic regression, and sensitivity analyses were used. Findings We enrolled 7,998 individuals from 1,068 households. The community attack rate was 1.1% (95% CI 0.7-1.4), 4.2 times (2.7-5.3) higher than facility-based estimates. The case fatality ratio was 8.8% (1.9-15.6) overall and 21.3% among children under five; two thirds of deaths occurred at home. Delayed care-seeking of four or more days was associated with markedly higher mortality (risk ratio 32.6, 95% CI 2.4-450.0). Vaccination was strongly protective against death (vaccine effectiveness 57%, 95% CI 34- 72%; E-value 4.07). Among campaign-eligible children, routine EPI coverage was 56.6%; the reactive campaign reached few previously unvaccinated children (99.7% overlap with prior recipients), leaving 11.6% of eligible children unvaccinated. Interpretation Community diphtheria burden substantially exceeded facility surveillance estimates, with most deaths occurring outside the health system. Delayed care-seeking and low vaccination coverage were the main drivers of mortality, highlighting the need for improved community surveillance, decentralised care, and better-targeted vaccination.

Severe neonatal hyperbilirubinaemia represents a considerable cause of mortality and long term-morbidity in neonates born in low resource settings. Early identification of risk factors, such as glucose-6-phosphate dehydrogenase (G6PD) status, has the potential to prevent severe hyperbilirubinaemia and improve the clinical outcomes. The primary aim of the study was to assess equivalency of cord blood and neonatal capillary blood for diagnosis of G6PD deficiency using the quantitative point-of-care "STANDARD G6PDTM" test (SD Biosensor, Korea). Additional secondary aims were to compare the "STANDARD G6PDTM" with gold standard spectrophotometry and to analyse changes in G6PD activity in the first 4 months of life. A total of 75 neonates born in Shoklo Malaria Research Unit (SMRU) clinics were selected based on their G6PD status assessed through routine cord blood screening using the "STANDARD G6PDTM" test. Using activity thresholds established before in this setting, 25 G6PD deficient, 25 G6PD intermediate and 25 G6PD normal neonates were identified and re-tested on capillary blood collected within 24 hours of life and at day 7. They were also followed-up at 1 and 4 months of age to study haematologic and G6PD activity changes over time. The results showed that the "STANDARD G6PDTM" can be used reliably up to one week of life for testing neonates using the same thresholds established in cord blood. Performance of the point-of-care test as compared to the gold standard spectrophotometry remained excellent at all sampling time-points. Nevertheless, G6PD activity assessed longitudinally in the same participants decreased over time, both at 1 month of age and at 4 months of age, and interpretation of results in female infants with intermediate activity might require different thresholds. The study demonstrated that the "STANDARD G6PDTM" can effectively support clinical care in neonates and infants in populations with prevalent G6PD deficiency at the primary care level and especially in low-resource settings.

This study evaluated the effects of different Arachis hypogaea dietary preparations on parasite load, haematological indices, and physiological responses in Plasmodium berghei-infected mice. Forty-five albino mice were randomly assigned to five groups: normal control, infected untreated control, roasted groundnut, boiled groundnut, and a combination of roasted and boiled groundnut diets. Data were analyzed using one-way ANOVA at p > 0.05. Infection resulted in a high parasite load in the untreated group, with no significant difference compared to the boiled and combined diet groups. However, the roasted groundnut group showed a reduction in parasite load and relatively higher chemosuppressive activity, although differences were not statistically significant. White blood cell counts increased significantly following infection, and dietary treatments did not restore normal levels. Similarly, red blood cell counts and packed cell volume were significantly reduced in infected mice. The roasted groundnut diet moderately improved PCV compared to other treatments but did not restore it to normal levels. Weight loss was most pronounced in untreated mice, while roasted groundnut intake showed slight mitigation. No significant effects on temperature regulation were observed. Overall, A. hypogaea diets did not significantly improve parasitemia or haematological parameters, indicating limited therapeutic value in malaria management. ImportanceThis study is of significant importance due to its contribution to the ongoing search for accessible, affordable, and nutritionally based supportive interventions in malaria management. Malaria remains a major public health burden, particularly in sub-Saharan Africa, where increasing resistance of Plasmodium species to conventional antimalarial drugs continues to undermine control efforts. By investigating the effects of Arachis hypogaea (groundnut), a widely consumed and locally available food resource, this research explores a practical dietary approach that could complement existing malaria treatment strategies. In summary, this research is important because it bridges nutrition, parasitology, and public health, offering practical insights that could inform both scientific advancement and real-world malaria management strategies.

The intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) remains the main strategy to prevent malaria in pregnancy. However, continued drug pressure may also contribute to the emergence of resistant parasites and impact the gametocyte carriage and subsequent infectiousness. Pregnant women are thought to be a potential reservoir for malaria transmission due to the increased carriage of gametocytes following long-lasting infections. We used molecular methods to examine 100 Plasmodium falciparum (P. falciparum) isolates collected from Mozambican women at delivery in 2014-15, to determine SP resistance polymorphisms in P. falciparum dihydrofolate reductase (pfdhfr) and dihydropteroate synthetase (pfdhps) genes as well as the presence of gametocytes by RT-qPCR. Overall, 54% and 7% of parasites harbored quintuple and sextuple pfdhfr/pfdhps mutant haplotypes, respectively. Gametocytes were detected in 34% of isolates. Gametocyte carriage was significantly associated with quintuple mutant infections (AOR = 7.5, p = 0.001), which accounted for 80% of infections with detectable gametocytes. Results indicate the relevance of ongoing surveillance of SP resistance in Mozambique to guide future evaluation of alternative IPTp approaches as resistance levels evolve and to anticipate potential implications for parasite transmission and maternal-fetal health.

Background: Sub-Saharan Africa (SSA) still experiences a high burden of micronutrient deficiencies. For monitoring of micronutrient status among young children in SSA, non-invasive alternatives to blood-based biomarkers are desirable. Handheld Raman spectrophotometry appears to offer this alternative to quantify intracellular stores of micronutrients. In rural Burkina Faso and Kenya, we validated the Cell-/SO-Check device (ZellCheck(R)) against conventional laboratory-based methods. Methods: For this validation study, we recruited children aged [&ge;]24 months attending routine clinics within the Health and Demographic Surveillance Systems (HDSS) in Siaya and Nouna. Anthropometric measurements and venous blood samples were taken. Plasma ferritin, soluble transferrin receptor (sTfR) and C-reactive protein (CRP) were measured by ELISA, and plasma zinc by atom absorption. The spectrometer was used to quantify zinc and iron. For continuous outcomes, we generated Bland Altman plots and calculated bias and limits of agreement (LoA). For binary outcomes, we produced Receiver Operator Characteristic (ROC) areas under the curve (AUC), and estimated sensitivity, specificity and predictive values. Results: We analysed data of 48 children from Burkina Faso and 54 children from Kenya (male: 53%; age range: 24-66 months). According to spectrophotometry, the proportions of iron deficiency and zinc deficiency were 16.7% and 25.5%, respectively. The median concentrations were for ferritin 24.0 {micro}g/L (range: 2.0-330.0), for sTfR 5.7 mg/L (2.8-51.0), and for zinc 9.9 {micro}mol/L (5.2-25.0). The corresponding bias for iron levels by spectrophotometry was 42.4 with LoA: -18.7, 103.6. The bias for zinc levels was 7.5 with LoA: -49.3, 64.2. For the classification of deficiency, the ROC-AUC, sensitivity, and specificity for spectrophotometry vs. biomarker-based diagnosis were for iron deficiency 0.62, 68% and 55%, respectively, and for zinc deficiency 0.55, 33% and 91%, respectively. Conclusions: The Cell-/SO-Check device may be used to rank children in population-based studies in SSA according to their zinc status, but not iron status. The method should not replace the standard laboratory measurements for clinical diagnoses of zinc and iron deficiencies.

BackgroundLaboratory services are essential to the provision of health service delivery across the world. In resource-constrained settings such as in low- and middle-income countries like Ghana, maintenance of a strong capacity could be more challenging. This study assessed the capacity and gaps in laboratory service delivery in three districts of the Savannah Region of Ghana. MethodsThe WHO laboratory assessment tool (LAT) was adapted to collect data in 10 health facilities based on 11 operational system modules. Data were collected through interviews. Capacity was defined based on a 100-point score scale and interpreted as weak (<50%), moderate (50-80%) and strong (>80%). Differences in median scores were determined using Friedman and Kruska-Wallis tests. Statistical significance was set at p < 0.05. A scale (0-5) was used to identify the needs of the laboratory. ResultsOverall, capacity score was moderate, mean 50% {+/-} 25.7 with a median score of 52.5%, IQR: 30.0-68.5%. Testing module received the highest score, 71.5%, while document module scored the lowest, 14.5%. Scores did not differ significantly between system components after multiple comparisons, p>adjusted alpha. Hospital-level laboratories performed significantly higher than polyclinics (adjusted p = 0.044) and health centers (adjusted p<0.001). The biggest needs were biosafety, equipment maintenance, human and financial resources (median gap score: 3-4). ConclusionThe laboratory capacity in the health system of the Savannah Region was moderate, requiring improvements in all operational areas. The biggest needs include safety, equipment, human and financial support systems. Addressing these critical gaps would have direct impact on public health and patient outcomes.

BACKGROUND: Integrated WASH interventions are essential for improving public health by increasing access to safe water, sanitation, and hygiene services. This study evaluates their impact on water access and household knowledge, attitudes, and practices (KAP) in rural communities by comparing intervention and non-intervention areas. METHODS: A cross-sectional survey was conducted in May 2025 across six kebele administrations (three intervention and three control). Data were collected from 396 households with children under five using structured questionnaires, with equal representation from both groups. Descriptive analysis was applied to compare outcomes. RESULTS: Children in intervention areas experienced significantly lower diarrhea rates (2.5% vs. 34.9%). Households also showed improved health behaviors, including higher rates of facility births (88.9% vs. 63.6%), breastfeeding (98% vs. 89.9%), and vaccination (78.8% vs. 59.1%). Access to safe water improved markedly: all intervention households used protected sources, spent less time collecting water (13.9 vs. 55.8 minutes), and consumed more water daily (20.6 vs. 10.5 liters). Safely managed water services reached 59.6% compared to just 1% in control areas. Sanitation and hygiene practices were also better, with higher latrine access (95% vs. 78.3%), reduced open defecation (23.2% vs. 52%), and increased handwashing with soap (48.5% vs. 12.1%). Knowledge, attitudes, and practices were significantly stronger in intervention communities. CONCLUSION: Integrated WASH interventions significantly improve water access, hygiene practices, and child health outcomes. Sustaining these benefits requires continued investment in infrastructure, community awareness, and behavior change programs. KEY WORDS: Water, sanitation and hygiene, KAP, rural Ethiopia

Soil is an important reservoir for antimicrobial resistance (AMR) and increasingly recognized as a pathogen transmission pathway. While studies have detected AMR in soil in various settings, dominant contributors to domestic soil contamination with antimicrobial-resistant organisms in low-income countries remain unidentified. We conducted a cross-sectional study with 237 households in southern Malawi, specifically peri-urban Bangwe near Blantyre, to identify factors associated with the abundance of cefotaxime-resistant E. coli in yard soil. Enumerators employed structured surveys and sampled 30 cm2 of yard soil per household. We used IDEXX Quanti-Tray/2000 with Colilert-18 and cefotaxime supplement to enumerate the most probable number (MPN) of cefotaxime-resistant E. coli per dry gram of soil. We conducted multivariable regression to assess associations between the abundance of cefotaxime-resistant E. coli and household sanitation, animal ownership and management, child health and antibiotic use, and weather. Of 228 soil samples, 68% harbored cefotaxime-resistant E. coli at a mean of 0.90 log10-MPN/dry gram. Compared to households without animals, households had approximately 0.50-log lower mean cefotaxime-resistant E. coli abundance in soil if animals were enclosed at night and 0.50-log higher abundance if they were not (p-values<0.005). Additionally, samples had approximately 0.70-log lower mean cefotaxime-resistant E. coli abundance if soil was dry at the time of collection and if it came from a household in the top wealth quintile (p-values<0.005). Daytime animal confinement, household sanitation, child health, antibiotic use, rainfall, temperature and ambient humidity were not associated with cefotaxime-resistant E. coli abundance. Findings suggest that animal husbandry and soil moisture had stronger associations with cefotaxime-resistant E. coli in soil compared to sanitation or antibiotic use. These results underscore the importance of a One Health approach and the relevance of domestic animals and environmental factors to AMR in soil. Studies should quantify soilborne AMR exposure and evaluate associations with specific animal management/enclosure practices.

BackgroundIn chronic asymptomatic Plasmodium vivax infections, the spleen accounts for more than 98% of total-body parasite biomass. Whether this splenic tropism also exists in acute infection and how the spleen influences pathogenesis have not been systematically explored. Materials and MethodsIn Papua, Indonesia, we compared plasma levels of P. vivax lactate dehydrogenase [PvLDH]) and circulating parasitemia in 24 spleen-intact and 25 previously splenectomized patients with acute uncomplicated vivax malaria. Clinical and hematology data were collected and plasma markers of intravascular hemolysis (cell-free hemoglobin [CFHb]), endothelial activation (angiopoietin-2), inflammation (interleukin [IL]-1 beta, IL-6, IL-18, IL-10, tumor necrosis factor-alpha) and neutrophil activation (elastase) were measured by ELISA. Giemsa-based histology in one spleen from an untreated patient splenectomized for trauma during an episode of acute vivax malaria enabled direct assessment of splenic and circulating parasitemia and biomass microscopically. ResultsCirculating parasitemia was 4-times higher in splenectomized compared to spleen-intact patients (median 21,100 vs 4,820 parasites/{micro}L, p=0.0002) but total-body P. vivax biomass (PvLDH) was 3-times lower in patients without a spleen (median 721 vs 2,140 ng/mL, p=0.026). Parasite staging and greater organ-specific symptoms suggest redistribution of parasites in the absence of a spleen. Linear regression modeling, adjusting for circulating parasitemia, patient age, sex and duration of fever, demonstrated an 8.1-fold higher PvLDH concentration in spleen-intact patients (95% confidence interval [CI]: 3.4-19.5-fold, p<0.0001), indicating a splenic biomass accounting for 89% (95%CI: 77.3-95.1%) of total-body parasites. Histopathology revealed a spleen-to-blood biomass ratio of 10.7, in-line with the PvLDH-based estimate. In spleen-intact patients, splenic P. vivax biomass correlated strongly with markers of disease intensity, endothelial activation and systemic inflammation, whereas circulating parasitemia correlated weakly or not at all. Compared to spleen-intact patients, CFHb, endothelial activation and systemic inflammation were higher in splenectomized patients while inflammasome-dependent responses were lower. ConclusionsP. vivax is predominantly an infection of the spleen, even in acute clinical vivax malaria. We conservatively estimate that 89% of total-body parasite biomass in acute infection is splenic. While the size of this hidden population correlates with disease intensity, the spleen likely regulates inflammatory pathways and heme-associated pathology.