Tropical Medicine & International Health

Backgroundanaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. MethodsA retrospective cohort study was conducted using medical records from 321 CLHIV aged 0-14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia. ResultsOverall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, cotrimoxazole (CTX) use during treatment was associated with increased odds of anaemia (Adjusted Odds Ratio, AOR=3.04; 95% CI: 0.95-9.74). Conversely, among females, the type of caregiver was a significant factor; care provided by an aunt was associated with 90% lower odds of anaemia compared to other arrangements (AOR=0.10; 95% CI: 0.01-0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. ConclusionsThe study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.

BackgroundAnaemia during childhood adversely affects mental, physical and social development of the children, therefore morphological patterns of anaemia in under-five children are considered essential for classification, diagnosis and management. AimThis study aimed at assessing morphological patterns, the prevalence and associated factors of anaemia among under-five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu County, Kenya. MethodA cross-sectional health facility-based study was conducted among 175 children aged 6 to 59 months who attended clinic for the PMTCT programme for the period of January 2020 to December 2020. Pretested and structured questionnaires were used to collect socioeconomic and demographic characteristics of the family and child. Capillary blood sample was collected from each child for malaria parasite and Peripheral Blood Film (PBF) examination. ResultComplete blood counts indicate that microcytic pattern was the most common, representing 30 (42.3%) followed by microcytic hypochromic pattern 20 (28.2%), normocytic normochromic pattern with 11 (15.5%) and lastly dimorphic pattern with 10 (14.0%). High prevalence of anaemia was observed in children who were urban dwellers (50.0%), in children whose mothers aged 18-27 years (44.0%) and had no formal education (48.1%). Besides, the high prevalence rate of anaemia was found among children with a family monthly income of less than 500 Ksh. (46.9%), early (<6 months) introduction of complementary foods (71.4%) ConclusionThis study has revealed that the prevalence of anaemia in children less than five years is high and is a severe public health problem in the study area. Therefore, the policymakers should make a strategy that can reduce poverty and increase the awareness to women on breastfeeding, nutrition, and other associated factors to reduce anaemia.

BackgroundSchistosomiasis is a neglected tropical disease with a greater burden in Africa, including Ghana. Female Genital Schistosomiasis (FGS), a gynaecological manifestation of urogenital schistosomiasis, is often missed or misdiagnosed due to similarities with sexually transmitted infections and other gynaecological infections, with limited ease of health worker identification and diagnostic capability. This study assessed healthcare workers knowledge and diagnostic capacity for FGS in the Central Gonja District of Ghana. MethodsA quantitative cross-sectional study sampled 237 healthcare workers from 19 facilities near the Black and White Volta rivers using a three-phase multistage sampling process. Data was collected via a self-administered Kobo Toolbox questionnaire, focusing on sociodemographic factors, whether facilities had functional screening tools for FGS and health workers capacity to diagnose and treat these conditions. Analysis was conducted in SPSS, employing descriptive statistics and Pearsons chi-square tests to assess inferential associations between variables and health workers knowledge of FGS/schistosomiasis, which served as the main outcome variable. ResultsThe study involved health workers with a mean age of 31.6 {+/-} 4.18 years, of whom 52.3% were male. Knowledge gaps were significant: only 30% (71/237) demonstrated good understanding of schistosomiasis and merely 16.9% (40/237) showed adequate knowledge of FGS. Despite 91.6% recognition of schistosomiasis ( Bilharzia), knowledge of genital manifestations lagged severely (FGS: 26.8%, MGS (Male genital schistosomiasis): 18.1%). While demographic factors showed no association, experienced staff demonstrated better FGS knowledge (p = 0.003). Critical health system deficiencies emerged; 74% of facilities lacked laboratories, 90% lacked praziquantel and 100% lacked FGS diagnostic capacity. Even among clinicians, <43% knew standard FGS treatment and only 1/3 considered FGS in relevant diagnoses. ConclusionHealthcare workers lack FGS knowledge and diagnostic capacity, urgently requiring integration into reproductive health guidelines, training, and better resources for early detection and management Author SummaryFemale Genital Schistosomiasis is a neglected yet serious health condition affecting women, especially in sub-Saharan Africa. It often goes undiagnosed or is mistaken for sexually transmitted or other gynaecological infections due to overlapping symptoms and limited awareness among healthcare providers. This study explored how well healthcare workers in the Central Gonja District of Ghana understand and diagnose FGS. Through a survey of 237 healthcare workers from 19 health facilities located near the Black and White Volta rivers, we uncovered significant knowledge gaps; only a small number had a clear understanding of FGS and how to treat it. Most health facilities lacked the necessary resources, including diagnostic tools and essential medication like praziquantel. Our findings highlight an urgent need to train healthcare workers and integrate FGS into routine reproductive health services to improve detection and care for affected women.

IntroductionAnaemia is a major cause of morbidity and mortality among children in sub-Saharan Africa. Anaemia has many aetiologies best addressed by different treatments, so regional studies of the aetiology of anaemia may be required. MethodsWe analysed data from Nigerias 2018 Demographic and Health Survey (DHS) to study predictors of anaemia among children ages 6-59m. We computed the fraction of anaemia at different degrees of severity attributable to malaria and sickle cell disease (SCD) using a regression model adjusting for demographic and socioeconomic risk factors. We also estimated the contribution of the risk factors to haemoglobin concentration. ResultsWe found that 63.7% (95% CI: 58.3-69.4) of semi-severe anaemia (<80 g/L) was attributable to malaria compared to 12.4% (95% CI: 11.1-13.7) of mild-to-severe (adjusted haemoglobin concentration <110 g/L) and 29.6% (95% CI: 29.6-31.8) of moderate-to-severe (<100 g/L) anaemia and that SCD contributed 0.6% (95%CI: 0.4-0.9), 1.3% (95% CI: 1.0-1.7), and 7.3% (95%CI: 5.3-9.4) mild-to-severe, moderate-to-severe, and semi-severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared to children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children. ConclusionThis approach used offers a new tool to estimate the contribution of malaria to anaemia in many settings using widely available DHS data. The fraction of anaemia among young children in Nigeria attributable to malaria and SCD is higher at more severe levels of anaemia. Prevention of malaria and SCD and timely treatment of affected individuals would reduce cases of severe anaemia.

Background and objectivesThe aim of the current study was to establish the relative prevalences of Female Genital Schistosomiasis (FGS) and sexually transmitted infections (STIs). We hypothesised that due to the use of syndromic management for STIs it is possible that FGS is being misdiagnosed and mismanaged as an STI. We therefore wanted to examine the relationship between FGS and the individual STIs in schistosomiasis endemic areas. MethodsBetween 2011 and 2013, a cross-sectional study was performed in 32 randomly selected secondary schools in rural KwaZulu-Natal, South Africa, where each school had at least 300 pupils. In a research clinic, FGS diagnosis, STI testing, and face-to-face interviews were performed in sexually active, young women aged 16 - 22 years. ResultsFGS was the second most prevalent current genital infection (23%). There were significantly more women who had presented FGS among those who had detectable urinary schistosomiasis (35%), compared to those without (19%, p< 0.001). In the FGS positive group 35% were positive for HPV infection, compared to 24 % in the FGS negative group (p=0.010). In the FGS positive group 37% were sero-positive for HSV infection, compared to 30% in the FGS negative group (p=0.079). There were significantly fewer chlamydia infections amongst women with FGS (20%, p=0.018) compared with those who did not have FGS (28%). ConclusionsFGS was the second most common genital infection after HSV but the two were not significantly associated. HPV infection was significantly associated with FGS. Surprisingly Chlamydia infection were negatively associated with FGS. The results show the importance of the inclusion of FGS in the management protocols for genital infections in areas endemic for urinary schistosomiasis, and highlight the importance for more research on suitable differential diagnostic tools and disease management. Key messages boxO_LIFGS was the second most common genital infection in this rural population after HSV. C_LIO_LIFGS was positively associated with HPV. C_LIO_LIFGS was negatively associated with genital chlamydia infections. C_LIO_LIFGS should be included in the syndromic management of genital infections. C_LI

BackgroundPrimaquine is an 8-aminoquinoline antimalarial. It is the only widely available treatment to prevent relapses of Plasmodium vivax malaria. The 8-aminoquinolines cause dose dependent haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals. G6PDd is common in malaria endemic areas but testing is often not available. As a consequence primaquine is underused. MethodsWe conducted a pharmacometric study to characterise the relationship between primaquine dose and haemolysis in G6PDd. The aim was to explore shorter and safer primaquine radical cure regimens compared to the currently recommended 8-weekly regimen (0.75 mg/kg once weekly), potentially obviating the need for G6PD testing. Hemizygous G6PDd healthy adult Thai and Burmese male volunteers were admitted to the Hospital for Tropical Diseases in Bangkok. In Part 1, volunteers were given ascending dose primaquine regimens whereby daily doses were increased from 7.5 mg up to 45 mg over 15 to 20 days. In Part 2, a single primaquine 45 mg dose was given. Results24 volunteers were enrolled in Part 1, and 16 in Part 2 (13 participated in both studies). In three volunteers, the ascending dose regimen was stopped because of haemolysis (n=1) and asymptomatic increases in transaminases (n=2; one was hepatitis E positive). Otherwise the ascending regimens were well tolerated with no drug-related serious adverse events. In Part 1, the median haemoglobin concentration decline was 3.7 g/dL (range: 2.1 to 5.9; relative decline of 26% [range: 15 to 40%]). Primaquine doses up to 0.87 mg/kg/day were tolerated subsequently without clinically significant further falls in haemoglobin. In Part 2, the median haemoglobin concentration decline was 1.7 g/dL (range 0.9 to 4.1; relative fall of 12% [range: 7 to 30% decrease]). The ascending dose primaquine regimens gave 7 times more drug but resulted in only double the haemoglobin decline. Conclusions and InterpretationIn patients with Southeast Asian G6PDd variants full radical cure treatment can be given in under three weeks compared with the current 8 week regimen.

IntroductionThe loss of splenic function is associated with an increased risk of infection in sickle cell disease (SCD); however, spleen function is rarely documented among SCD patients in Africa, due partly to the non-availability of sophisticated techniques such as scintigraphy. Methods of assessing splenic function which may be achievable in resource-poor settings include counting red blood cells (RBC) containing Howell Jolly Bodies (HJB) and RBC containing silver-staining (argyrophilic) inclusions (AI) using a light microscope. We evaluated the presence of HJB - and AI - containing RBC as markers of splenic dysfunction among SCD patients in Nigeria. MethodsWe prospectively enrolled children and adults with SCD in steady state attending outpatient clinics at a tertiary hospital in North-East Nigeria. The percentages of HJB- and AI-containing red cells were estimated from peripheral blood smears and compared to normal controls. ResultsThere were 182 SCD patients and 102 healthy controls. Both AI- and HJB-containing red cells could be easily identified in the participants blood smears. SCD patients had a significantly higher proportion of red cells containing HJB (1.5%; IQR 0.7% - 3.1%) compared to controls (0.3%; IQR 0.1% - 0.5%) (P = 0.0001). The AI red cell counts were also higher among the SCD patients (47.4%; IQR 34.5% - 66.0%) than the control group (7.1%; IQR 5.1% - 8.7%) (P = 0.0001). The intra-observer reliability for assessment of HJB-(R = 0.92; R2 = 0.86) and AI-containing red cells (R = 0.90; R2 = 0.82) was high. The estimated intra-observer agreement was better with the HJB count method (95% limits of agreement, -4.5 to 4.3; P = 0.579). ConclusionWe have demonstrated the utility of light microscopy in the assessment of red cells containing - HJB and AI inclusions as indices of splenic dysfunction in Nigerian SCD patients. These methods can be easily applied in the routine evaluation and care of patients with SCD to identify those at high risk of infection and initiate appropriate preventive measures.

BackgroundSickle cell disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin S, leading to various complications. This study aimed to assess the spectrum of SCD-related complications and outcomes among pediatric patients at Mbeya Zonal Referral Hospital in Tanzania. MethodsA retrospective cross-sectional study was conducted, reviewing medical records of pediatric SCD patients admitted between June 2019 and June 2023. ResultsThe study found an inpatient prevalence of 7.7% for SCD. Vaso-occlusive pain events (68%), infections (55.3%), and severe anaemia (27.7%) were the leading causes of admission. Low rates of hydroxyurea (11.4%) and penicillin V (28.3%) use was observed. The median haemoglobin level was 6.5 g/dL, indicating significant anaemia. Newly diagnosed patients (50%) had an average age of 5.12 years at diagnosis, suggesting delayed identification. The mortality rate was 3%. ConclusionThese findings highlight the need of improved early diagnosis, management strategies, and access to essential medications for pediatric SCD patients in Tanzania. Implementation of newborn screening programs and increased awareness about SCD management could significantly improve patient outcomes.

BackgroundFemale genital schistosomiasis (FGS) is a chronic gynaecological disease caused by the deposition of Schistosoma haematobium eggs in the female genital tract. It is highly prevalent in sub-Saharan Africa (SSA), the region with the highest cervical cancer incidence and mortality rates globally. Persistent infection with high risk (HR-) human papilloma virus (HPV) is necessary for cervical cancer development. We aimed to determine the cross-sectional association between FGS and HR-HPV genotypes in women across three communities in Zambia. MethodsWomen aged 15-50, sexually active, not menstruating or pregnant, were recruited at home by community health workers. Participants provided two cervicovaginal self-swabs, a urine sample, collected HIV and Trichomonas vaginalis self-tests and completed a questionnaire. At clinic follow-up, midwives collected two cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODTiZI). Swabs were analysed for 14 HR-HPV types (GeneXpertiZI) and for Schistosoma DNA (ITS-2 qPCR). Urine samples were analysed for Schistosoma ova by microscopy and for circulating anodic antigen (CAA) to detect active infection. Visual FGS was defined as colposcopic identification of specific genital lesions. Molecular FGS was defined as Schistosoma qPCR positivecervicovaginal swabs. ResultsA total of 2,532 women (median age 28 years [IQR:22-36]) were recruited at home and 67% (1,694/2,532) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV were 35.2% [595/1,691], 6.5% [165/2,532], and 28.7% [690/2,401], respectively. HIV seropositivity was 17.5% (443/2,530), with 91.2% (406/443) self-reporting the use of antiretroviral therapy (ART). Risk factors crudely associated with HR-HPV infection included younger age, marital status, higher number of pregnancies, molecular FGS positivity, and urinary S. haematobium positivity detected using microscopy. There was evidence of a weak association between molecular FGS and all HR-HPV (adjusted Odds Ratio [aOR]=1.3, 95% Confidence Intervals [CI] 0.9-1.9). Women with molecular FGS were significantly more likely to test positive for HR-HPV 16/18/45 (aOR=1.7, 95%CI 1.0-2.8). No significant association was observed between visual FGS and HR-HPV infection (crude [c] OR = 0.9, 95% CI 0.7-1.1). ConclusionsTo our knowledge, this is the first study to jointly screen for FGS and HR-HPV in Zambia and to report an association between the most oncogenic HR-HPV types and molecular FGS. These findings call for the need for integrating FGS and HR-HPV screening strategies to address the dual burden in SSA.

BackgroundUltrasonography is an established and reliable method for assessing the spleen. Because of variation due to genetic and other environmental factors including malaria endemicity, interpretation of splenic sizes requires a knowledge of the normal reference range for a given population. The aim of this study was to determine spleen size in different age groups among healthy people in North-Eastern Nigeria and use this as a reference to determine spleen size amongst sickle cell disease (SCD) patients. MethodsUsing a cross-sectional study design, spleen size was measured in healthy people of different age groups, and steady-state SCD patients (children and adults) using abdominal ultrasonography. Using the age-group specific reference values obtained from the controls, spleens were classified into small, normal size, or enlarged among the SCD patients. ResultsAbdominal ultrasonography was performed for 313 participants, comprising 109 (34.8%) healthy controls and 204 (65.2%) steady-state SCD patients. The spleen was visualized in all the controls. However, 97(47.6%) of the SCD patients had no visible spleen. Small, normal, and enlarged spleens were observed in 16.7% (n=18/107), 63.6% (n=68/107) and 19.6% (n=21/107) SCD patients, respectively. Compared to the control group, splenic length was three-fold higher in the first two years of life in SCD patients, followed by a progressive age-related decline in size. Enlarged spleens were detected among 5(2.4%) SCD patients by manual palpation method compared to 21 (19.6%) using ultrasonography. ConclusionModel-based age-specific reference ranges and percentile curves for splenic dimensions based on ultrasonography among normal controls in North-Eastern Nigeria were established and may be of value in assessing spleen sizes among SCD patients living in malaria-endemic regions of Africa. Regular spleen scans to assess changes in size can help identify SCD patients at risk of splenomegaly complications including subclinical acute sequestration and hypersplenism, and those who are developing splenic atrophy.

ObjectiveSexually Transmitted Infections (STIs) present significant challenges to global public health, affecting physical and mental well-being and straining healthcare systems and economies. This study aims to enhance the predictive performance of models for congenital syphilis prediction by incorporating additional information obtained during gestational follow-up. Building upon the work of Teixeira et al. [1], which utilizes clinical and sociodemographic data, our model was enriched with results from venereal disease research laboratory (VDRL) and rapid tests for congenital syphilis conducted on pregnant women. MethodThe dataset utilized in this study comprised 47,604 records spanning the period from 2013 to 2022, with 27 attributes collected from pregnant women enrolled in the Mae Coruja Pernambucana Program in Pernambuco, Brazil. Among these attributes, we included clinical and sociodemographic factors, as well as results from venereal disease research laboratory (VDRL) and rapid tests for congenital syphilis. ResultsOur proposed model surpassed Teixeiras models exhibiting higher specificity (94.74%) and a slight increase in sensitivity (70.37%). ConclusionsOur study highlights the value of incorporating additional information from VDRL and rapid tests into models for predicting congenital syphilis. The combined approach involving both clinical, sociodemographic, and test result data enhances the accuracy of predictions thereby facilitating better informed healthcare decisions at different stages of pregnancy. This approach also holds significant potential in combating and managing congenital syphilis by providing assistance to health system decision makers and public policymakers. As a result, it can ultimately enhance the overall outcomes of maternal and child health and contribute to disease control.

INTRODUCTIONThe timing of antenatal care (ANC) attendance may affect outcomes for mother and child health. Using the Zambia Demographic and Health Survey (ZDHS), we describe the adoption of at least four early ANC (ANC4+) visits and early uptake of ANC among women of reproductive age in Zambia between 2007 and 2019. METHODSWe made use of ZDHS data gathered between 2007 and 2019. In this investigation, all women between the ages of 15 and 49 were taken into account. Early ANC4+ was the desired result, which was defined as having at least four ANC visits with the first ANC visit occurring during the first four months of pregnancy. In Stata v17, weighted univariate, bivariate, and multivariate logistic regression analyses were performed. RESULTSA total of 11633 (56%) of the 20661 women enrolled in our study had received early initiation of ANC4+. We saw an increase in the proportion of women who started ANC4+ early, from 55% in 2007 to 63% in 2018/19. There was a decreasing trend in the odds of early ANC4+ initiation with parity, but an increasing trend in the odds of early ANC4+ initiation with a higher level of education. Being a member of a wealthier household was associated with a lower risk of ANC4+ (OR= 0.81, 95%CI: 0.66-0.99, P=0.03). Twenty-seven percent of the 12,333 women who had at least four ANC visits, regardless of the timing of their first visit, reported being late for ANC. CONCLUSIONEarly ANC4+ uptake increased in Zambia between 2007 and 2019. There were, however, disparities due to wealth, education, and parity. We found that 27% of women who were misclassified as having at least ANC4+ using conventional analysis were actually late for ANC. We provide some key considerations for ensuring that Zambia and other similar settings achieve universal antenatal care coverage by 2030.

Background: Female genital schistosomiasis (FGS) is a neglected gynaecological manifestation of Schistosoma haematobium (S. haematobium) infection, resulting from the deposition of parasite eggs in the female genital tract. Although urogenital schistosomiasis is highly prevalent in parts of coastal Kenya, including Kilifi County, the burden of FGS among women of reproductive age remains poorly characterised. Routine diagnosis of S. haematobium infection relies largely on urine microscopy, which may underestimate genital involvement. This study aimed to assess the prevalence, diagnostic concordance, and risk factors for FGS among women of reproductive age in Kilifi County, Kenya. Methodology: In this cross-sectional study, 320 randomly selected women aged 15-50 years were recruited from rural Kilifi County; 261 provided complete data for analysis. A structured questionnaire was administered to collect sociodemographic and behavioural information. Urinary schistosomiasis was assessed using triplicate urine microscopy over three consecutive days, and FGS was evaluated using real-time polymerase chain reaction (PCR) targeting the S. haematobium Dra1 gene sequence on self-collected high vaginal swabs. Results: Overall, the prevalence of PCR-confirmed FGS was 36.0% (94/261), while urinary egg excretion was detected in 13.0% (34/261) of participants. Concordance between urine microscopy and genital PCR was 70.9%. Notably, 72% of women with PCR-confirmed FGS had no detectable parasite eggs in their urine. In bivariate analyses, factors such as urinary infection severity, water contact behaviours, haematuria, dysuria, age group, place of residence, and prior history of schistosomiasis were found to be associated with female genital schistosomiasis (FGS). However, in the multivariable logistic regression, only sub-location and urinary infection severity remained independently associated with the infection. Additionally, PCR cycle threshold (Ct) values showed a non-linear relationship with mean urinary egg counts, indicating that the detection of genital parasite DNA does not directly correspond to the urinary egg burden. Conclusion: FGS prevalence among women in Kilifi County was substantially higher than indicated by urine microscopy alone. The majority of women with genital schistosomiasis did not exhibit detectable urinary egg excretion, highlighting the limitations of routine parasitological screening for identifying genital disease. These findings underscore the need to incorporate genital sampling and molecular diagnostics into schistosomiasis control strategies targeting women of reproductive age in endemic settings.

BackgroundVisceral leishmaniasis (VL) is a life-threatening parasitic disease endemic in Somalia, where its control is severely challenged by a fragile health system, ongoing conflict, and socioeconomic barriers. This study aimed to assess the availability, accessibility, and quality of VL services in Somalia and to develop evidence-based, context-specific strategies to improve service delivery. MethodsA qualitative study was conducted across five major VL treatment sites. Data were collected through in-depth interviews (n=57) with health managers and providers, focus group discussions (n=2) with patients and caregivers, and observational assessments using an adapted WHO Service Availability and Readiness Assessment (SARA) tool. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis to identify key determinants of implementation. The CFIR-ERIC Matching Tool was then employed to translate these findings into actionable strategies. ResultsFacility readiness assessments uncovered critical gaps and disparities in infrastructure, diagnostics, and essential medical supplies. CFIR analysis identified major barriers across multiple domains: the low adaptability and high complexity of VL protocols to the local context; unsustainable reliance on external funding; frequent service disruptions due to emergencies and outbreaks; and pervasive sociocultural misconceptions about the disease. Enablers included strong partnerships and committed local leadership. Based on this analysis, a set of tailored implementation strategies was developed, focusing on: creating flexible service delivery models (e.g., mobile clinics); securing sustainable financing; strengthening clinical and community referral networks; instituting continuous training and support for healthcare workers; and proactively engaging patients and communities. ConclusionThe effective delivery of VL services in Somalia is impeded by a complex array of intervention-specific, systemic, and contextual barriers. This study provides a comprehensive assessment of these challenges and, crucially, generates a set of targeted, practical strategies to address them. Implementing these evidence-based, context-specific recommendations is essential for strengthening VL care and advancing progress towards disease elimination in Somalia.

IntroductionDespite improved access to modern contraceptives in sub-Saharan Africa (SSA), the region has the highest fertility rate. Although modern contraceptive usage and its determinants in SSA have been assessed, most authors were not guided by behavioral change theories. This study sought to assess the modern contraceptive coverage in SSA and identify the theory-based determinants that need to be considered in demand creation interventions. MethodsData was obtained from the most recent demographic and health surveys conducted across 37 countries in SSA. Estimates of country-specific and pooled Regional modern contraceptive coverage were generated from 501,324 responses. Logistic regression was used to assess the relationship between modern contraceptive use and determinants selected based on the Health Belief and Social-Ecological behavior change models. ResultsModern contraceptive coverage in SSA was 22.26% (95% CI: 17.91, 26.60). The health belief model determinants of modern contraceptive use included last birth by caesarian section (AOR=1.44, 95% CI:1.31,1.59), hearing of family planning at the health facility (AOR=1.18, 95% CI:1.12,1.24), or from at least one media source, being able to negotiate condom use (AOR=1.65, 95% CI: 1.55,1.76), and having a previous terminated pregnancy (AOR=0.76, 95%CI: 0.71, 0.81). The social ecological model determinants of modern contraceptive use included being above 24 years, having at least primary education, non-urgent need for a last child, and being involved in decision-making concerning personal health (AOR=1.81,95% CI:1.71,1.92). DiscussionModern contraceptive coverage in SSA is low. Age, educational status, past obstetric history, exposure to family planning information, ability to negotiate condom use or make personal health-related decisions, and the need for a child were the determinants for modern contraceptive use in the region. Countries need to develop context-specific interventions considering these determinants to help improve coverage and reduce the poor maternal and child health outcomes and the developmental gaps resulting from unplanned pregnancies.

Background Cutaneous leishmaniasis (CL) is highly prevalent in Ethiopia, including the Tigray region. However, there is a dearth of information on the levels of knowledge, attitude, and health seeking behavior among the communities in CL-endemic areas of Tigray region, northern Ethiopia. Objective This study aimed to investigate CL-related knowledge, attitude, treatment-seeking and prevention practices in disease-endemic areas of Tigray. Methods Between November and December 2022, a cross-sectional survey was conducted among communities living in seven districts of Tigray. A mixed sampling method was implemented. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS 25 (IBM, Chicago). Results A total of 512 participants were included. Overall, 43%, 36% and 34% of participants had a good level of knowledge, a favorable attitude and a good treatment-seeking and prevention practices towards CL, respectively. However, nearly all participants did not know about CL transmission, about 25% perceived CL to be genetically acquired and about 67% believed it to be stigmatizing. Traditional medication was the preferred option over modern treatment for 63.3%. Rural dwelling participants (AOR = 1.60; 95% CI: 1.00-2.57) and participants living in households with CL episode (AOR = 10.19; 95% CI: 6.36-16.30) had good knowledge towards the disease. However, urban/ semi-urban residents (AOR = 2.17; 95% CI: 1.42-3.31) had favorable attitude towards CL. Gender (AOR = 1.49; 95% CI: 1.01-2.22) and education level (AOR = 0.39; 95% CI: 0.24-0.62) were significantly associated with treatment-seeking and prevention practices. Participants living in households with CL episode (AOR = 2.99; 95% CI: 1.96-4.57) had good treatment-seeking and prevention practices. Conclusion In this study, over one half of participants had poor knowledge about CL, nearly two-third of them had unfavorable attitude towards the disease and two-third of them had poor treatment-seeking and prevention practices. Residence and previous CL episode in households were determinants of respondents knowledge about CL and their attitude towards the disease. Level of education and living in households with CL episode were determinants of participants treatment-seeking and prevention practices. These findings support for an integrated intervention through health education focusing on CL transmission and preventive measures.

BackgroundExtreme leukocytosis (EL), defined as an abnormally high white blood cell (WBC) count, is a critical clinical indicator associated with various underlying conditions, such as infections and malignancies. This study investigated the etiological factors and clinical profiles of patients presenting with EL at Mbeya Zonal Referral Hospital (MZRH). MethodsA retrospective cohort study was conducted among patients with WBC counts [&ge;]50x109/L who attended MZRH between January 2021 and December 2022. Data were retrieved from electronic health records and analyzed using Stata Version 16. ResultsA total of 178 patients with EL were included in the study. Malignant conditions accounted for 47.2% of cases, with haematological malignancies comprising 89.3%, predominantly chronic myeloid leukaemia (CML). Infections were the second most frequent cause (43.2%). Patients with malignancies had significantly higher median WBC counts (221 vs. 56 x 109/L, p<0.0001) and were more likely to present with symptoms such as bleeding, bone pain, B symptoms, splenomegaly, hepatomegaly, and lymphadenopathy. Severe thrombocytopenia (platelet count <50 x 109/L) was more common in the malignant group (p=0.0008). ConclusionMalignant etiologies, particularly haematological malignancies, are a leading cause of EL in patients with WBC counts [&ge;]50 x 109/L. Clinicians should maintain a high suspicion of malignancies in such patients and conduct thorough diagnostic evaluations to ensure optimal management.

IntroductionReferral guidelines are meant to ensure coordination and continuity across all levels of healthcare. Poor adherence to these guidelines could result in increased morbidity and mortality among the patients who are denied access; especially in the resource constrained healthcare settings in developing economies. AimTo determine adherence to the national healthcare referral guidelines and immediate outcomes of children seen at a tertiary teaching hospital in Western Kenya. Materials and methodsA Cross-sectional study conducted at the Pediatric emergency department of Moi Teaching and Referral Hospital in Western Kenya between February to June 2016. A total of 422 children aged below 15 years were recruited systematically. Sociodemographic and clinical data were collected using interviewer administered questionnaires and clinical chart reviews respectively. Checklists were used to collect information from ambulances. Pearson chi-square tests and odds ratios were used to test for association between predictor and outcome variables using statistical package for social science (SPSS) version-24. ResultsMore than half (55.5%) of the 422 children enrolled were male while 51.4% were aged between 5 to 14 years. Hospital referrals accounted for 15.9% (n=67) with the rest being self-referrals and no counter referrals seen. Adherence to all the four transfer guideline requirements was observed in 46.3% (n=31) of the 67 hospital referrals. Less than half (46.3%) of the hospital referrals had their referring facilities calling the receiving facility prior to initiating the referral; 83.6% had a referral document; 64.2% were transferred in ambulances while 68.7% (n=46) were accompanied by health care workers. Most (88.1%) of the hospital referrals were admitted. Lower level of parental education (p= 0.025), residing outside the host county (p<0.001) and a child being older than five years (p = 0.015) were significantly associated with hospital referrals. Hospital referrals were nearly three times (AOR = 2.932; 95% CI: 2.422 - 3.550; p<0.001) more likely to be admitted compared to children who were self-referred. ConclusionThere is low adherence to national healthcare referral guidelines among children seen at the second largest national hospital in Kenya; with less than half of hospital referrals transferred as per the transfer process guidelines.

IntroductionAnaemia is one of the most prevalent global public health challenges, particularly among women of reproductive age and children. According to the World Health Organization, anaemia is defined as a hemoglobin concentration below 13.0 g/dL in adult men, 12.0 g/dL in non-pregnant women, and 11.0 g/dL in pregnant women. Hemoglobin measurement therefore plays a critical role in diagnosis, classification, and monitoring of anaemia at both clinical and public health levels. Hemoglobin estimation allows early identification and intervention in at-risk populations. MethodologyA cross-sectional study was conducted at Aniniwaa Medical Centre, Kumasi, involving 100 participants who visited the laboratory for a complete blood count. Venous blood samples were collected aseptically into EDTA tubes and analysed first with the fully automated analyser, followed by the two Hb meters. Data were analysed using Chi-square tests, Bland-Altman plots, and descriptive statistics. ResultsResults showed that the prevalence of anaemia varied across methods: 28% by the analyser, 60% by Urit, and 64% by Mission. Both meters demonstrated 100% sensitivity but lower specificities (55.6% for Urit and 50.0% for Mission). Bland-Altman analysis indicated negative biases (Urit = -1.665 g/dL; Mission = -1.55 g/dL), suggesting both underestimated hemoglobin values compared to the reference. ConclusionThe study revealed that while Hb meters offer convenience and portability for field screening, the fully automated analyser remains more accurate and reliable for diagnosing anaemia in clinical settings.

BackgroundHealthcare workers (HCWs) are the safeguards that help prevent illnesses and eliminate them when they occur. This study aimed to scan the related literature and provide pooled data about the level of knowledge/attitude toward infections, vaccination status and infection prevalence among African HCWs to provide better evidence toward specific detailed determination of gaps to strengthen. A total of 11,038 published articles were identified from the search strategy. Among them, 163 articles met our inclusion criteria and passed the quality assessment procedure. ResultsThe prevalence of HBV was tested for 6,599 African HCWs;6.00% [95% Cl; 3.66, 8.33] were positive. The question Are you fully vaccinated against HBV?" was answered by 12,036 HCWs; 43.22% [95% Cl; 31.22, 55.21] answered yes. The most crucial local factor identified among respondents for the spread of antimicrobial resistance (AMR) was self-antibiotic prescription 42.00 % [18.79, 65.20]. The question "Does the infection prevention and control (IPC) guidelines available in your workplace?" was asked to 1,582 HCWs; 50.95% [95% Cl; 40.22, 61.67] answered yes. ConclusionThis study determined many weaknesses to be addressed for the sake of improving health in Africa. The current pooled data are critically significant to be implemented in planning governmental or NGOs strategies.