Tropical Medicine & International Health

Background: Anaemia in women of reproductive age is a persistent contributor to maternal morbidity and adverse birth outcomes in sub-Saharan Africa. Ghanaian surveys have repeatedly placed national anaemia prevalence in the World Health Organization's severe public health problem range, yet the geographical distribution of this burden, and the socioeconomic factors that may account for it after geographical adjustment, remain insufficiently elucidated. Methods: This cross-sectional study analysed the women's and geospatial files of the 2022 Ghana Demographic and Health Survey. Anaemia was defined as altitude- and smoking-adjusted haemoglobin below World Health Organization thresholds among 7,557 women aged 15-49 years with a valid measurement. Survey-weighted multivariable logistic regression, accounting for clustering, stratification, and sampling weights, was used to elucidate socioeconomic and demographic correlates. Cluster-level prevalence was tested for spatial clustering with global Moran's I and local Getis-Ord Gi* statistics (k-nearest neighbour weights, k = 8). Results: Weighted anaemia prevalence was estimated at 41.1% (mild: 22.6%, moderate: 17.3%, and severe: 1.1%). Pregnant women appeared to have higher adjusted odds of anaemia than non-pregnant women (adjusted odds ratio [AOR] 1.71, 95% CI 1.38-2.12), as did women in the Northern (AOR 1.54, 95% CI 1.16-2.06) and Savannah (AOR 1.35, 95% CI 1.04-1.76) regions relative to Greater Accra, while the Ahafo region showed lower odds (AOR 0.64, 95% CI 0.43-0.94). Associations with rural residence, education, and wealth that were significant in crude analysis appeared substantially attenuated after adjustment. Moran's I suggested significant positive spatial autocorrelation (I = 0.156, p = 0.001); Getis-Ord Gi* identified 109 hotspot and 117 cold spot clusters among 618 clusters, with hotspots concentrated in the north and cold spots in the mid-southern forest belt. Conclusion: Two in five women of reproductive age in Ghana were estimated to have been anaemic in 2022. Risk appeared to be shaped more by region and pregnancy status than by household wealth or education once geography was accounted for. Anaemia-control programming may benefit from prioritising the identified northern hotspot areas alongside routine antenatal supplementation.

Background Malaria and HIV remain major causes of illness in sub-Saharan Africa, accounting for 94% of the global malaria burden and over two-thirds of the global HIV burden. HIV-related immunosuppression increases susceptibility to malaria, with a higher malaria burden of up to 47% and severe malaria complications compared to HIV-negative individuals. Socio-demographic factors, individual knowledge, attitude, and perception are recognized determinants of malaria prevention behaviours, but no study has modelled their combined contribution, and there is scant research on these factors among people living with HIV. We assessed the level of knowledge, attitudes, and perceptions towards malaria, and identified the predictors of malaria prevention practice among HIV-positive individuals in Kampala, Uganda. Methods This cross-sectional study enrolled 620 HIV-positive patients attending the ART clinic of China-Uganda Friendship Hospital, Naguru, selected by systematic random sampling. Data collection was conducted from 21st July 2025 to 18th August 2025 using a structured, interviewer-administered questionnaire that measured socio-demographic characteristics, knowledge, attitude, perception, and the practice of malaria prevention. Associations were assessed using Mann-Whitney U, Kruskal-Wallis H, and Spearman correlation. The independent predictors of good malaria prevention practice were identified using binary logistic regression. Results Participants had a mean age of 34.8 years, were predominantly female (68.9%), Baganda (38.1%) by tribe, and the majority had a secondary level of education(46.0%). Most had good knowledge of malaria (97.3%) and a positive attitude (90.5%), while 57.3% held a positive perception of malaria risk and prevention; only 62.6% reported good malaria prevention practice, and most prevention methods used were sleeping under a mosquito net (71.1 3%) and closing windows early in the evening (70.3%). In regression analysis, knowledge (adjusted odds ratio [AOR] 1.198, 95% CI 1.03-1.40, p = 0.023) and attitude (AOR 1.101, 95% CI 1.04-1.17, p = 0.001) independently predicted good practice, while perception did not (AOR 1.00, 95% CI 0.96-1.04, p = 0.994). Scores of Attitude, perception, and malaria prevention practices varied significantly, though non-linearly, by education level, and were highest among non-educated participants. Conclusions Despite near-universal knowledge and predominantly positive attitudes in this study, more than a third of HIV-positive participants did not practice adequate malaria prevention, and perception did not independently predict malaria prevention practice once knowledge and attitude were accounted for. Programmes seeking to close this know-do gap should pair health education with structural support for prevention tools rather than education alone.

Abstract Background: Cervical cancer is a leading malignancy and mortality cause among Ethiopian women. Despite screening expansions coverage remains low. Traditional models miss complex determinants. This study aimed to develop machine learning models to predict cervical cancer screening utilization and identify drivers using the 2024 to 2025 Ethiopian Demographic and Health Survey. Methods: A secondary analysis of the 2024 to 2025 Ethiopian Demographic and Health Survey was conducted among women aged 15 to 49. Six algorithms Logistic Regression, Decision Tree, Support Vector Machine, Random Forest, Gradient Boosting Machine and Extreme Gradient Boosting were trained. Synthetic Minority Over-sampling Technique handled class imbalance with a 4.2 percent screening prevalence. Models were evaluated on a holdout set using Area Under the Receiver Operating Characteristic curve, Area Under the Precision-Recall Curve, Brier score and Decision Curve Analysis. SHapley Additive exPlanations explained model predictions. Results: Extreme Gradient Boosting achieved superior discrimination with an Area Under the Receiver Operating Characteristic curve of 0.896 and Area Under the Precision-Recall Curve of 0.781 outperforming baseline Logistic Regression at 0.772. Isotonic calibration optimized prediction loss with a Brier score of 0.038. Decision Curve Analysis confirmed clinical net benefit across thresholds from 5 percent to 55 percent. Explanatory analysis identified cancer awareness, education, autonomy, wealth quintile, recent health visits and urban residence as primary screening drivers. Conclusions: Probability-calibrated Extreme Gradient Boosting with explainability provides an accurate tool for identifying un-screened women in Ethiopia. Public health programs can deploy these tools in primary care applications to target outreach, optimize community engagement and accelerate World Health Organization elimination targets.

Urogenital schistosomiasis, caused by Schistosoma haematobium, remains a major public health challenge among school-aged children in rural Ghana. Although urogenital indicators are well-established, systemic hepatic biomarker alterations in post-mass drug administration pediatric settings remain poorly characterized. This cross-sectional study evaluated point-of-care urinalysis profiles alongside a panel of serum hepatic and renal biomarkers in 174 children (aged 3 to 16 years) from the Sene West District, Ghana. Active infection (urine microscopy egg detection) was identified in 84 participants (48.3%, median egg count = 4.50 eggs/10 mL, IQR: 1.00 - 9.25). Active infection was strongly associated with microhematuria (57.1% vs. 11.1%, p < 0.001), proteinuria (42.9% vs. 22.2%, p = 0.004), and leukocyturia (27.4% vs. 4.4%, p < 0.001). Children with active infection also demonstrated a higher frequency of composite categorical hepatic biomarker alterations (60.7% vs. 37.8%, p = 0.002), whereas categorical renal alterations showed no significant difference (p = 0.332). Controlling for age and sex, multivariable logistic regression confirmed active infection as a significant independent predictor of composite hepatic biomarker alterations (aOR = 2.54, 95% CI: 1.37 - 4.69, p = 0.003), but not renal alterations (aOR = 1.40, p = 0.359). Continuous medians for individual serum biomarkers showed no significant differences between groups. Combining composite hepatic biomarker thresholds with routine dipstick screening improves the detection of subclinical morbidity in pediatric field settings.

Quantitative measurement of fetal hemoglobin (HbF) using high-performance liquid chromatography (HPLC) is standard but expensive and widely unavailable in low-income settings. The newer Gazelle method, which employs single-use alkaline electrophoresis cartridges, provides a portable and relatively inexpensive potential alternative. In the current study, we tested 3055 venous blood samples collected from 1780 children with sickle cell anemia who were enrolled into the H-PRIME trial by both Gazelle and the Bio-Rad D-10 HPLC instrument, before and during hydroxyurea treatment. Data reinterpretation was required to quantify accurately high HbF values derived using the D-10. Mean (standard deviation) baseline HbF values by HPLC and Gazelle (N=2042) were 11.4% (SD 5.9%) versus 16.3% (SD 7.5%), respectively, while mean on-treatment HbF values (N=1013) were 18.9% (SD 9.0%) versus 25.4% (SD 11.5%), respectively. While overall agreement was good (Lins concordance 0.76, 95% CI 0.75-0.78), HbF values derived using Gazelle were modestly higher than HPLC values (Bland-Altman agreement mean +5.4%, 95%CI -2.4% to +13.2%), with the difference between measures increasing at higher HbF percentages. With strong concordance and more easily interpretable HbF values, Gazelle represents an attractive and inexpensive alternative to HPLC for HbF quantification in the low-income settings where most patients with sickle cell anemia live.

BackgroundFebrile neutropenia requires rapid empirical antibiotic therapy, with regimen selection shaped by local prescribing practice and pathogen patterns. We described starting treatment, later drug changes, microbiological findings, and inpatient outcomes. MethodsThis ambispective cohort comprised 96 episodes from 90 patients admitted to a tertiary-level teaching hospital. Treatment and outcome analyses used each episode as the unit of observation. Recorded variables included the starting antibiotics, later regimen modification, microbiology, hospitalization length, invasive fungal infection (IFI) as captured in study records, and disposition. Comparisons based on escalation status were exploratory. ResultCefoperazone-sulbactam appeared in 62/96 initial regimens (64.6%), amikacin in 42 (43.8%), teicoplanin in 28 (29.2%), and meropenem in 14 (14.6%). Eighteen episodes (18.8%) required a change that broadened or substituted antibacterial therapy. Among 31 microbiologically documented infections, 22 (71.0%) yielded Gram-negative organisms and 9 (29.0%) were polymicrobial. Median length of admission was 18.5 days in the escalation group and 9 days in the remainder (p<0.001). Mortality was 27.8% (5/18) with escalation and 5.1% (4/78) without it (p=0.011), with nine inhospital deaths overall (9.4%). ConclusionAntibacterial management differed within this cohort, with treatment escalation required in 18 of 96 episodes. Gram-negative organisms comprised most microbiologically confirmed infections. Escalation marked a clinically complex course with prolonged hospitalization and greater observed mortality; the observational design does not establish comparative efficacy or causation.

Introduction: The continuing high and inequitable global malaria burden requires improved methods to understand trends and target control. Current methods often involve infection prevalence surveys, but additional parasitological measures could increase precision in estimating infection burdens of communities. Methods: Focusing on the country with most malaria globally, examinations of slides from 10,651 children under five sampled in the 2021 national Malaria Indicator Survey in Nigeria were performed to measure asexual parasite densities in infected children and discriminate sexual stages and species. Variation in these indices among the six different geopolitical zones and 37 individual states including the Federal Capital Territory were compared with the variation indicated by infection prevalence alone. Results: Among the six major geopolitical zones, only one had significantly higher asexual parasite prevalence than others, but parasite densities within infected children revealed more significant variation among the different zones. Comparing results for 2021 with previous data from 2018, one zone showed lower asexual parasite prevalence and two had lower sexual parasite prevalence, but three had higher asexual parasite densities in infected children. Variation in parasite densities among individual states also highlighted significant geographical and temporal differences, extending the detection of heterogeneity within each geopolitical zone. Overall trends were driven by the predominant parasite species Plasmodium falciparum as prevalence and density of the other species were much lower. Conclusions: Findings indicate that understanding complex patterns of geographical and temporal variation is enhanced by including asexual parasite density measurement, providing opportunities for more precise targeting of malaria control within high burden countries.

Introduction Reliable, well-maintained laboratory equipment is essential for timely, accurate and reliable laboratory results for patient care, surveillance, and health system resilience. Tanzania implemented the Standard Medical Laboratory Equipment Guideline (SMLEG-2018) to harmonise procurement and improve efficiency across a tiered laboratory system and network. However, equipment functionality gaps remain a critical challenge for healthcare delivery. This study determined the functionality status of standardised laboratory analysers in Tanzania mainland and identified the drivers of non-functionality. Methods We conducted a facility-based cross-sectional study to identify the causes of non-functionality of standardised chemistry, haematology, and urine analysers across mainland Tanzania. We assessed 3,044 analysers and used Pareto analysis to identify the primary drivers of non-functionality. Results Of the 3,044 standardised analysers assessed, 987 (32.4%) chemistry 1,308 (43.0%) haematology, and 749 (24.6%) urine) assessed; 397 (13.0%) were non-functional. Proportionally, urine analysers were the most non-functional (n=176/749, 23.5%), followed by chemistry (n=135/987, 13.7%), and haematology (n=86/1308, 6.6%) analysers, p<0.001. Urine analysers had significantly higher non-functional equipment (23.5%), followed by Chemistry analysers (13.7%), than Haematology analysers (6.6%), p<0.001. Equipment breakdown was the leading cause of non-functionality, accounting for 70.9% (61/86), 70.5% (124/176) and 60.0% (81/135) of the non-functional haematology, urine and chemistry analysers, respectively, among all causes identified for each analyser type. Conclusion Although the SMLEG 2018 implementation identified broad coverage of functional standardised laboratory equipment, persistent equipment breakdowns of more than 10% highlight a systemic, concerning gap that requires immediate corrective action to sustain high performance. Strengthening preventive maintenance, timely repair services and sustainable equipment lifecycle planning is critical to sustaining quality laboratory services for robust preventive and curative care.

Background Viral load suppression (VLS) remains suboptimal among adolescents and youth living with HIV (AYLWH) in Malawi. Depressive symptoms may affect treatment adherence and HIV outcomes, but evidence is limited. We assessed the association between depressive symptoms and VLS among AYLWH using Malawi Population-based HIV Impact Assessment (MPHIA) 2020-2021 data. Methods We conducted a cross-sectional secondary analysis of AYLWH aged 15-24 years. VLS was defined as HIV RNA less than 200 copies/mL and depressive symptoms as a Patient Health Questionnaire-2 score of 3 or higher. Survey-weighted logistic regression assessed associations with VLS, adjusting for sex, education, residence, household wealth, alcohol use, Teen Club participation, and awareness of HIV-positive status. Findings Among 201 participants, viral-load results were available for 200; 137 (68.5%) achieved VLS. Six (3.0%) participants had depressive symptoms. Depressive symptoms were not associated with VLS in univariable analysis (OR 0.8, 95% CI 0.1-4.6; p=0.80) or multivariable analysis (aOR 0.3, 95% CI 0.1-2.4; p=0.28). Urban residence (aOR 0.2, 95% CI 0.1-0.5; p=0.0020) and unawareness of HIV-positive status (aOR 0.1, 95% CI 0.02-0.1; p<0.001) were associated with lower odds of VLS. Interpretation Depressive symptoms were not significantly associated with VLS, although their low prevalence and PHQ-2 limitations reduced precision. The findings highlight the importance of strengthening HIV-status awareness and addressing context-specific barriers to care among AYLWH. Funding This secondary analysis received no specific funding.

Background Schistosomiasis is a parasitic disease caused by flatworms known as schistosomes. The infection cycle starts when people shed eggs through the stool or the urine. Larva infects freshwater snails to later infect humans through the skin during water based activities. Schistosomiasis is commonly associated with rural areas. In this study, we wanted to see if the schistosomiasis distribution is different in rural and urban areas, along with potential risk factors associated with schistosomiasis distribution. Methodology Fresh urine samples were collected from 1,699 school-aged children (5 - 15 years old) in urban and rural sites in the Kimpese health district. Prevalence of haematobium and mansoni schistosomiasis was determined using, respectively, the urine sedimentation and the Point-of-Care Circulating Cathodic Antigen test with a quantitative estimate of infection intensity obtained with an RDT-Reader. Collected risk factors were tested for association with schistosomiasis infection and its intensity. Results The overall prevalence of schistosomiasis found in urban and rural areas was 75% and 82% respectively, with higher prevalence of S. mansoni in rural schools, and higher S. haematobium prevalence in urban schools. The difference in total prevalence between schools in urban and rural areas was significant, X2 (1, N = 1699) = 13.03, p = .0003. S. mansoni intensity of infection was also higher in rural children (mean = 162 mV) compared to those in urban areas (mean = 76 mV) (p < 2e-16). Male gender, washing dishes in the river, and swimming were associated with schistosomiasis in urban areas. Age, Springs, and rivers were significant factors in rural sites. Age, river, and washing dishes in the river were factors associated with the intensity of infection. Conclusion Our results showed very high prevalence in both rural and urban areas, which implies that control programs should consider them with the same interest and also revise control strategies.

Background: Nigeria introduced single-dose HPV vaccination for girls aged 9-14 in 2023, reaching approximately 60% aggregate coverage by 2025. While an important achievement, this remains short of the 90% coverage called for under the WHO's 90-70-90 cervical cancer elimination targets, and further scale-up depends on reaching out-of-school girls. In this study we used a model of HPV transmission in Nigeria to quantify the residual cervical cancer burden under continued adolescent delivery, assess how additional screening scale-up and equity assumptions modify it, and identify the effective coverage requirements for an infant HPV vaccination program to be non-inferior to the existing adolescent strategy. Methods: We used HPVsim, an agent-based microsimulation calibrated to Nigerian sexual behavior, HPV prevalence, and cervical cancer incidence, to project new cervical cancer cases and age-standardized incidence over 2025-2100 under scenarios which vary vaccination delivery mode (status-quo adolescent, WHO 90-70-90 adolescent scale-up, and 60/75/90% infant delivery), screening coverage (opportunistic 15% vs. scaled 70% aggregate), and the degree to which primary school completion correlated with vaccination (odds ratio 1 vs. 5) and with screening (odds ratio 1 vs. 3). Infant delivery scenarios were run at hypothetical effective-vaccine-efficacy-at-exposure values of 50%, 70%, and 95% - scenario inputs bracketing the plausible waning range, not evidence-based estimates of infant vaccine performance (no HPV vaccine trial has enrolled anyone below age 10). Each scenario was run at 50 replicates (10 calibration draws, 5 seeds); reported outcomes are the median across replicates and uncertainty ranges are interquartile (25th-75th percentile). Results: Continuation of Nigeria's current adolescent program is projected to avert 1.82 million cervical cancer cases (IQR 1.65-1.90 million; 95% UI 1.39-2.02 million) over 2025-2100 (a 53% reduction relative to no vaccination, IQR 51-55%; 95% UI 46-58%), with age-standardized incidence falling from 19.7 to 7.8 per 100,000 by 2100. However, 82% of the near-term (2025-2075) burden is projected to fall on the pre-2015 birth cohort, i.e. women already beyond the vaccination target age, leaving approximately 945,000 residual cases (IQR 905K-1.00M; 95% UI 835K-1.14M) in this cohort. Scaling up screening to WHO targets was estimated to avert a further ~387K cases (IQR 331-424K; 95% UI 269-515K), roughly 25% of the residual burden; results were about 6-8% better if the scale-up instead reached all women equitably regardless of education. Under a hypothetical scenario of infant vaccination at 90% coverage and 95% effective vaccine efficacy at exposure (matching adolescent-age performance), outcomes were comparable to full WHO adolescent scale-up (49% vs. 54% reduction in vaccine-targetable cohort cancers), but under a hypothetical 50% effective efficacy at Nigeria's DTP3-anchored 62% coverage the strategy averted only a fraction of these cancers. Conclusions: The near-term cervical cancer burden in Nigeria is dominated by cohorts vaccination cannot reach; scaling screening for them is the more consequential lever over the coming three decades and rests on established evidence. Findings on infant HPV delivery are exploratory and hypothesis-generating: they depend on three unverified empirical prerequisites - infant HPV vaccine immunogenicity in the first months of life, durability of protection across the ~15-25-year interval to peak HPV exposure, and coverage achievable through Nigeria's routine childhood immunization platform - and should not be read as a basis for any policy recommendation contingent on infant HPV delivery until those prerequisites are established.

BackgroundModern contraceptive use remains low in many sub-Saharan African countries, including Mozambique, limiting progress towards sexual and reproductive health and Sustainable Development Goals (SDGs). Understanding the prevalence, determinants, and inequalities in modern contraceptive use based on Mozambique-wide national survey is critical to informing effective family planning interventions. MethodWe analyzed the most recent data from the Mozambique Demographic and Health Survey (DHS), 2022-2023, focusing on a total of 11,783 reproductive-aged women (15-49 years). The outcome variable was current use of modern contraceptives. Several individual, household-related and community determinants of modern contraceptives were examined employing multivariable logistic regression. Adjusted odds ratio with corresponding confidence intervals and p-values were reported. Erreygers Concentration Index (ECI) and concentration curves were used to assess wealth-and empowerment-related inequalities. All analyses were conducted on weighted data. ResultOverall, 27.6% of women reported current use of modern contraceptive methods. Younger age, higher education, being employed, higher parity, greater wealth, and a partner with higher education were positively associated with modern contraceptive use. Significant wealth-related (ECI = 0.32, p < 0.001) and womens empowerment-related (ECI = 0.26, p < 0.001) inequalities were observed, indicating that wealthier and more empowered women had higher use of modern contraceptive methods. ConclusionModern contraceptive use in Mozambique is suboptimal and influenced by a combination of individual, household, and contextual factors, with marked socioeconomic and empowerment-related disparities. Policy interventions should focus on improving access to and encouraging use of contraceptives for economically disadvantaged and women with low-empowerment, promoting womens autonomy, enhancing male involvement, and leveraging media and community-based programs to increase awareness and uptake. Equity-focused strategies are essential to achieving national and global family planning targets.

Background: Severe malaria remains a major cause of hospitalization in malaria-endemic sub-Saharan Africa, and anemia is among its most frequent severity criteria. Data on the impact of anemia on hospital length of stay (LOS) among adults with severe malaria remain limited in Central Africa. We assessed the impact of anemia on LOS among adults hospitalized for severe malaria in Brazzaville, Republic of Congo. Methods: We conducted a cross-sectional, descriptive, and analytic study of medical records from adult patients ([&ge;]18 years) diagnosed with severe malaria (WHO criteria) and admitted to four hospitals in Brazzaville between January 2020 and December 2024. We dichotomized LOS as short (<5 days) or prolonged ([&ge;]5 days). Multivariable logistic regression, using a backward stepwise procedure, identified factors independently associated with prolonged LOS; isolated hemoglobinuria served as the reference severity category. Results: Among 523 patients hospitalized for severe malaria, 296 met the inclusion criteria. Median age was 25.5 years (IQR 20-40); 51.7% were female, and 82.1% had a low socioeconomic status. Median hemoglobin was 10.55 g/dL, and median LOS was 4 days (IQR 3-5). In multivariable analysis, prolonged LOS was independently associated with delay to consultation (aOR 1.25/day, 95% CI 1.09-1.44), isolated anemia (aOR 7.07, 1.23-40.55), convulsions (aOR 5.86, 1.81-18.97), prostration (aOR 4.42, 1.21-16.2), and impaired consciousness (aOR 4.29, 1.17-15.7). The strongest associations involved combined severity criteria: anemia with prostration (aOR 8.58), anemia with jaundice or hemoglobinuria (aOR 16.21), and impaired consciousness with anemia (aOR 33.31). Conclusions: Anemia is a major, potentially modifiable determinant of prolonged hospitalization in adults with severe malaria, with a markedly amplified effect when combined with neurologic impairment. Early anemia screening, improved access to safe blood transfusion, and reduced delays to care could shorten hospital stays and ease the burden on health systems in this setting.

ABSTRACT Background: The double burden of malnutrition, combining overweight or obesity with anemia is vital in nutritional transitions. Evidence regarding its national distribution and prediction using routine survey data in Ethiopia remains limited. Objective: To estimate the national prevalence of individual-level double burden of malnutrition among non-pregnant Ethiopian women aged 15-49 years and evaluate machine-learning models using data from the 2024/25 Ethiopian Demographic and Health Survey. Methods: we analyzed 14250 non-pregnant women. Double burden of malnutrition was defined as a body mass index equal to or greater than 25.0 kilograms per square meter with an altitude- and smoking-adjusted hemoglobin concentration below 12.0 grams per deciliter. Data were split into an 80% training set and a 20% holdout test set. Six algorithms were evaluated using cross-validation, while SHapley Additive exPlanations described feature contributions. Results: the weighted national double burden of malnutrition prevalence was 8.4% (95% confidence interval 7.9%-8.9%), higher in urban residents (20.0% versus 4.0%) and the richest wealth quintile (26.7% versus 2.7%). Extreme Gradient Boosting achieved an area under the receiver operating characteristic curve of 0.892 (95% confidence interval 0.875-0.909) and an area under the precision-recall curve of 0.764 outperforming logistic regression (area under the receiver operating characteristic curve of 0.781). Extreme Gradient Boosting sensitivity was 82.1%, specificity was 81.4% and the Brier score was 0.068. Household wealth, residence and respondent age were top predictors. Conclusions; the double burden of malnutrition affected one in twelve non-pregnant Ethiopian women unevenly across groups. Routine characteristics effectively discriminated double burden of malnutrition cases though external validation is needed prior to clinical use.

Background The abrupt withdrawal and uneven restoration of United States PEPFAR support in 2025 disrupted HIV service delivery in aid-dependent countries worldwide. In Zambia, decreases in HIV service delivery have been documented at a national level, but variations by facility and by quarter have largely been masked by existing aggregate district- and province-level estimates. We examined facility-level variation in HIV service volumes delivered before and after the funding cuts. Methods We analysed monthly District Health Information System (DHIS2) data covering testing volumes, ART initiations, and numbers on ART for January 2024-December 2025) for two sets of facilities: 1) 24 selected SENTINEL network facilities across four provinces (Central, Copperbelt, Lusaka, and Southern); and 2) all facilities in two districts, Chongwe in Lusaka Province, which was supported by the U.S. CDC under PEPFAR, and Mpongwe in Copperbelt Province, which was supported by USAID under PEPFAR. For each facility, we calculated quarterly 2025:2024 ratios of service volumes and summarized quarterly and annual percentage changes in numbers of tests, treatment initiations, and clients on ART. Results Aggregate HIV testing volumes declined 18% in SENTINEL facilities from 2024 to 2025, with 17 of 24 facilities showing net annual decreases. Aggregate ART initiations declined 16%, with 23 of 24 facilities experiencing net decreases. For both indicators, variation between quarters and among individual facilities matched or exceeded aggregate changes. Numbers of clients currently on ART were comparatively stable, with only 6 facilities showing net declines exceeding 5%. District-level analyses showed divergent patterns. Net aggregate testing volumes increased by 7% in Chongwe District, but 28/39 facilities experienced quarterly declines exceeding 10% in at least one quarter and fell by 40% in Mpongwe District overall. Only 4 of 36 sites in Chongwe showed a net loss of clients over the course of 2025, with most experiencing gains, while Mpongwe experienced substantial variation by facility, with many having declines of >30% during some quarters and 14 of the 25 facilities suffering a net loss from 2024 to 2025. Conclusions Facility-level performance varied substantially within the same district following the 2025 PEPFAR funding disruptions, with some sites losing most of their service volumes while others remained stable or exceeded 2024 levels. These findings emphasize the need for facility-level monitoring to target recovery support where it is needed most.

Objectives To assess microfilaraemia, chronic lymphatic filariasis (LF)-related morbidity, and community knowledge and self-reported preventive behaviours in a rural community in northern Ghana following prolonged mass drug administration (MDA). Design Community-based cross-sectional study. Setting Birifor community, Lawra Municipality, Upper West Region, northern Ghana, from October 2024 to January 2025. Participants A total of 261 community members aged 10 years and above were selected using random sampling and participated in the study. Outcome measures Outcome measures included microfilaraemia detected by night blood microscopy, chronic LF-related morbidity identified through clinical examination, and community knowledge and self-reported preventive behaviours assessed using a structured questionnaire. Results No microfilariae were detected (0/261; 0%). Chronic lymphoedema was identified in five individuals (1.9%), all aged over 40 years. Awareness of LF was high (95.8%), yet only 39.5% of participants demonstrated good community knowledge and self-reported preventive behaviours. Misconceptions regarding transmission, particularly beliefs that LF is hereditary or caused by spiritual factors, were common. MDA participation was high (93.1%). All five individuals with chronic lymphoedema reported loss of income, and three (60%) reported additional household income loss due to caregiving responsibilities. Conclusions No microfilaraemia was detected, suggesting very low transmission in the study area, although residual infection cannot be excluded. Chronic LF-related morbidity and gaps in community knowledge persist despite high MDA participation. Sustained surveillance using more sensitive diagnostic approaches, together with morbidity management and disability prevention, community education and support for affected households, will be important to sustain LF elimination efforts.

Children living with HIV face significant challenges with adherence to daily oral antiretroviral (ARV) treatment due to poor palatability, complicated dosing, and caregiver burden. Long-acting delivery systems designed specifically for children may help overcome these barriers. Microarray patches, also known as microneedle patches, are a needle-free drug delivery technology that could simplify treatment administration and improve adherence. This study explored the acceptability and usability of a pediatric ARV microarray patch prototype among stakeholders in South Africa and Uganda, two countries with a high burden of pediatric HIV. A formative study was conducted in 2024 with 48 participants, including caregivers, community health workers, health care providers, and decision-makers. Data were collected through qualitative methods: interviews, simulated use sessions, and observations. Participants demonstrated high usability of the prototype, with 97% completing all application steps and nearly all reporting the prototype as easy to use and expressing confidence in successful administration. Most participants found the prototypes size, wear time, and temporary skin changes acceptable, and all preferred a weekly patch over daily oral treatment. Applying multiple patches at once to achieve a therapeutic dose was considered feasible. Decision-makers foresaw strong programmatic fit of a pediatric ARV microarray patch if caregivers apply the patch at home following initial facility-based guidance. Overall, the pediatric ARV microarray patch prototype was perceived as highly acceptable and usable across diverse end users, findings that generally align with studies of microarray patches for other use cases (e.g., contraception, HIV pre-exposure prophylaxis, vaccine delivery). The simplicity, comfort, and convenience of a pediatric ARV microarray patch could substantially improve treatment adherence and quality of life for children living with HIV. Further development and clinical evaluation are warranted to advance this promising technology toward real-world use.

BackgroundTuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains a leading global public health challenge. Malnutrition is a major, modifiable driver of this vulnerability to the disease, creating a lethal, bidirectional link with TB. This s review aims to synthesize available evidence to estimate the pooled prevalence of TB and identify associated factors among malnourished children in Ethiopia, providing critical data to guide targeted, integrated public health interventions. MethodsA systematic review and meta-analysis were conducted on studies reporting the prevalence of TB and associated factors among malnourished children in Ethiopia. Electronic databases including PubMed/Medline, EMBASE, CINAHL, ScienceDirect, Academic Search Complete, and Google Scholar were searched. In addition, bibliographies of relevant articles were reviewed, and a search for relevant conference abstracts was performed. Eligible studies were those published in peer-reviewed journals that specifically addressed TB prevalence among malnourished children. A random-effects model was employed to estimate the pooled prevalence of TB and its associated factors. ResultsA total of 746 studies were initially identified through database and catalog searches. Following screening and eligibility assessment, 12 studies were included in the final systematic review and meta-analysis. These studies, published between 2017 and 2024, collectively involved 5,749 participants. The smallest sample size (133) was reported in a study from the Oromia region, while the largest (1,201) was from the Amhara region. The pooled prevalence of TB among malnourished children was estimated at 16%. The highest prevalence (95%) was reported in a study conducted in Addis Ababa, while the lowest (6%) was from Harar. Considerable variation in prevalence was noted across the included studies. ConclusionThis review resulted in the substantial prevalence of TB among malnourished children in Ethiopia, with a pooled prevalence of 16%. This finding highlights the urgent need for integrated healthcare interventions targeting both TB and malnutrition

Brucellosis is a globally distributed and widely under-appreciated zoonotic bacterial disease that causes infertility and abortion in livestock and febrile illness in humans, sometimes with debilitating sequelae. Brucellosis incidence estimates typically focus on acute presentations and range from 50 to 100 per 100,000 people per year for endemic settings, showing marked variation within and between countries. Estimating brucellosis incidence in low-resource settings is complicated by lack of access to and utilisation of health care and high-quality diagnostic testing for many people in rural communities. To estimate brucellosis incidence in a pastoralist population in northern Tanzania, we developed a Bayesian model that integrates multiple data sources including diagnostic test results from a hospital-based prevalence study performed in 2016-2017, test sensitivity and specificity, and data from a community-based healthcare utilisation survey in 2019-2020. We show that this population experienced a high incidence of brucellosis with wide uncertainty, with estimates of 387.6 (95% HPDI: 103.3 - 903.5) illnesses per 100,000 people per year for the total population, 199.7 (95% HPDI: 16.2 - 584.6) for individuals aged >15 years, and 632.4 (95% HPDI: 180.1 - 1379.4) for children aged [&le;]15 years. These incidence estimates were among the highest in the world to date. The wide density intervals for these incidence estimates reflect uncertainty in the underlying parameter values used. Sensitivity analyses show that healthcare utilisation influenced incidence estimates the most. This result indicates that accounting for low levels of healthcare utilisation is essential to avoid under-estimating disease incidence. Our findings illustrate that brucellosis is a frequent cause of illness in this population. Increased access to treatment, prevention, and accurate diagnostic testing would greatly improve understanding of brucellosis epidemiology and the health of many people living in similar at-risk communities.

Background Evidence on {beta}-thalassaemia carrier prevalence is fragmented across heterogeneous surveys and national summaries, leaving within-country variation and geographic concentration of carriers poorly resolved. This study characterises {beta}-thalassaemia carrier prevalence and carrier populations at high spatial resolution and identifies where additional data would most improve geographic coverage. Methods Using carrier-prevalence records curated through ITHANET, a global haemoglobinopathy resource, Bayesian geostatistical modelling generated high-resolution predictions across 25 countries. Predictions were integrated with population data to estimate national and subnational carrier numbers. Prediction uncertainty and gaps in existing survey coverage informed prioritisation of healthcare sites for additional surveys. Findings Predicted prevalence varied markedly within countries, and highest-prevalence areas did not coincide with the largest carrier populations. National mean prevalence was highest in Cyprus (12.99%), whereas India, China, and Pakistan had the largest carrier populations, together accounting for 81.21% of estimated carriers. Random five-fold cross-validation favoured a model capturing broad geographic patterns and location-specific variation. Predictive performance deteriorated when geographically clustered records were withheld together, indicating reduced reliability across larger gaps in geographic sampling and the need for additional data from poorly characterised areas. Survey prioritisation identified 183 healthcare sites across 17 countries for future carrier-prevalence surveys. Interpretation By distinguishing areas of high carrier prevalence, large carrier populations, and evidence gaps, this updatable framework provides a subnational evidence base to inform {beta}-thalassaemia prevention planning and guide future data collection, screening, and genetic counselling.