Abstract:

It is argued that more could be achieved if African countries utilise the evidence from the 2024 Global School Meals Survey Report and other data sources to inform their practices, decision making and strategic resource allocation towards the prevention of nutrition-related noncommunicable diseases. If evidence is not consistently translated into decision making, strategic planning and implementation practice, all developmental efforts are unlikely to yield the intended results. Therefore, the incorporation of quantified targets and performance indicators for tracking and reporting is recognised as a major improvement in the transition from the Millenium Development Goals to the Sustainable Development Goals and the 2023 adoption of the school meals indicator 4.a.4 on the proportion of school attending children receiving school meals. This study examines the profiles of 26 African countries from out of the total 142 countries across all the continents whose data was captured in the 2024 Global School Meals Report. Data is extracted and analysed to establish the pattern from the 2024 Global Child Nutrition Survey indicators on school meal coverage, sources of funding, infrastructure, nutrition, complementary school health activities and employment. Based on observed trends among the selected 26 countries, recommendations are proposed towards the accelerated achievement of desired school meals targets and realisation of African Union objectives of using the home-grown school feeding approach.

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Abstract:

igh-quality malaria surveillance is essential for elimination. This study assessed routine malaria surveillance data quality in Botswana's highest-burden districts against WHO-recommended malaria elimination data-quality indicators and examined geographic and temporal variation during 2023–2025. A retrospective data-quality assessment used national Case-Based Surveillance (CBS) records and Integrated Disease Surveillance and Response (IDSR) aggregate counts. Districts were selected using a Pareto approach. Completeness, timeliness, internal consistency and CBS-IDSR agreement were assessed separately. Indicator proportions were summarized with 95% confidence intervals; geographic and annual differences were assessed using Pearson chi-square tests and multivariable logistic regression. The CBS dataset contained 3,393 records with valid analysis years. Okavango, Ngamiland and Chobe contributed 2,729 (80.4%) and formed the primary analytic population. Overall core-variable completeness was 79.5% (2,169/2,729), documented case investigation was 40.9% (1,117/2,729), notification within the day-level 24-hour approximation was 92.5% (2,409/2,603), investigation within 3 days among investigated cases was 58.0% (648/1,117), and internal consistency among evaluable records was 92.7% (825/890). Aggregate CBS-IDSR count agreement across the three districts was 95.7% (2,612 IDSR versus 2,729 CBS cases). Geographic differences were significant for all five case-level indicators (p < 0.001). Core completeness, documented investigation and investigation timeliness varied significantly by year, whereas notification timeliness (p = 0.640) and internal consistency (p = 0.311) did not vary significantly by year. Surveillance performance was heterogeneous across data-quality dimensions, districts and years. Timely notification and aggregate CBS-IDSR agreement were comparatively strong, whereas case-investigation documentation and timeliness remained important weaknesses requiring targeted surveillance strengthening.

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Abstract:

Zambia's Constituency Development Fund (CDF) provides a decentralised mechanism for financing local priorities, including projects that affect health service delivery. This qualitative single-case study explored stakeholder perspectives on the contribution of CDF investments to primary health care (PHC) in Lufwanyama District, Zambia. It examined stakeholders' understanding of CDF, their participation in implementation processes, and perceived factors that enable or constrain the contribution of Constituency Development Fund investments to Primary Health Care service delivery. In July 2026, 40 purposively selected participants from the local authority, District Health Office, health facilities and community structures took part in semi-structured key-informant and in-depth interviews. Relevant documents were also reviewed, and the data were analysed thematically using deductive and inductive procedures. Participants viewed CDF investments as important service-enabling inputs, particularly facility infrastructure, staff accommodation, maternity spaces, water and sanitation, ambulances, roads, facility rehabilitation and selected equipment. These investments were perceived to improve access, facility readiness and referral systems. Stakeholder-perceived enablers included timely funding, coordination, technical appraisal, community participation, monitoring, alignment with district health priorities and recurrent health-system support. Delayed implementation, procurement challenges, weak coordination, uneven feedback, staffing gaps, medicine shortages and limited recurrent support constrained the translation of completed projects into day-to-day PHC services. CDF should therefore be understood as an enabling financing pathway rather than a complete service-delivery intervention. Its contribution to PHC could be strengthened through alignment with district health priorities, technical review, recurrent health-system inputs, functionality-based monitoring and clearer community feedback and accountability mechanisms.

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Abstract:

Ergonomic challenges within university learning environments are increasingly recognized as important determinants of student health and academic performance. However, most studies in low- and middle-income countries focus on quantitative assessments, with limited attention to students' lived experiences. This study employed a qualitative descriptive design using open-ended responses collected via an online survey administered to 352 undergraduate students at the University of Calabar, Nigeria. Data were analyzed using inductive thematic analysis to explore students’ experiences, perceived impacts, and coping mechanisms related to ergonomic challenges in their learning environments. Three major themes emerged: (1) Physical strain and bodily discomfort, characterized by musculoskeletal pain and visual strain due to non-adjustable furniture and poor environmental conditions; (2) Cognitive exhaustion and academic disruption, where discomfort impaired concentration, reduced engagement, and contributed to absenteeism; and (3) Institutional neglect and adaptive coping, highlighting the absence of supportive infrastructure and students’ reliance on improvised strategies. These findings demonstrate that poor ergonomic conditions extend beyond physical discomfort to significantly affect mental well-being and academic outcomes. Ergonomic deficiencies in university settings represent a critical but under-addressed public health issue. Interventions should prioritize human-centered classroom design, inclusive infrastructure, and institutional policies that support student well-being.

References:

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[2].   Roofe NL, Campbell ME. Educational ergonomics: Positioning physical health as a baseline requirement for academic excellence. J Am Coll Health. 2023;71(4):312-25.

[3].   Zhumazhanova KI. Learning analytics and ergonomic educational spaces for active learning: A case study. Front Educ. 2026;11(1):180-95.

[4].   Gomes BS, Santos AC. Ergonomic design and spatial planning in higher education: Enhancing comfort and productivity. Appl Ergon. 2021;92:103340.

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[6].   Kurnia F. Translating student needs into ergonomic design: An importance-performance analysis for a university student desk. Global J Multidiscip Stud. 2025;6(4):215-30.

[7].   Agyapong E, Glalah M. Ergonomic design of university classroom furniture: Evaluation of comfortability and musculoskeletal disorders. Arch Occup Health. 2021;5(3):1102-12.

[8].   Costa ML. The spatial politics of learning: Exploring classroom ergonomics and student comfort. Int J Educ Des. 2024;22(1):78-95.

[9].   Saha PK. Overcrowding and acoustic hostility in modern lecture hall environments. J Environ Psychol Educ. 2024;31(2):102-19.

[10].     Sajja SS. Qualitative frameworks in educational spaces: Shifting from statistics to student voices. Qual Res Educ. 2023;12(4):301-16.

[11].     Subramaniam S, Dhillon SK. Ergonomic awareness and postural hazards among undergraduate university students during study sessions. Int J Environ Res Public Health. 2020;17(22):8540.

[12].     Castellucci HI, Arezes PM, Molenbroek JF. Applying anthropometry in school furniture design: A review of global mismatches and health implications. Ergonomics. 2021;64(8):1015-31.

[13].     Afrifah KO, Kwarteng A, Mensah P. Student furniture preferences and prevalence of bodily fatigue in Ghanaian tertiary institutions. J Sci Technol. 2021;41(1):45-58.

[14].     Nwafor CC, Okeke CI. Physical strain, domestic demands, and academic coping mechanisms among university students. J Gender High Educ. 2022;15(4):210-26.

[15].     Adeyemi TO, Babatunde JO. Classroom ergonomics and learning engagement in Nigerian federal universities. J Educ Facil Environ. 2023;8(2):101-15.

[16].     Olabisi OA, Adebayo SO. Socio-demographic determinants of academic success and physical coping among students in Sub-Saharan African universities. Afr High Educ Rev. 2023;19(2):78-92.

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Abstract:

Health equity remains a central concern in achieving universal health coverage in Zambia. Despite reforms such as the abolition of user fees and the introduction of the National Health Insurance Management Authority (NHIMA), disparities in healthcare access and utilisation persist. This study examined the influence of an equity-focused approach to health services on health-seeking behaviour among residents of Matero Township in Lusaka, Zambia. A cross-sectional comparative design using mixed methods was employed, involving 252 respondents from public and private health facilities. Findings revealed that while 58.3% of respondents reported access to healthcare services, 41.7% still lacked access, indicating persistent inequities. Systemic barriers were reported by 65.5% of participants, while 57.4% perceived inequalities in service delivery. Key determinants of health-seeking behaviour included distance to health facilities (25.6%), availability of medication (23.3%), and cost of services (22.0%). Although 70.4% expressed confidence in local health services, utilisation remained irregular. The study concludes that while equity-focused reforms have improved access, structural barriers continue to limit optimal utilisation.

References:

[1].   Chansa C. Zambia Health Sector Public Expenditure Review. Washington (DC): World Bank; 2018. doi:10.1596/31784.

[2].   Ministry of Health Zambia. National Health Strategic Plan 2017–2021. Lusaka: Ministry of Health; 2017.

[3].   Gao W, et al. Care-seeking pattern for diarrhea among children under 36 months old in rural western China. PLoS One. 2012;7(8):e43103.

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[6].   World Health Organization. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva: WHO; 2008.

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[9].   Andersen RM. Revisiting the behavioral model and access to medical care. J Health Soc Behav. 1995;36(1):1–10.

[10].  Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 5th ed. Thousand Oaks (CA): Sage Publications; 2018.

[11].  Adegoke AA. Correlates of health behaviour practices among literate adults of South-West Nigeria. BMC Public Health. 2010;10(2).

[12].  Kanungo S, Mahapatra T, Bhowmik K, et al. Perceived morbidity, health-seeking behaviour and their determinants in a poor-resource setting in India. PLoS One. 2015;10(5):e0125865.

[13].  Mani G, Annadurai K, Danasekaran R. Perceptions and health-seeking practices among an urban population of Tamil Nadu, India: a baseline survey. MRIMS J Health Sci. 2014;2:37–39.

[14].  Manzi A, Munyaneza F, Mujawase F, et al. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of the Rwanda Demographic and Health Survey 2010. BMC Pregnancy Childbirth. 2014;14(1):290–299.

[15].  Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM. It's up to the woman's people: how social factors influence facility-based delivery in rural Northern Ghana. Matern Child Health J. 2014;18(1):109–119.

[16].  Mwase I. Social Capital and Household Health-Seeking Behaviour for Children in the Context of Urban Neighbourhoods: The Case of Khayelitsha in the Western Cape, South Africa [dissertation]. Cape Town: University of Cape Town; 2015.

[17].  Nyonator FK, Kutzin J. The effects of user fees in the Volta Region of Ghana. Health Policy Plan. 1999;14(4):329–341.

[18].  Ibiwoye A, Adeleke IA. Does national health insurance promote access to quality healthcare? Geneva Pap Risk Insur Issues Pract. 2008;33(2):219–233.

[19].  Ilesanmi OS, Adebiyi AO, Fatiregun AA. National Health Insurance Scheme: how protected are households in Oyo State, Nigeria? Health Policy Plan. 2014;29(2):173–180.

[20].  Carrin G, Mathauer I, Xu K, Evans DB. Universal coverage of health services: tailoring its implementation. Bull World Health Organ. 2008;86(11):857–863.

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[22].  Mkhailef Hawi Al-tameemi M, Bahmanpour K, Mohamadi-Bolbanabad A, Moradi Y, Moradi G. Insights into determinants of health-seeking behavior: a cross-sectional investigation in the Iraqi context. Front Public Health. 2024;12:1367088. 

Abstract:

This study evaluates the progress toward Universal Health Coverage (UHC) in Ghana, Kenya, Nigeria, and Tanzania using Demographic and Health Survey (DHS) data from 2022–2024. While the global goal is to achieve UHC by 2030, sub-Saharan Africa faces significant structural barriers, including vast informal economies and chronic underfunding of public health infrastructure. Results reveal a concerning divergence in national trajectories: Ghana experienced a significant decline in functional coverage from 62.4% to 5.7% due to the structural failure of its voluntary enrollment model, delayed provider reimbursements, and a subsequent deterioration of public trust. Conversely, Kenya’s shift toward mandatory enrollment for the formal sector increased overall population coverage to 34%, although a persistent pro-rich bias remains evident. Meanwhile, Nigeria and Tanzania continue to register low, single-digit functional coverage despite recent ambitious legislative reforms, heavily hindered by extreme poverty and system fragmentation. Multivariate logistic regression confirms that educational attainment and household wealth remain the primary, universal determinants of health insurance status across all four nations. The study concludes that sustainable UHC requires an immediate shift from voluntary, fragmented schemes to unified mandatory systems, supported by robust, automated poverty subsidies and synchronized investments in supply-side health infrastructure.

References:

[1].   World Health Organization. Global monitoring report on universal health coverage 2023: Focusing on sub-Saharan Africa. WHO Press; 2023. Available from: https://www.who.int/publications/i/item/9789240080379

[2].   Amu H, Dickson KS, Kumi-Kyereme A, Darteh EK. Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania. PLOS ONE. 2018;13(8):e0203115. Available from: https://doi.org/10.1371/journal.pone.0203115

[3].   Abuya T, Maina T, Chuma J. Historical account of the national health insurance formulation in Kenya. BMC Health Services Research. 2015;15(1):56. Available from: https://doi.org/10.1186/s12913-015-0992-0

[4].   Afriyie DO, Amankwah S, Anyane-Yeboa A, Fenny AP. Incidence and intensity of catastrophic health expenditure in Ghana. Journal of Global Health. 2024;15. Available from: https://doi.org/10.7189/jogh.15.04018

[5].   Atuoye KN, Kuuire VZ, Kangmennaang J, Antabe R, Luginaah I. Who are the "missing middle" in Ghana's National Health Insurance Scheme? Health Policy and Planning. 2021;36(5):654-66. Available from: https://doi.org/10.1093/heapol/czab007

[6].   Barasa E, Rogo K, Mwaura N, Chuma J. Assessing the progress towards Sustainable Development Goal 3.8: Universal Health Coverage in Kenya. International Journal for Equity in Health. 2021;20(1):1-15. Available from: https://doi.org/10.1186/s12939-020-01362-7

[7].   Adewole DA, Adebayo AM, Akande OW, Sambo MN. Determinants of health insurance enrollment among informal sector workers in Lagos State, Nigeria. BMC Public Health. 2022;22(1):415. Available from: https://doi.org/10.1186/s12889-022-12798-y

[8].   Chemouni B. The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda. World Development. 2018;106:87-98. Available from: https://doi.org/10.1016/j.worlddev.2018.01.014

[9].   Fenny AP, Yates R, Thompson R. Financial protection and equity in health insurance: Evidence from the National Health Insurance Scheme in Ghana. Global Health Action. 2023;16(1). Available from: https://doi.org/10.1080/16549716.2023.2185250

[10].  Ghana Statistical Service (GSS) and ICF. Ghana Demographic and Health Survey 2022. GSS and ICF; 2024. Available from: https://dhsprogram.com/publications/publication-fr387-dhs-final-reports.cfm

[11].  Mtei G, Makawia S, Ally M, Kuwawenaruwa A. Challenges in scaling up mandatory health insurance in Tanzania: A stakeholder analysis. Tanzania Journal of Health Research. 2024;25(2). Available from: https://doi.org/10.4314/thrb.v25i2.5

[12].  Brough M. Tanzania: All residents must be covered by health insurance. Willis Towers Watson; 2024. Available from: https://www.wtwco.com/en-us/insights/2024/02/tanzania-all-residents-must-be-covered-by-health-insurance

[13].  Sani M. National Health Insurance Authority Act 2022: Implications for UHC in Nigeria. Nigerian Medical Journal. 2022;63(4). Available from: https://nigerianmedjournal.org/

[14].  Okpani AI, Abimbola S. Operationalizing the Basic Health Care Provision Fund in Nigeria: A gateway to UHC. The Lancet Global Health. 2021;9(12):e1651. Available from: https://doi.org/10.1016/S2214-109X(21)00398-7

[15].  Oraro T, Ngwerume K. Moving from NHIF to SHIA: Analyzing Kenya’s transition to the Social Health Insurance Act. Journal of African Health Policy. 2023;12(1). Available from: https://www.ajol.info/

[16].  National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2023-24. NPC and ICF; 2024. Available from: https://dhsprogram.com/methodology/survey/survey-display-617.cfm

[17].  Otoo N, Owoo N. Health insurance for the informal sector: An assessment of the NHIS in Ghana. International Journal for Equity in Health. 2018;17(1). Available from: https://doi.org/10.1186/s12939-018-0775-6

[18].  Uzochukwu BSC, Ughasoro MD, Etiaba E, Okwuosa C, Envuladu E, Onwujekwe OE. Health care financing in Nigeria: Implications for achieving UHC. Nigerian Journal of Clinical Practice. 2015;18(4):437-44. Available from: https://doi.org/10.4103/1119-3077.170811

[19].  Wang H, Soni A, Wang Z. Impact of education on health-seeking behavior and insurance demand in sub-Saharan Africa. Social Science & Medicine. 2022;301:114890. Available from: https://doi.org/10.1016/j.socscimed.2022.114890

[20].  World Health Organization. Country cooperation strategy 2023-2027, Nigeria. Brazzaville: WHO African Region; 2024. Available from: https://www.afro.who.int/countries/nigeria

[21].  Obinna OE, Onwujekwe O, Uzochukwu BS. The National Health Insurance Authority (NHIA) Act 2022: A roadmap to mandatory coverage in Nigeria. Nigerian Journal of Medicine. 2022;31(4):450-8. Available from: https://doi.org/10.4103/njm.njm_91_22 

Abstract:

Unintended pregnancy among adolescents is a growing public health concern, particularly in sub-Saharan Africa where cultural and religious norms significantly influence sexual health behaviors. This study explores the level of awareness and the influence of religious perceptions on birth control among teenagers in selected secondary schools in Douala, Cameroon. Employing a cross-sectional design, data were collected through structured questionnaires targeting students aged 13–19 years. The findings reveal that although a portion of the respondents demonstrated basic awareness of birth control methods such as condoms and pills, significant gaps remain in their understanding of natural contraceptive methods, ovulation cycles, and access to reproductive health services. Religious beliefs, particularly within Christianity and Islam, were shown to play a central role in shaping attitudes toward contraceptive use, with many teenagers reporting that birth control was either discouraged or regarded as sinful. The study also identified multiple barriers to effective birth control usage, including socio-cultural taboos, poor parent-child communication on sexual matters, misinformation, fear of side effects, and economic limitations. The results underscore the urgent need for comprehensive sexual education programs tailored to adolescents, incorporating accurate reproductive health information while respecting religious and cultural contexts. Collaboration between schools, religious leaders, healthcare providers, and parents is essential to empower teenagers to make informed decisions about their sexual health. By bridging knowledge gaps and addressing religious concerns, stakeholders can help reduce unintended pregnancies and associated health and social burdens among Cameroonian adolescents.

References:

[1].   World Health Organization (WHO). Adolescent Pregnancy: Issues in Adolescent Health and Development. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/adolescent-pregnancy-issues-in-adolescent-health-and-development

[2].   World Health Organization (WHO). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation. Geneva: World Health Organization; 2017. https://www.who.int/publications/i/item/9789241512343

[3].   United Nations Population Fund (UNFPA). Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy. New York: UNFPA; 2013. https://www.unfpa.org/publications/motherhood-childhood-facing-challenge-adolescent-pregnancy

[4].   United Nations Department of Economic and Social Affairs. World Contraceptive Use 2021. New York: United Nations; 2021. https://www.un.org/development/desa/pd/data/world-contraceptive-use

[5].   Darroch JE, Woog V, Bankole A, Ashford LS. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents. Guttmacher Institute; 2016. https://www.guttmacher.org/report/adding-it-meeting-contraceptive-needs-of-adolescents

[6].   Tchameni SN, Ndongo S. Teenage Pregnancy in Cameroon: A Public Health Challenge. International Journal of Adolescent Health. 2020;12(2):56-62. https://doi.org/10.1016/j.adolescence.2020.02.005

[7].   Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: A World Health Organization multicountry study. BJOG: An International Journal of Obstetrics & Gynaecology. 2014;121(Suppl 1):40-8. https://doi.org/10.1111/1471-0528.12630

[8].   National Institute of Statistics Cameroon. Cameroon Demographic and Health Survey 2011. Yaoundé: National Institute of Statistics; 2012. https://dhsprogram.com/pubs/pdf/FR260/FR260.pdf

[9].   Ndonko FT, Aziato L. Adolescents and Access to Sexual and Reproductive Health Services in Cameroon. Reproductive Health Matters. 2017;25(50):90-8. https://doi.org/10.1080/09688080.2017.1389365

[10].  Tsehayo G, Abdu A. Religious and cultural constraints to family planning among adolescents. African Journal of Reproductive Health. 2015;19(2):40-7. https://www.ajrh.info/index.php/ajrh/article/view/703

[11].  Pope Pius XI. Encyclical Casti Connubii. Vatican City: The Holy See; 1930. https://www.vatican.va/content/pius-xi/en/encyclicals/documents/hf_p-xi_enc_19301231_casti-connubii.html

[12].  Omran AR. Family Planning in the Legacy of Islam. London: Routledge; 1992. https://www.routledge.com/Family-Planning-in-the-Legacy-of-Islam/Omran/p/book/9780415904063

[13].  Chitando A. Religion and Sexual Health in Africa. Pietermaritzburg: Cluster Publications; 2009. https://www.clusterpublications.co.za/religion-and-sexuality

[14].  Freedman R, Landy U. Family planning and Judaism: Perspectives from Israel and the diaspora. Studies in Family Planning. 2001;32(1):12-22. https://doi.org/10.1111/j.1728-4465.2001.00012.x

[15].  Dzedong M, Ako M. Adolescent sexual and reproductive health in Cameroon: Exploring religious perspectives. Journal of Religion and Health. 2020;59(6):2896-910. https://doi.org/10.1007/s10943-020-01054-3

[16].  World Health Organization (WHO). Unsafe Abortion: Global and Regional Estimates. Geneva: World Health Organization; 2021. https://www.who.int/news-room/fact-sheets/detail/abortion

[17].  Kumi-Kyereme A, Awusabo-Asare K. Adolescents’ reproductive health knowledge in Ghana. African Journal of Reproductive Health. 2015;19(1):63-77. https://www.ajrh.info/index.php/ajrh/article/view/650

[18].  Bankole A, Malarcher S. Removing barriers to adolescents' access to contraceptive information and services. Studies in Family Planning. 2010;41(2):117-24. https://doi.org/10.1111/j.1728-4465.2010.00232.x

[19].  United Nations Educational, Scientific and Cultural Organization (UNESCO). International Technical Guidance on Sexuality Education: An Evidence-Informed Approach. Paris: UNESCO; 2018. https://unesdoc.unesco.org/ark:/48223/pf0000260770

[20].  UNESCO, UNAIDS, UNFPA, UNICEF, UN Women, World Health Organization (WHO). International Technical Guidance on Sexuality Education: Revised Edition. Paris: UNESCO; 2018. p. 1-139. https://unesdoc.unesco.org/ark:/48223/pf0000260770

Abstract:

The translation of nutritional policies into routine healthcare and sustainable dietary practices is crucial for the effective management of diabetes and hypertension. The Social Ecological Model (SEM) was employed in this study to evaluate the effect of nutritional policy interventions in some health facilities in Region Three, Guyana. A mixed-methods study was conducted at four public health facilities: the Goed Intent Health Centre (GIHC), the Parfaite Harmonie Health Centre (PHHC), Leonora Cottage Hospital (LCH) and the West Demerara Regional Hospital (WDRH). Quantitative data included 2,745 patients’ records, 17 healthcare providers and facility assessments, complemented by qualitative evidence on patient and community experiences. Inferential and descriptive statistics, which included multivariable logistic regression, were integrated with thematic findings across SEM levels. The overall facility implementation was 40.0%; however, provider knowledge ranged from 45.0% to 60.0%, and reported practice ranged from 33.8% to 50.0%. Awareness of Food-Based Dietary Guidelines ranged from 51.7% to 75.6%, compared with 16.9%–48.2% for the Dietary Approaches to Stop Hypertension (DASH). Greater nutritional awareness was independently associated with high reported dietary practice (OR = 1.11, 95% CI: 1.10–1.12; p < 0.001). Cost and affordability constituted the predominant patient-level barrier (63.5%), followed by cultural and food norms (19.7%). Qualitative findings reinforced the influence of economic constraints, household food practices, provider capacity limitations and weaknesses in routine implementation. Nutritional policy implementation for diabetes and hypertension in Region Three is shaped by the interplay of patient, provider, organizational, community and policy influences. Strengthening implementation requires coordinated multilevel action that combines provider and facility support with affordable, culturally appropriate, and practical dietary guidance.

References:

[1].   World Health Organization, 2025, Noncommunicable diseases [Internet]. Geneva: World Health Organization [cited 2026 Aug 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

[2].    World Health Organization, 2024, Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases. 2nd ed. Geneva: World Health Organization.

[3].   World Health Organization, 2024, Diabetes [Internet]. Geneva: World Health Organization [cited 2026 Aug 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes

[4].   World Health Organization, 2025, Hypertension [Internet]. Geneva: World Health Organization [cited 2026 Aug 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension

[5].   World Health Organization, 2026, Healthy diet [Internet]. Geneva: World Health Organization [cited 2026 Aug 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet

[6].   World Health Organization, 2013, Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization.

[7].   Ministry of Public Health Guyana, Pan American Health Organization/World Health Organization. Guyana STEPS Survey Country Report [Internet]. Georgetown: Ministry of Public Health; 2021 [cited 2026 Aug 8]. Available from: https://www.paho.org/en/documents/guyana-steps-survey-country-report

[8].   Pan American Health Organization. Guyana: Country Profile. Health in the Americas+ [Internet]. Washington (DC): Pan American Health Organization; [cited 2026 Aug 8]. Available from: https://hia.paho.org/en/country-profiles/guyana

[9].   Pan American Health Organization. Plan of action on noncommunicable disease prevention and control 2025–2030 [Internet]. Washington (DC): PAHO; 2026 [cited 2026 Aug 8]. Available from: https://www.paho.org/en/documents/plan-action-noncommunicable-disease-prevention-and-control-2025-2030

[10].  McLeroy KR, Bibeau D, Steckler A, Glanz K, 1988, An ecological perspective on health promotion programs. Health Educ Q, 15(4):351–377. https://doi.org/10.1177/109019818801500401.

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[12].  Nilsen P, 2015, Making sense of implementation theories, models and frameworks. Implement Sci, 10:53. https://doi.org/10.1186/s13012-015-0242-0.

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[14].  Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al, 2001, Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med, 344(1):3–10. https://doi.org/10.1056/NEJM200101043440101.

[15].  American Diabetes Association Professional Practice Committee for Diabetes. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S89–S131. https://doi.org/10.2337/dc26-S005.

[16].  Food and Agriculture Organization of the United Nations, International Fund for Agricultural Development, UNICEF, World Food Programme, World Health Organization. The State of Food Security and Nutrition in the World 2026: Understanding and addressing the high cost of a healthy diet. Rome: FAO; 2026. https://doi.org/10.4060/cd8306en.

[17].  Gulliford MC, Alert CV, Mahabir D, Ariyanayagam-Baksh SM, Fraser HS, Picou DI, 1996, Diabetes care in middle-income countries: a Caribbean case study. Diabet Med, 13(6):574–581. https://doi.org/10.1002/(SICI)1096-9136(199606)13:6 < 574: AID-DIA113>3.0.CO;2-C.

[18].  Berners-Lee B, Duberry N, Hazel-Blake D, Mallen C, Shepherd T, Tirion AS, et al, 2026, Qualitative study of barriers and facilitators to Dietary Approaches to Stop Hypertension (DASH) on the Caribbean island of Montserrat. BMJ Public Health, 4(2): e004552. https://doi.org/10.1136/bmjph-2025-004552.

[19].  Oladele CR, Colón-Ramos U, Galusha D, Tran E, Adams OP, Maharaj RG, et al, 2022, Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort study. Prev Med Rep, 26:101694. https://doi.org/10.1016/j.pmedr.2022.101694.

[20].  Henry FJ, Lawrence B, Nelson M, 2022, Comparative cost of diets for low-income families in the Caribbean. Rev Panam Salud Publica, 46: e120. https://doi.org/10.26633/RPSP.2022.120. 

Abstract:

Cholera, an acute diarrheal disease, is caused by the bacterium Vibrio cholerae and is usually transmitted through contaminated water or food. This study assessed the environmental factors associated with endemic cholera in Lukanga Swamps from January 2010 to January, 2018. This was a Time Series Correlational Study. Air temperature and precipitation data were collected from 19 lagoons using satellite remote sensing from 2010 to 2016. Water samples were also collected for analysis. Data were analyzed in Stata Version 14. Results from the standard Poisson regression (PR) model were compared with those from the Zero-Inflated negative binomial regression (ZINBR) to determine the best-fit model. The study reported 133 cholera cases during the study period. It found that increased rainfall was associated with decreased risk of cholera cases (IRR = 0.992, 95% CI: 0.988 – 0.997, P=0.002). We also found that a 1-degree increase in temperature increased the risk of cholera cases by 27%, which was statistically significant (IRR = 1.265, 95% CI: 1.142–1.402, P = 0.0001). Water quality monitoring tests from 19 lagoons revealed that 19/36 (53%) of water samples had faecal coliforms. The study further revealed a pH range of 7.1 to 8.5 or higher. V. cholerae was not isolated from 164 water samples. In conclusion, air temperature was strongly associated with cholera outbreaks in the Lukanga Swamps. Increased rainfall was also associated with a decreased risk of cholera cases. Therefore, a multifaceted approach should be used to prevent and control cholera in Lukanga Swamps.

References:

[1].   Levy S. Warming trend: how climate shapes Vibrio ecology. Environmental Health Perspectives. 2015;123(4):A82.

[2].   WHO. Weekly Epidemiological Record, No. 31, 1st August, 2014. Geneva; 2014.

[3].   Fernández MÁL, et al. Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003–2006: analysis of a time series. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009;103(2):137-43.

[4].   Jutla A. Environmental factors influencing cholera transmission and outbreaks. International Journal of Environmental Research and Public Health. 2015;12(2):246-59.

[5].   MOH. Health Information Management System and district surveillance linelisting data bases, Kapiri Mposhi District Health Office, Zambia; 2016.

[6].   McCartney M, et al. The Lukanga Swamps: use, conflicts, and management. Journal of International Wildlife Law & Policy. 2011;14(3-4):293-310.

[7].   Mbuti HK. Assessment of Diarrhoeal Disease attributable to Water and Sanitation and Hygiene among under five in Kasrani, Nirobi County, Kenya. (P57/PT/10518/2008). 2013.

[8].   TAMSAT Group. Tropical Applications of Meteorology using Satellite Data and Ground-Based Observations. University of Reading, United Kingdom; 2017. Available from: https://www.tamsat.org.uk/.

[9].   Tarnavsky E, et al. Extension of the TAMSAT Satellite-based Rainfall Monitoring over Africa and from 1983 to Present. Journal of Applied Meteorology and Climate. 2014;53(12):2805-22.

[10].  Maidment RI, et al. The 30 year TAMSAT African Rainfall Climatology and Time series (TARCAT) data set. Journal of Geophysical Research. 2014;119(18):10619-44.

[11].  Ohene SA, Klenyuie W, Sarpeh M. Assessment of the response to cholera outbreaks in two districts in Ghana. Infectious Diseases of Poverty. 2016;5(99). https://doi.org/10.1186/s40249-016-0192-z

[12].  Namkinga LA, et al. Co-variation of Cholera with Climatic and Environmental Parameters in Coastal Regions of Tanzania. 2014.

[13].  Jutla AS, Akanda AS, Islam S. Tracking cholera in coastal regions using satellite observations1. Wiley Online Library. 2010.

[14].  Igbinosa EO, Okoh AI. Emerging Vibrio species: an unending threat to public health in developing countries. Research in Microbiology. 2008;159(7):495-506.

[15].  Trærup SLM, Ortiz RA, Markandya A. The Health Impacts of Climate Change: A Study of Cholera in Tanzania. BC3 working paper series (2010-01,). 2010.

[16].  Fu SJS, Liu Y, Chen K. A predictive model of Vibrio cholerae for combined temperature and organic nutrient in aquatic environments. Journal of Applied Microbiology. 2012. ISSN 1364-5072, (Nanchang Center for Disease Control and Prevention, Nanchang, China).

[17].  Gaudart J, Rebaudet S, Barrais R, Boncy J, Faucher B, Piarroux R, Magloire R. Spatio-temporal dynamics of cholera during the first year of the epidemic in Haiti. PLoS Neglected Tropical Diseases. 2013;7(3):e2145. https://doi.org/10.1371/journal.pntd.0002145

[18].  Rajendran K, et al. Influence of relative humidity in Vibrio cholerae infection: a time series model. Indian Journal of Medical Research. 2011;133(2):138.

[19].  Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Neglected Tropical Diseases. 2015;9(6):e0003832. https://doi.org/10.1371/journal.pntd.0003832

[20].  Sebastian T, et al. Role of seasonality and rainfall in Vibrio cholerae infections: A time series model for 11 years surveillance data. Clinical Epidemiology and Global Health. 2015;3(3):144-8.

[21].  Wu J, et al. Influences of heatwave, rainfall, and tree cover on cholera in Bangladesh. Environ Int. 2018;120:304-11.

[22].  Juliana U. Stimulating diffusion of Cholera in Ghana. Master's thesis; Faculty of Geo-Information Science and Earth observation of the University of Twente. Ghana; 2011.

[23].  Almagro-Moreno S, Taylor RK. Cholera: Environmental Reservoirs and Impact on Disease Transmission. Microbiol Spectrum. 2013;1(2).

[24].  Pachepsky Y. Escherichia Coli and Fecal Coliforms in Freshwater and Estuarine Sediments. 2011;V41:1067.

[25].  Emily C., Sanders, Y.Y.a.A.P. Fecal Coliform and E. coli Concentrations in Effluent-Dominated Streams of the Upper Santa Cruz Watershed. Water. 2013;5:243-61; doi:10.3390/w5010243 (Landscape Ecology Branch, Environmental Sciences Division, National Exposure Research Laboratory, United States Environmental Protection Agency Office of Research and Development, 944 East Harmon Avenue, Las Vegas, NV 89119, USA).

[26].  Alam M, Hasan NA, Sadique A, Bhuiyan NA, Ahmed KU, Nusrin S, Nair GB, Siddique AK, Sack RB, Sack DA, Huq A, Colwell RR. Seasonal cholera caused by Vibrio cholerae serogroups O1 and O139 in the coastal aquatic environment of Bangladesh. Applied and Environmental Microbiology. 2006;72(6):4096-4104. https://doi.org/10.1128/AEM.00196-06

Abstract:

The strive toward achieving adolescent girls' sexual and reproductive health empowerment (SRHE) cannot be without challenges. The study examined governance and implementation gaps in establishing effective operational mechanisms that enhance and sustain adolescent girls' SRHE. The study obtained ethical approval and used a concurrent triangulation and sequential exploratory mixed-methods design, combining quantitative and qualitative approaches within a survey framework. A total of 395 participants took part in the study, comprising 384 adolescent girls and 11 key informants from the traditional, educational, health, social, legal, women and gender empowerment, and NGO’s sectors. We analyzed quantitative data using SPSS, while we conducted thematic analysis of qualitative data using ATLAS.ti and NVivo. The findings revealed breaches in adolescent girls' SRHE, ranging from early indulgent sex, transactional sex, unintended pregnancy, school dropout, unsafe abortion, and low perception of contraceptives, with a preference for condoms. Although the socio-political crisis contributed through poverty, displacement, and family disruption, other salient facilitators included inadequate policies and governance, with the education sector still lacking structure and specificity. To improve and sustain adolescent girls’ SRHE, stakeholders suggested the refinement of SRH education, notably in secondary school, and the proper structuring and implementation of policies in a multi-sectoral approach while striving to end the socio-political crisis, alleviating poverty and fostering early home-based education, comprehensive / intensified school-based education with effective integration into the curriculum, intensified community-based education and awareness, and controlled information through mass and social media, while intensifying education from early adolescence. The T-SAG-SRHE Model (Tiko–Sexual and Reproductive Health Empowerment of Adolescent Girls Model) is introduced as a context-responsive framework designed to address policy and implementation gaps in adolescent sexual and reproductive health education and services within the Tiko Health District and comparable contexts

References:

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[2].   Dávila, F., Cala-Vitery, F., & Gómez, L.-T. (2025). Determinants of Access to Sexual and Reproductive Health for Adolescent Girls in Vulnerable Situations in Latin America. International Journal of Environmental Research and Public Health, 22(2), 248. https://doi.org/10.3390/ijerph22020248

[3].   Nsamenang A. B. (2005). Developmental psychology: Search for a diversity paradigm. Human Development Resource Center.

[4].   Blakemore SJ, Burnett S and Dahl RE (2010). The role of puberty in the developing adolescent brain. Human Brain Mapping 31(2) 926-33.

[5].   Tegegne TK and Sisay MM. (2014). Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health. 14 (1118). 3.

[6].   Hsu HY, Lien YF, Lou JH, Chen SH and Wang RH (2010). Exploring the effect of sexual empowerment on sexual decision making in female adolescents. Journal of Nursing Research. 18: 44-52.

[7].   Sommer M (2010). Where the education system and women's bodies collide: The social and health impact of girls' experiences of menstruation and schooling in Tanzania. Journal of Adolescence. 33: 521-9.

[8].   Oche M, Umar A, Gana G and Ango J (2012). Menstrual health: the unmet needs of adolescent girls in Sokoto, Nigeria. Scientific Research and Essays. 7: 410-8

[9].   UNICEF (2019). Child marriage: A violation of girls’ rights. UNICEF.

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[11].  WHO (2011). The sexual and reproductive health of younger adolescents: Research issues in developing countries: Background paper for a consultation. World Health Organization (WHO).

[12].  Chandra, A., Copen, C. E., & Stephen, E. H. (2013). Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. National Health Statistics Reports, (67), 1–19.

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[14].  Nicholson, N. R. (2012). A Review of Social Isolation: An Important but Underassessed Condition in Older Adults. The Journal of Primary Prevention, 33, 137-152. https://doi.org/10.1007/s10935-012-0271-2

[15].  Shimekaw, B. , Megabiaw, B. and Alamrew, Z. (2013) Prevalence and associated factors of sexual violence among private college female students in Bahir Dar city, North Western Ethiopia. Health (5), 1069-1075. doi: 10.4236/health.2013.56143.

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[17].  UNFPA WCARO (2026). Adolescent and Youth Sexual and Reproductive Health and Rights Services: Key elements for implementation and scaling up services in West and Central Africa. United Nations Population Fund West and Central Africa Regional Office (UNFPA WCARO). https://wcaro.unfpa.org/sites/default/files/pub-pdf/EN-UNFPA-WCARO-MUSKOKA-AYSRHR-Brochure-WEB-1.pdf. Visited 26 March 2026.

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[23].  Ngowa, J.D.K., Neng, H.T., Domgue, J.F., Nsahlai, C.J. and Kasia, J.M. (2015) Voluntary Induced Abortion in Cameroon: Prevalence, Reasons, and Complications. Open Journal of Obstetrics and Gynecology, 5, 475-480. http://dx.doi.org/10.4236/ojog.2015.59069

[24].  Gabriel, E., Halle-Ekane, G., Isah, M., Wirsiy, F., Lebaga, M., Siysila, N., Musi, C., Chia, N. and Victor, M. (2020) Prevalence and Associated Factors of Teenage Pregnancy among Secondary and High School Students in the Tiko Health District, South West Region, Cameroon. Journal of Biosciences and Medicines, 8, 99-113. doi: 10.4236/jbm.2020.89008.

[25].  Regional Delegation of Public Health for the Southwest region (2021). List of villages—report from the Regional Delegation of Public Health for the Southwest region, Buea.

[26].  The World Bank (2021). The Socio-Political Crisis in the Northwest and Southwest Regions of Cameroon: Assessing the Economic and Social Impacts. The World Bank.

[27].  Cutherell M, Bwire J, Mtei E, Musau A, Kahabuka C, Luhanga I, Julius A and Kihwele G (2023) Accelerated institutionalization of an adolescent sexual and reproductive health (ASRH) intervention in Tanzania: Findings from a mixed-methods evaluation. Front. Glob. Womens Health 4 (942418). doi: 10.3389/fgwh.2023.942418

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[29].  Santhya, K. G., & Jejeebhoy, S. J. (2015). Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries. Global Public Health, 10(2), 189–221. https://doi.org/10.1080/17441692.2014.986169

[30] Alimoradi Z, Kariman N, Simbar M and Ahmadi F (2017). Empowerment of Adolescent Girls for Sexual and Reproductive Health Care: A Qualitative Study. African Journal of Reproductive Health; 21 (4): 80. DOI: 10.29063/ajrh2017/v21i4.9

Abstract:

In Cameroon, malaria remains a major public health burden, particularly in semi-rural communities such as Mangoum. Malaria incidence remains high, prompting the introduction of new-generation LLINs designed to improve vector control, overcome insecticide resistance, and enhance durability, despite widespread distribution of Long-Lasting Insecticidal Nets (LLINs). Evidence on their effectiveness in community settings is however limited. This study looked at the effectiveness of new-generation LLINs on malaria transmission in Mangoum, Foumbot. A community-based quasi-experimental design was conducted among 395 households receiving new-generation LLINs. Structured questionnaires via Kobo Collect were used to collect multistage sampling selected participants, and quantitative data on LLIN ownership, usage patterns, and malaria cases before and after distribution. Descriptive statistics and Chi-square tests in SPSS version 25 were used to analyze data, with p < 0.05 set as significance. Analysis showed strong associations between LLIN utilization and motivation to use nets (χ²(9) = 60.079, p < 0.001), net sufficiency (χ² = 27.219, p = 0.001), and perceived effectiveness (χ² = 29.54, p < 0.001). Households reporting more than five malaria cases decreased from 8.6% to 1.8% (χ² = 62.39, p < 0.001), LLIN usage correlated with malaria reduction (χ² = 26.237, p < 0.001), and longer net use was associated with fewer cases (χ² = 31.442, p < 0.001), which signifies malaria incidence declined significantly after distribution. A 40.7% decline in confirmed malaria cases was confirmed by health facility records. These findings demonstrate that malaria incidence is significantly reduced at the household level by new-generation LLINs, and that the effectiveness of LLIN-based malaria control strategies in similar community settings could further be enhanced by strengthening household coverage and promoting consistent nightly use.

References:

[1].   World Health Organization. World malaria report 2023. Geneva: World Health Organization; 2023.

[2].   Rossati A. Global warming and its health impact. Int J Environ Res Public Health. 2016;13(7):623. doi:10.3390/ijerph13070623.

[3].   Snow RW. Global malaria burden and control. Annu Rev Public Health. 2015;36:115-33. doi:10.1146/annurev-publhealth-031914-122838.

[4].   Ministry of Public Health Cameroon. National malaria control programme report. Yaoundé: Ministry of Public Health Cameroon; 2022.

[5].   Gimnig JE, Ochomo E, Bayoh M, Otieno B, Olang G, Kemei B, et al. Field evaluation of malaria prevention strategies in endemic settings. Malar J. 2020;19:1-12. doi:10.1186/s12936-020-03316-7.

[6].   Takken W, Knols BGJ. Emerging challenges in malaria vector control in sub-Saharan Africa. Annu Rev Entomol. 2021;66:229-45. doi:10.1146/annurev-ento-061020-094926.

[7].   Hemingway J, Ranson H, Magill A, Kolaczinski J, Fornadel C, Gimnig J, et al. Averting a malaria disaster: Will insecticide resistance derail malaria control? Lancet. 2016;387(10029):1785-8. doi:10.1016/S0140-6736(15)00417-1.

[8].   Hancock PA, Hendriks CJM, Tangena JAA, Gibson H, Hemingway J, Coleman M, et al. Mapping insecticide resistance in malaria vectors across sub-Saharan Africa. Nat Commun. 2020;11:893. doi:10.1038/s41467-020-14742-2.

[9].   Moyes CL, Athinya DK, Seethaler T, Battle KE, Sinka M, Hadi MP, et al. Evaluating insecticide resistance across African malaria vectors. Nat Commun. 2020;11:1-11. doi:10.1038/s41467-020-19188-8.

[10].  Pulford J, Hetzel MW, Bryant M, Siba PM, Mueller I. Factors influencing the use of insecticide-treated nets: Evidence from household surveys. Malar J. 2019;18:1-15. doi:10.1186/s12936-019-2844-5.

[11].  Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L. Behavioral factors influencing malaria prevention. Malar J. 2021;20:1-14. doi:10.1186/s12936-021-03642-2.

[12].  World Health Organization. World malaria report 2020. Geneva: World Health Organization; 2020.

[13].  Egbuche CM, Etukumana EA, Uzochukwu BSC. The role of insecticide-treated nets in malaria prevention and control in endemic communities. Asian Pac J Trop Dis. 2013;3(6):472-6. doi:10.1016/S2222-1808(13)60102-3.

[14].  Kilian A, Koenker H, Baba E, Onyefunafoa E, Selby RA, Lynch M. Universal coverage with insecticide-treated nets: Achievements and challenges. Malar J. 2016;15:1-12. doi:10.1186/s12936-016-1480-3.

[15].  Protopopoff N, Mosha JF, Lukole E, Charlwood JD, Wright A, Mwalimu CD, et al. Effectiveness of a long-lasting piperonyl butoxide-treated insecticidal net and indoor residual spray interventions against malaria transmission. Lancet. 2018;391(10130):1577-88. doi:10.1016/S0140-6736(18)30427-6.

[16].  Staedke SG, Gonahasa S, Dorsey G, Maiteki-Sebuguzi C, Lynd A, Katureebe A, et al. Effect of long-lasting insecticidal nets with and without piperonyl butoxide on malaria infection in Uganda: A cluster randomized trial. Lancet. 2020;395(10232):1292-303. doi:10.1016/S0140-6736(20)30331-6.

[17].  Mosha JF, Kulkarni MA, Lukole E, Kiware SS, Lorenz LM, Bradley J, et al. Effectiveness of PBO-treated long-lasting insecticidal nets in malaria-endemic regions. Lancet Infect Dis. 2022;22(5):711-20. doi:10.1016/S1473-3099(21)00456-5.

[18].  Afolabi AA, Adebayo AM, Akinyemi OO, Ojo OA. Community knowledge and utilization of long-lasting insecticidal nets for malaria prevention in sub-Saharan Africa. Malar J. 2020;19(1):1-10. doi:10.1186/s12936-020-03205-6.

[19].  World Health Organization. WHO guidelines for malaria vector control. Geneva: World Health Organization; 2021.

[20].  Ranson H, Lissenden N. Insecticide resistance in African Anopheles mosquitoes: A worsening situation that needs urgent action to maintain malaria control. Trends Parasitol. 2016;32(3):187-96. doi:10.1016/j.pt.2015.11.010.

[21].  Strode C, Donegan S, Garner P, Enayati AA, Hemingway J. The impact of insecticide resistance on malaria vector control: A systematic review and meta-analysis. PLoS Med. 2014;11(3):e1001619. doi:10.1371/journal.pmed.1001619.

[22].  Mosha JF, Kulkarni MA, Lukole E, Kiware SS, Bradley J, Mosha D, et al. Effectiveness of dual-active ingredient insecticide-treated nets in reducing malaria prevalence: A cluster-randomized controlled trial. Lancet. 2022;399(10331):1227-37. doi:10.1016/S0140-6736(22)00247-9.

Abstract:

The COVID-19 pandemic resulted in a wave of disruptions worldwide and its effect on the higher education systems significantly impacted their service units, among them being their academic libraries. This study discusses the transformation of the University of Guyana Berbice Campus (UGBC) Library operations and services across three phases: Pre-, During-, and Post-COVID-19 periods. This study utilises a content analysis, a qualitative research approach to discuss the UGBC Library’s experience before, during and after the COVID-19 pandemic. Among the findings are that prior to the pandemic, the library was heavily dependent on traditional modes of operations, with the face-to-face services, the physical resources, and integrated minimal digital applications into its operations. In the face of the pandemic, although the abrupt and forced response to remote operations exposed various weaknesses, it also accelerated digital adoption and resulted in forward thinking and innovative work behaviour. During the pandemic timeline, the library first adopted full online operations, then gradually incorporated the hybrid service delivery model, pulling together both the physical and digital service modalities. Library operations in the post covid period can be described as being a continuation of the hybrid service model. The study concludes that despite the challenges brought about by the COVID-19 pandemic, the UGBC Library utilised the experience as an opportunity to transform its services and build greater resilience for the future. Some future recommendations for the UGBC Library include adopting a flexible work schedule, strengthening the hybrid service model, improving ICT infrastructure, and engaging in continuous Professional Development (PD) activities.

References:

[1].   Ow G. Resiliency. MedEdMentor; 2023 Apr 14. Available from: https://mededmentor.org/theory-database/theory-index/resiliency/

[2].   Appleton L. Trendspotting - looking to the future in a post-pandemic academic library environment. New Review of Academic Librarianship. 2022;28(1):1-6. Available from: https://doi.org/10.1080/13614533.2022.2058174

[3].   Fitzgerald SR, Hutton S, Reznik-Zellen R, Barlow C, Oldham W. Decision-making by and for academic libraries during COVID-19. Portal: Libraries and the Academy. 2023;23(1):45-65. Available from: https://preprint.press.jhu.edu/portal/sites/default/files/06_23.1fitzgerald.pdf

[4].   Chigwada J. Adaption and reorganisation of academic libraries following the COVID-19 pandemic. South African Journal of Libraries and Information Science. 2024;90(1):1-8. Available from: https://doi.org/10.7553/90-1-2302

[5].   Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly. 1989;13(3):319-40. Available from: https://doi.org/10.2307/249008

[6].   Adarkwah MA, Okagbue EF, Oladipo OA, Mekonen YK, Anulika AG, Nchekwubemchukwu IS, Okafor MU, Chineta OM, Muhideen S, Islam AYMA. Exploring the transformative journey of academic libraries in Africa before and after COVID-19 and in the generative AI era. The Journal of Academic Librarianship. 2024;50(4). Available from: https://doi.org/10.1016/j.acalib.2024.102900

[7].   Wright J. Securing the cultural heritage of the West Indies: The role of the West Indiana and Special Collections, The University of the West Indies, Trinidad and Tobago. Caribbean Library Journal. 2023;7:17-28. Available from: https://journals.sta.uwi.edu/ojs/index.php/clj/article/view/8988

[8].   Wenborn C. How technology is changing the future of libraries. Wiley; 2018 Apr 11. Available from: https://www.wiley.com/en-us/network/research-libraries/libraries-archives-databases/library-impact/how-technology-is-changing-the-future-of-libraries

[9].   Dickson A, Holley RP. Social networking in academic libraries: The possibilities and the concerns. New Library World. 2010;111(11/12):468-79. Available from: https://digitalcommons.wayne.edu/slisfrp/33/

[10].  Chu SKW, Du HS. Social networking tools for academic libraries. Journal of Librarianship and Information Science. 2013;45(1):64-75. Available from: https://doi.org/10.1177/0961000611434361

[11].  Harris S. The role of the University of the West Indies Mona libraries in HIV/AIDS information access and dissemination. West Indian Medical Journal. 2013;62(4):346-9. Available from: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/dr_s_harris_hivaids.pdf

[12].  University of the West Indies, St. Augustine Campus. Annual report 2010/2011. University of the West Indies; 2011. Available from: https://uwispace.sta.uwi.edu/server/api/core/bitstreams/936dad9f-9a48-4025-a72a-5882a99e894d/content?utm_source=chatgpt.com

[13].  Uwakwe BS, Onyeneke CO, Njoku IN. Effect of user education on law students' use of the library: A case study of the Faculty of Law Library, Imo State University, Owerri, Nigeria. Information Impact: Journal of Information and Knowledge Management. 2016;7(1):70-85. Available from: https://distantreader.org/stacks/journals/iijikm/iijikm-144902.pdf

[14].  Gurikar R, Mukherjee B. Information technology usage scenario in academic libraries of higher education in Chhattisgarh: Challenges and opportunities. DESIDOC Journal of Library & Information Technology. 2015;35(4):273-9. Available from: https://doi.org/10.14429/djlit.35.4.8844

[15].  Peters R, La Rose S, Schwiers K, Bhagwandin N. Prepared to function in spite of the COVID-19 pandemic: An academic library’s experience in resilience and sustenance [poster presentation]. Acceso. Puerto Rican Journal of Library Science and Documentation. 2022. Available from: https://revistas.upr.edu/index.php/acceso/article/view/20336?articlesBySimilarityPage=1

[16].  Allied. The history of telecommuting. [date unknown]. Available from: https://www.alliedtelecom.net/the-history-of-telecommuting/

[17].  Barrero JM, Bloom N, Davis SJ. The evolution of working from home. 2023. Available from: https://wfhresearch.com/wp-content/uploads/2023/07/SIEPR1.pdf

[18].  Goek SS. The future of remote work is flexibility. Public Library Association; 2021 Apr 16. Available from: http://publiclibrariesonline.org/2021/04/the-future-of-remote-work-is-flexibility/

[19].  Gormley KJ. Work from home like LibraryThing does. LibraryThing; 2020 Mar 17. Available from: https://blog.librarything.com/2020/03/work-from-home-like-librarything-does/

[20].  Chad. Librarian perspectives on working from home, flexible work schedules, and telecommuting. Library Voice; 2020 Apr 13. Available from: https://libraryvoice.com/libraries/librarian-perspectives-on-working-from-home-flexible-work-schedules-and-telecommuting

[21].  Chisita CT, Chiparausha B, Tsabetse V, Olugbara CK, Letseka M. Remaking academic library services in Zimbabwe in the wake of COVID-19 pandemic. The Journal of Academic Librarianship. 2022. Available from: https://doi.org/10.1016/j.acalib.2022.102521

[22].  Bennett S, Chriszt MH, Cole J, Day M, Dickson C. Georgia librarians working from home during the COVID-19 pandemic. Georgia Library Quarterly. 2020;57(3):1-18. Available from: https://doi.org/10.62915/2157-0396.2328

[23].  Mitchell C, Magnuson L, Hampton H. Please scream inside your heart: How a global pandemic affected burnout experiences in an academic library. Journal of Radical Librarianship. 2023;9:159-79. Available from: https://journal.radicallibrarianship.org/index.php/journal/article/view/93

[24].  Connell RS, Wallis LC, Comeaux D. The impact of COVID-19 on the use of academic library resources. Information Technology and Libraries. 2021;40(2):1-20. Available from: https://doi.org/10.6017/ital.v40i2.12629

[25].  Rafiq M, Batool SH, Ali AF, Ullah M. University libraries response to COVID-19 pandemic: A developing country perspective. The Journal of Academic Librarianship. 2021;47(1):1-10. Available from: https://doi.org/10.1016/j.acalib.2020.102280

[26].  Osorio NL, Droog A. Exploring the impact of the pandemic on reference and research services: A literature review. New Review of Academic Librarianship. 2021;27(3):280-300. Available from: https://doi.org/10.1080/13614533.2021.1990092

[27].  Streams S. Library staff learning surges on WebJunction amid COVID-19 closures. OCLC; 2020 May 7. Available from: https://blog.oclc.org/next/library-staff-learning-surges-on-webjunction-amid-covid-19-closures/

[28].  Dube TV, Jacobs L. Academic library services extension during the COVID-19 pandemic: Considerations in higher education institutions in the Gauteng Province, South Africa. Library Management. 2023;44(1-2):17-39. Available from: https://doi.org/10.1108/LM-04-2022-0039

[29].  Paterson AM, Eva N. “Always at work”: Canadian academic librarian work during COVID-19. Partnership. 2022;17(2):1-24. Available from: https://journal.lib.uoguelph.ca/index.php/perj/article/view/6783/6740

[30].  Hosoi M, Reuter L, Zabel D. Reshaping perspectives on flexible work: The impact of COVID-19 on academic library management. Libraries and the Academy. 2021;21(4):695-713. Available from: https://eric.ed.gov/?id=EJ1317786

[31].  Civica. Librarian’s mental health in the time of COVID-19. [date unknown]. Available from: https://www.civica.com/en-gb/thought-leadership-library/librarians-mental-health/

[32].  Georgetown University. Resumption of graduate hybrid courses; continued pause on undergraduate hybrid courses. 2021 Feb 10. Available from: https://www.georgetown.edu/news/resumption-of-graduate-hybrid-courses-continued-pause-on-undergraduate-hybrid-courses/

[33].  Nero LM, Ramtahal K. A post-pandemic future for library planning: Perceptions of Caribbean academic library leaders. In: Kerr PA, Marshall JL, Palmer NA, Drysdale DA, editors. Continuing change, constant engagement: Caribbean academic libraries at the forefront of transformation. Emerald Publishing Limited; 2025. Chapter 15. Available from: https://doi.org/10.1108/S0065-283020250000057016

[34].  Ashiq M, Jabeen F, Mahmood K. Transformation of libraries during Covid-19 pandemic: A systematic review. Journal of Academic Librarianship. 2022;48(4):102534. Available from: https://doi.org/10.1016/j.acalib.2022.102534

[35].  Gillum S. The changing face of public services in health sciences libraries post-pandemic. Medical Reference Services Quarterly. 2024;43(2):152-63. Available from: https://doi.org/10.1080/02763869.2024.2330244

[36].  Safin K. Top 5 articles on remote work in librarianship. ACRL DOLS; 2022 Sep 9. Available from: https://acrl.ala.org/dols/2022/09/top-5-articles-on-remote-work-in-librarianship/ 

Abstract:

Maternal micronutrient deficiencies remain an important public health challenge in Ethiopia and contribute to adverse maternal and newborn outcomes. Ethiopia introduced Multiple Micronutrient Supplementation (MMS) through routine antenatal care services and progressively expanded implementation from 21 pilot woredas in 2023–2024 to 80 woredas nationwide by 2026. However, evidence on implementation performance during national scale-up remains limited. This study assessed temporal trends and geographic variation in MMS implementation performance using routine program monitoring data collected between January 2023 and June 2026. A longitudinal secondary analysis was conducted using woreda-month observations from the national MMS monitoring database. MMS achievement was defined as the percentage of pregnant women newly supplemented with MMS relative to the monthly target. Descriptive and non-parametric statistical analyses were applied. The final analytical dataset included 2,268 unique woreda-month observations of which 1,724 (76.0%) had available MMS achievement data. Mean MMS achievement was 100.2% (SD 56.3), while the median was 94.6% (IQR 70.5–120.4). Median achievement declined from 98.8% during 2023–2024 to 93.2% in 2025 and 89.9% in 2026. Existing woredas achieved higher median performance than Expansion woredas (96.4% vs. 85.3%; p<0.001). Significant regional variation was observed, with median achievement ranging from 64.1% in Somali to 102.0% in Oromia and Dire Dawa. Reporting completeness declined substantially during scale-up. MMS implementation remained broadly aligned with program targets but varied across regions and implementation settings, highlighting the need for strong implementation support, monitoring systems, and data-quality assurance during national expansion.

References:

[1].   World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: nutritional interventions update, multiple micronutrient supplements during pregnancy. Geneva: World Health Organization; 2020.

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[3].   Haider BA, Yakoob MY, Bhutta ZA. Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health. 2011;11(Suppl 3):S19.

[4].   Smith ER, Shankar AH, Wu LSF, Aboud S, Adu-Afarwuah S, Agustina R, et al. Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: an individual patient data meta-analysis from 17 randomized trials in low-income and middle-income countries. Lancet Glob Health. 2017;5(11):e1090-e1100.

[5].   Kawai K, Spiegelman D, Shankar AH, Fawzi WW. Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression. Bull World Health Organ. 2011;89(6):402-411.

[6].   World Health Organization. WHO recommendation on multiple micronutrient supplementation during pregnancy. Geneva: World Health Organization; 2021.

[7].   Federal Democratic Republic of Ethiopia, Ministry of Health. National Nutrition Program II (2016-2020). Addis Ababa: Ministry of Health; 2016.

[8].   Federal Democratic Republic of Ethiopia. National Food and Nutrition Strategy (2021-2030). Addis Ababa: Government of Ethiopia; 2021.

[9].   UNICEF Ethiopia. Multiple Micronutrient Supplements boost the health of pregnant women and their babies. Addis Ababa: UNICEF Ethiopia; 2023.

[10].  Marchant T, Alemayehu S, Asfaw E, Daba AK, Defar A, Opondo C, et al. Effect of prenatal multiple micronutrient supplementation on birth weight in Ethiopia: protocol for a pragmatic cluster-randomized trial. BMJ Open. 2022;12:e063757.

[11].  UNICEF. Maternal Nutrition Programming Guidance. New York: United Nations Children's Fund; 2022.

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[14].  Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-477.

[15].  Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-451.

[16].  Ethiopian Public Health Institute (EPHI), ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: EPHI and ICF; 2017.

[17].  Ethiopian Public Health Institute (EPHI), Federal Ministry of Health (FMoH), ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: EPHI, FMoH, and ICF; 2021.

[18].  Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347:f6753.

[19].  Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009;36(1):24-34.

[20].  World Health Organization. Data quality review: a toolkit for facility data quality assessment. Geneva: WHO; 2017.

[21].  Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy Plan. 2009;24(3):217-228.

Abstract:

Childhood vaccination remains a major public health challenge; global third-dose coverage of the combined diphtheria, tetanus, and pertussis (DTP3) vaccine reached 85% in 2025, yet 13.5 million children remained zero-dose. In Cameroon, national third-dose coverage of the combined diphtheria, tetanus and pertussis vaccine (DTP3) rose to 82.5% in 2024, but sub-national performance remains undocumented: a South-West Region study reported only 47.7% coverage. Whether the Tiko Health District follows this national pattern of declining coverage between initial and subsequent doses had not previously been documented. This cross-sectional study assessed vaccination coverage, timeliness, and associated factors in the Tiko Health District, combining a review of 800 vaccination records and a survey of 604 caregivers of children aged 0–59 months. Age-appropriate vaccination completion was 30.3% (242/800). Coverage declined markedly from 98.6% for Bacillus Calmette-Guerin (BCG) and 76.0% for Pentavalent 1 (Penta1) to 48.1% for Pentavalent 3 (Penta3) and 9.0% for the first measles-rubella (MR) dose. Timeliness remained high for later doses (95.3% for Penta3) despite low coverage. Untimely vaccination was significantly associated with caregivers' lack of schedule knowledge adjusted odds ratio [aOR] = 4.3; 95% confidence interval [CI]: 2.41–7.92), absence of reminders (aOR = 2.2; 95% CI: 1.30–3.66), and age of child under 5 years in the household (aOR = 3.22; 95% CI: 1.26–8.26). Routine immunisation in Tiko shows high initial access but substantial attrition across subsequent doses, indicating that retention, rather than initial uptake, is Tiko's principal challenge. Caregiver knowledge and reminders emerged as the strongest modifiable determinants of timeliness, pointing to clear priorities for improving retention and equity in the district.

References:

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[2].   World Health Organization, United Nations Children's Fund. Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated [Internet]. Geneva: WHO; 2025 Jul 15 [cited 2026 Aug 14]. Available from: World Health Organization website.

[3].   Janusz CB, Frye M, Mutua MK, Wagner AL, Banerjee M, Boulton ML. Vaccine delay and its association with undervaccination in children in sub-Saharan Africa. Am J Prev Med. 2021;60(1 Suppl 1):S72–S79. doi:10.1016/j.amepre.2020.10.003.

[4].   Zeufack AGD, Njinkui DN, Youdom SW, Ateudjieu J. Timeliness and missed opportunities for vaccination among children aged 0 to 23 months in Dschang Health District, West Region, Cameroon: a cross-sectional survey. PLOS Glob Public Health. 2023;3(6):e0001721. doi:10.1371/journal.pgph.0001721.

[5].   United Nations Children's Fund (UNICEF). Humanitarian Action for Children 2024: Cameroon [Internet]. Yaoundé: UNICEF Cameroon; 2024 [cited 2026 Aug 14]. Available from: UNICEF Cameroon website.

[6].   World Health Organization, United Nations Children's Fund. Cameroon: WHO and UNICEF estimates of immunization coverage: 2023 revision [Internet]. Geneva: World Health Organization; 2024 [cited 2026 Aug 14]. Available from: World Health Organization.

[7].   Institut National de la Statistique (INS), ICF. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé, Cameroon and Rockville (MD): INS and ICF; 2020.

[8].   Yakum MN, Atanga FD, Ajong AB, Eba Ze LE, Shah Z. Factors associated with full vaccination and zero vaccine dose in children aged 12–59 months in 6 health districts of Cameroon. BMC Public Health. 2023;23:1693. doi:10.1186/s12889-023-16609-4.

[9].   Chiabi A, Nguefack FD, Njapndounke F, Kobela M, Kenfack K, Nguefack S, et al. Vaccination of infants aged 0 to 11 months at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital in Cameroon: how complete and how timely? BMC Pediatr. 2017;17:206. doi:10.1186/s12887-017-0954-1.

[10].  Ngandjon JK, Ostermann T, Kenmoe V, Laengler A. Insights into predictors of vaccine hesitancy and promoting factors in childhood immunization programs—a cross-sectional survey in Cameroon. Int J Environ Res Public Health. 2022;19(5):2721. doi:10.3390/ijerph19052721.

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Abstract:

This paper examined how digital marketing has transformed the traditional marketing mix to the digital marketing mix, moving businesses from company-focused and one-way marketing toward more interactive, customer-centered, and data-driven strategies. Using the traditional 4 Ps—product, price, place, and promotion—and the extended 7 Ps framework, the paper compares traditional marketing with modern digital marketing. Digital technologies such as artificial intelligence, big data, machine learning, e-commerce, personalization, and social media have transformed each element of the marketing mix. Products can now be digitally customized and continuously improved, prices can be adjusted using real-time data, distribution has expanded through online and omnichannel platforms, and promotion has become more interactive through social media, SEO, and content marketing. The additional 3 Ps-people, process, and physical evidence have also evolved. Businesses now build online communities, automate customer service through CRM and AI, and use websites, apps, reviews, and digital credentials to establish trust and credibility. Overall, the paper concludes that digital marketing has changed the marketing mix from a static, traditional tool into a dynamic and continuously adaptable strategic framework. While digital marketing provides benefits such as global reach, personalization, cost efficiency, and better customer insights, it also creates challenges involving cybersecurity, data privacy, misinformation, and increased competition. Therefore, businesses need to adopt a flexible, integrated, and ethical digital marketing strategy to maintain customer trust and achieve long-term competitive advantage.

References:

[1].   Dahiya S. Digital marketing mix is a facelift of traditional marketing mix. ResearchGate. 2021. doi:10.17051/ilkonline.2021.02.205.

[2].   Kotler P, Armstrong G. Principles of marketing. 16th ed. Harlow, UK: Pearson; 2016.

[3].   Extension K, Special K, Dheere FS. 7 Ps of marketing: overview of marketing. ResearchGate. 2025. doi:10.1098/gdshajsd.

[4].   Xia Y. The 4Ps of marketing and applications in various brands. Journal of Education, Humanities and Social Sciences. 2023;16. doi:10.54097/ehss.v16i.9601.

[5].   Ehmke C, Fulton J, Lusk J. Marketing's four P's: first steps for new entrepreneurs. Purdue University; 2022.

[6].   Latent V. A complete guide to marketing mix modeling and use cases. 2019.

[7].   Saidani BS, Sudiarditha IKR. Marketing mix 7 Ps: the effects on customer satisfaction. ResearchGate. 2019. doi:10.21009/JPEB.007.1.7.

[8].   Solomon MR, Marshall GW, Stuart EW. Marketing: real people, real decisions. Harlow, UK: Pearson; 2018.

[9].   Wilson A, Zeithaml VA, Bitner MJ, Gremler DD. Services marketing: integrating customer focus across the firm. 7th ed. Boston, MA: McGraw-Hill Education; 2017.

[10].  Saidan B, Sudiarditha IKR. Marketing mix-7Ps: the effect on customer satisfaction. ResearchGate. 2019. doi:10.21009/JPEB.007.1.7.

[11].  Wilson A, Zeithaml VA, Bitner MJ, Gremler DD. Services marketing: integrating customer focus across the firm. 7th ed. Boston, MA: McGraw-Hill Education; 2017.

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[13].  Caliskan A, Ozen Y, Ozturkoglu Y. Digital transformation of traditional marketing business model in a new industry area. Journal of Enterprise Information Management. 2021;34(4).

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Abstract:

Diabetes and hypertension remain major public health challenges in Guyana. The extent to which evidence-based nutrition guidelines are translated into routine clinical practice remains insufficiently understood. This study assessed the policy-to-practice gap in the implementation of nutrition guidelines for diabetes and hypertension in Region 3, Guyana. A convergent mixed-methods implementation study was conducted across four public health facilities. Quantitative data were obtained from 2,745 patient records, facility audits and healthcare provider surveys, while qualitative data were collected through focus group discussions, community outreach activities, and key informant interviews. The study was guided by the Social Ecological Model (SEM), the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, and the Knowledge-to-Action (KTA) framework. Although all facilities demonstrated moderate policy readiness (60%), overall implementation fidelity remained low, with a mean implementation score of 40%. Patients frequently reported receiving nutrition counselling; however, documentation of counseling within clinical records was limited. Healthcare providers demonstrated moderate knowledge of nutrition recommendations, but implementation practices were comparatively weaker, with training deficiencies and limited educational resources identified as major provider barriers. Patient awareness was positively associated with reported dietary practices, although elevated blood pressure and random blood sugar levels remained common. Cost and affordability (63.5%) and cultural food norms (19.7%) were the most frequently reported barriers to implementing recommended dietary practices. The combined application of the SEM, RE-AIM, and KTA frameworks identified implementation gaps across organizational, provider, community, and policy levels. A substantial policy-to-practice gap exists in the implementation of nutrition guidelines for diabetes and hypertension in Region 3, Guyana. Strengthening provider capacity, implementation monitoring, clinical documentation and culturally responsive, affordable nutrition interventions are essential to improve implementation fidelity, support knowledge translation and enhance the sustainability of nutrition services within primary healthcare.

References:

[1].   World Health Organization. Invisible numbers: the true extent of noncommunicable diseases and what to do about them. Geneva: World Health Organization; 2022. 42 p. ISBN 978-92-4-005766-1.

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[3].   Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, et al. RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review. Front Public Health. 2019; 7:64. doi:10.3389/fpubh.2019.00064.

[4].   Holtrop JS, Estabrooks PA, Glasgow RE. Fidelity of implementation: development and testing of a measure. Implement Sci Commun. 2021;2(1):1-10. doi:10.1186/s43058-021-00167-3.

[5].   Caribbean Public Health Agency. The NCD problem: fact sheet. Port of Spain: Caribbean Public Health Agency; 2017.

[6].   Food and Agriculture Organization of the United Nations. Food-based dietary guidelines for Guyana. Rome: FAO; 2018.

[7].   Pan American Health Organization. HEARTS in the Americas: improving cardiovascular disease prevention and control. Washington, DC: PAHO; 2020.

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Abstract:

Maternal undernutrition affects 19.5% to 41.2% of pregnant women in Ethiopia, with limited progress from conventional programs. Despite the recognized benefits of theory-driven approaches, behavioral frameworks to guide maternal nutrition education interventions are not explored through interventional designs in severely affected rural pastoralist settings. This community-based, two-arm cluster-randomized controlled trial evaluated the effectiveness of a Health Belief Model-based nutrition education intervention in promoting nutritional status among 328 pregnant women (164 per arm) in rural Nuer Zone, Gambella Region, Western Ethiopia, from March to June 2026. A standard non-stretchable Middle-Upper Arm Circumference (MUAC) tape was used to assess nutritional status. Linear Mixed-Effects Models with Mediation analysis were employed to test intervention effects and pathways through Health Belief Model (HBM) constructs. At baseline, the prevalence of undernutrition (MUAC < 23 cm) was comparable between intervention and control groups (30.2% vs. 24.5%, respectively, p = 0.285), and mean MUAC values were similar (24.08 cm vs. 24.28 cm, p = 0.285). At endline, the intervention group showed a 1.334 cm increase in mean MUAC, compared with a 0.455 cm decline in controls (DiD = 1.789 cm, 95% CI: 1.485–2.093, p < 0.001). Likewise, undernutrition prevalence decreased from 30.2% to 5.6% in the intervention group, while it increased from 24.5% to 26.4% in controls, with changes in HBM constructs mediating 51.4% of the intervention effect. The HBM-based education intervention significantly improved nutritional status among pregnant women in rural western Ethiopia. Integrating theory-driven behaviour change approaches into Ethiopian maternal nutrition programs is recommended.

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Abstract:

Community health workers (CHWs) are central to community surveillance and primary health care in Zimbabwe, yet the data systems supporting their work are especially vulnerable during epidemics, cyclones and other health emergencies. This study examined the contextual factors undermining the collection, transmission, verification and use of CHW data during health emergencies in Zimbabwe between 2018 and 2025 and identified priorities for strengthening system resilience. A cross-sectional, multi-cadre structured survey was administered through Kobo Toolbox to 142 respondents across eleven cadres spanning the community, facility, district and provincial levels of the health system. Respondents reported near-universal involvement in emergency-related data work (95.0%) and described data roles as clearly defined (89.3%), but only 67.1% could still transmit data when electricity or internet connectivity failed. Data collection was the most disrupted stage of the CHW data pathway (30.7%), and tools and devices (67.6%) together with power and connectivity (58.5%) were the factors most often blamed for undermining continuity. Only 33.6% rated emergency-specific training as adequate, and overall data timeliness and quality was rated good or very good by 48.6% of respondents, falling to 40% among community-level respondents. Respondents' priorities for the Ministry of Health and Child Care centred on infrastructure investment (32.9%) and workforce training (30.0%). The findings indicate that Zimbabwe's community health information system is broadly functional at its technical core but remains constrained at the point of community-level data capture, pointing to sequenced, practical investment priorities for strengthening emergency-responsive CHW data systems.

References:

[1].   Bogale TN, Teklehaimanot SM, Fufa Debela T, Enyew DB, Nigusse Bedada A, Dufera Kebebew S, et al. Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia. Front Digit Health. 2023;5:1162239. Available from: https://doi.org/10.3389/fdgth.2023.1162239

[2].   Ministry of Health and Child Care Zimbabwe. National Health Strategy 2026-2030. Harare: Government of Zimbabwe; 2026.

[3].   World Vision International. A new era in public health emergency preparedness and response in Zimbabwe. Harare: World Vision International Zimbabwe; 2025. Available from: https://wvi.org/stories/zimbabwe/new-era-public-health-emergency-preparedness-and-response-zimbabwe

[4].   Degaga SD, Yesuf SS, Aweke GT. Implementation of the electronic community health information system in rural East Shewa zone, Eastern Ethiopia: a CFIR-ERIC framework for facilitators, barriers and implementation strategies. Front Digit Health. 2025;7:1554995. Available from: https://doi.org/10.3389/fdgth.2025.1554995

[5].   Mashe T, Chaibva BV, Nair P, Sani KA, Jallow M, Tarupiwa A, et al. Descriptive epidemiology of the cholera outbreak in Zimbabwe 2018-2019: role of multi-sectorial approach in cholera epidemic control. BMJ Open. 2023;13(1):e059134. Available from: https://doi.org/10.1136/bmjopen-2021-059134

[6].   World Health Organization. Strengthening health emergency prevention, preparedness, response and resilience. Geneva: WHO; 2023. Available from: https://www.who.int/publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience

[7].   World Health Organization. Zimbabwe: data-driven decisions maintain availability and access to essential health services during the COVID-19 response. Geneva: WHO Universal Health Coverage Partnership; 2021. Available from: https://www.who.int/news-room/feature-stories/detail/zimbabwe-data-driven-decisions-maintain-availability-and-access-to-essential-health-services-during-the-covid-19-response

[8].   Ballard M, Olsen HE, Millear A, Yang J, Whidden C, Yembrick A, et al. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis. BMJ Open. 2022;12(5):e052407. Available from: https://doi.org/10.1136/bmjopen-2021-052407

[9].   Namuhani N, Babirye Z, Monje F, Salawu MM, Bosonkie M, Bello S, et al. Leveraging community health workers for COVID-19 response in Democratic Republic of Congo, Nigeria, Senegal, and Uganda: roles, barriers, and facilitators. BMC Prim Care. 2024;25(1):269. Available from: https://doi.org/10.1186/s12875-024-02531-0

[10].  Simbini T, Adimado E, Adjorlolo S, Guerrero-Torres L, Srinivas P, Zizhou S, et al. Digital health interventions in strengthening primary healthcare systems in sub-Saharan Africa: insights from Ethiopia, Ghana and Zimbabwe. PLOS Digit Health. 2026;5(1):e0000863. Available from: https://doi.org/10.1371/journal.pdig.0000863

[11].  The Global Fund to Fight AIDS, Tuberculosis and Malaria. Zimbabwe digital health case study. Geneva: The Global Fund; 2025. Available from: https://www.theglobalfund.org/media/qksld2tg/publication_zimbabwe-digital-health_casestudy_en.pdf

[12].  Olatunji G, Kokori E, Moradeyo A, Olatunji D, Ajibola F, Otolorin O, et al. A perspective on the 2023 cholera outbreaks in Zimbabwe: implications, response strategies, and policy recommendations. J Epidemiol Glob Health. 2024;14(1):243-8. Available from: https://doi.org/10.1007/s44197-023-00165-6

[13].  International Federation of Red Cross and Red Crescent Societies. Zimbabwe: cholera outbreak response, DREF Operation MDRZW021. Geneva: IFRC; 2023. Available from: https://reliefweb.int/report/zimbabwe/zimbabwe-cholera-outbreak-response-dref-operation-mdrzw021

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Abstract:

This review examines the theoretical and empirical literature at the intersection of strategic management and cybersecurity, and how organisations can strategically manage cybersecurity to strengthen their resilience in the digital era. The review synthesises eight components of the literature, including the theoretical foundations of strategic management; the role of strategic management in cybersecurity; cybersecurity challenges in the digital era; emerging technologies; cybersecurity incidents and business continuity; leadership and organisational culture; building organisational resilience; and best-practice frameworks. The literature consistently indicates that cyber resilience is not achieved through isolated information technology (IT) controls but through integrated strategic management that connects cyber risk, operational priorities, and business continuity. Gaps remain in the contextual literature on developing economies, where empirical evidence on the relationship between strategic management and cybersecurity remains limited.

References:

[1].   Dal Cin P. State of cybersecurity resilience 2025. Accenture; 2025. Available from: https://www.accenture.com/en/insights/security/state-cybersecurity-2025

[2].   Thompson A, Peteraf M, Gamble J, Strickland AJ III. Crafting and executing strategy: The quest for competitive advantage. New York: McGraw Hill Education; 2016.

[3].   European Union Agency for Cybersecurity. ENISA threat landscape 2021. 2021. Available from: https://www.enisa.europa.eu/sites/default/files/publications/ENISA%20Threat%20Landscape%202021.pdf

[4].   Sithole M, Odette S, Munzhelele F. Cybersecurity challenges and a conceptualised maturity typology in Ugandan SMEs: A qualitative analysis. Int J Bus Ecosyst Strateg. 2026;8:105-19.

[5].   Kumar S, Gangwar SP, Singh N, Pagaria R, Garg A, Das S. Securing the skies: Innovating cybersecurity governance for India's emerging small airports. Eur Conf Cyber Warf Secur. 2025;24:318-27.

[6].   Alnaabi AAH, Al Mahruqi AAH. Artificial intelligence methods for enhancing cybersecurity in Oman: A comprehensive review. J Cloud Comput. 2026;15.

[7].   Agyemang R, Furnell S, Muller T. A context-aware cybersecurity readiness assessment framework for organisations in developing and emerging environments. Future Internet. 2026;18:178.

[8].   Khresat O. Compliance with regulatory, legislative and contractual requirements for cyber security and its impact on the continuity of the Jordanian banking sector. Asian Econ Financ Rev. 2025;15:1592-603.

[9].   Albustanji H, Paulovics A. A critical review of the Jordanian legal frameworks on international cooperation in combating cybercrime. AAU J Bus Law. 2026;10.

[10].  von Solms B, Upton D. Cyber security capacity governance. Bus Manag Rev. 2016;7(4):35-9.

[11].  GuruFocus. Westport (WPRT) faces cybersecurity breach but ensures business continuity. Newstex Finance Account Blogs. 2026 Mar 20.

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[16].  Malatji M, Marnewick AL, Von Solms S. Cybersecurity capabilities for critical infrastructure resilience. Inf Comput Secur. 2021;30:255-79.

[17].  Zhang X, Ba X, Li B. Cyberattacks in supply chains: A multi-case study. PLoS One. 2026;21:e0350010.

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Abstract:

Ergonomic challenges in university learning environments are increasingly recognized as important factors influencing student health and academic performance. However, there is limited evidence on how these challenges interact with socio-demographic factors such as marital status, particularly in low- and middle-income countries. This cross-sectional study was conducted among 352 students at the University of Calabar, Nigeria. Data were collected using a structured online questionnaire that incorporated elements of the Standard Nordic Musculoskeletal Questionnaire. Descriptive statistics, correlation analysis, and logistic regression were applied to examine the relationship between marital status, cumulative ergonomic challenges, and academic performance. Married students accounted for 2.56% of the study population. Commonly reported ergonomic challenges included musculoskeletal strain, poor lighting, non-adjustable furniture, and inadequate learning infrastructure. A moderate positive relationship was observed between cumulative ergonomic burden and academic performance impairment (r = 0.508), although this was not statistically significant. In the unadjusted analysis, married female students had higher exposure to ergonomic stressors and poorer academic outcomes compared to their male counterparts (OR = 2.00). However, after adjusting for ergonomic burden, this relationship reversed (AOR = 0.533), suggesting that the observed differences were largely driven by unequal exposure to environmental stressors rather than gender. Ergonomic challenges are a significant but often overlooked determinant of academic performance among university students. These findings highlight the need for institution-wide ergonomic interventions, particularly for vulnerable groups, to improve learning conditions, reduce physical strain, and support better academic outcomes.

References:

[1].   Burr S. Navigating non-traditional paths: A study on the socio-academic experiences of married university students. J Contemp High Educ. 2026;14(2):112-8.

[2].   Tantawy SA, Abdul Rahman AA, Al-Douri S, Elgohary HM. Prevalence of musculoskeletal disorders and its relationship with academic stress among university students. Int J Med Res Health Sci. 2017;6(5):68-5.

[3].   Duignan M. The architecture of hybrid learning: Workstation design and its educational consequences. Educ Rev Q. 2025;48(1):45-2.

[4].   Irshad M. Physical ergonomics in higher education: Evaluating classroom comfort and cognitive efficiency. Int J Educ Dev Ergon. 2025;31(3):201-9.

[5].   Zerroug A. Environmental stressors and cognitive endurance in educational spaces. Afr J Ergon Hum Factors. 2025;9(2):87-104.

[6].   Al-Shagankery HM, El-Enein NYA. Ergonomic factors and musculoskeletal symptoms among university students: An environmental and health assessment. J Egypt Public Health Assoc. 2021;96(1):18-27.

[7].   Alam M, Chowdhury S, Rahman T. The compounding cycle of psychological stress and musculoskeletal strain among professional students. South Asian J Public Health. 2024;12(1):15-29.

[8].   Osita FC, Chukwuemeka-Onuzulike NF, Olayinka HL, Onyeizugbe CU. Ergonomic factors and performance of academics in public universities in Nigeria. Ann Manage Organ Res. 2024;6(2):139-51.

[9].   Öznur Muz FN, Kılınç A, Tepetaş M, Ünsal A, Arslantas D. Assessment of ergonomic working conditions and stress perceptions of office workers: A university example. Osmangazi J Med. 2023;45(6):931-42.

[10].  Adegoke BO, Akosile CO, Maruf FA. Work-related musculoskeletal disorders and ergonomic risks among tertiary institution staff in South-Western Nigeria. Afr J Biomed Res. 2021;24(3):321-9.

[11].  Ekpenyong CE, Inyang UC. Associations between classroom physical environment, ergonomics, and health outcomes among Nigerian undergraduates. Nig J Ergon. 2022;11(1):45-58.

[12].  Olabisi OA, Adebayo SO. Socio-demographic determinants of academic success among married female students in Sub-Saharan African universities. Afr High Educ Rev. 2023;19(2):78-92.

[13].  Subramaniam S, Dhillon SK. Ergonomic awareness and postural hazards among undergraduate university students during remote learning. Int J Environ Res Public Health. 2020;17(22):8540.

[14].  Adeyemi TO, Babatunde JO. Classroom ergonomics and learning engagement in Nigerian federal universities. J Educ Facil Environ. 2023;8(2):101-15.

[15].  Nwafor CC, Okeke CI. Gender roles, domestic strain, and academic coping mechanisms among non-traditional university students. J Gender High Educ. 2022;15(4):210-26.

[16].  Chiemeke SC, Longe OB. Assessment of physical workstations and user comfort in Nigerian university computer laboratories. J Comput Syst Sci. 2020;12(1):33-42.

[17].  Okon EE, Archibong IA. Spatial layout, lighting, and academic performance in Nigerian tertiary institutions: A case study of Cross River State. J Environ Soc Sci. 2022;18(3):142-56.

[18].  Udo SO, Akpan EJ. Psychosocial and environmental stressors in Nigerian higher education: Implications for student retention and academic success. West Afr J Educ. 2023;41(1):89-102.

[19].  Mambo SB, Lodhi, Asiimwe, Bizimana, Makelele, Mbina, et al. Healthcare workers' attitudes and factors affecting provision of sexual and reproductive health services to adolescents in refugee settlements, Western Uganda. Front Reprod Health. 2025;7:Art1498305. Available from: https://doi.org/10.3389/frph.2025.1498305

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[21].  Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-7.

Abstract:

Drug-resistant tuberculosis threatens global tuberculosis control, and diabetes mellitus is a plausible but incompletely characterised driver of both active and resistant disease in high-burden settings. This study characterised first-line anti-tuberculosis drug-resistance patterns, including multidrug-resistant tuberculosis, and examined their association with diabetes co-morbidity among presumptive tuberculosis patients at a national reference centre in northern Nigeria. A facility-based, descriptive cross-sectional study enrolled 200 consecutive presumptive-TB adults at the National Tuberculosis and Leprosy Training Centre, Saye, Zaria. Tuberculosis was diagnosed using Ziehl–Neelsen smear microscopy, the Xpert MTB/RIF assay, and Löwenstein–Jensen culture with first-line drug-susceptibility testing by the proportion method; a single fasting plasma glucose measurement classified diabetes status. Associations were assessed using chi-square or Fisher exact tests and logistic regression at a significance threshold of 0.05. Bacteriologically confirmed tuberculosis was identified in 26.0% of participants and diabetes in 17.0%. Among 48 culture-positive isolates with valid drug-susceptibility testing, isoniazid resistance was most frequent (22.9%), followed by rifampicin (16.7%), streptomycin (14.6%), and ethambutol (10.4%); across all 52 confirmed cases, rifampicin resistance was 17.3% (9/52) and multidrug-resistant tuberculosis 11.5% (6/52). Any first-line resistance and multidrug resistance were more than twice as frequent among the 13 tuberculosis patients with diabetes than among the 39 without (46.2% versus 20.5% and 23.1% versus 7.7%, respectively), although these differences did not reach statistical significance (Fisher exact p = 0.086 and p = 0.157). Diabetes independently predicted confirmed tuberculosis (adjusted odds ratio 2.34, 95% CI 1.08–5.05), alongside prior tuberculosis treatment and low body-mass index. Because diabetes was based on a single fasting plasma glucose measurement obtained during acute illness, stress hyperglycaemia cannot be excluded. These findings reveal a substantial resistance burden at referral level and a consistent but statistically unconfirmed resistance signal associated with diabetes. Routine drug-susceptibility testing and bidirectional tuberculosis–diabetes screening are warranted, and larger studies are needed to confirm the resistance association.

References:

[1].   World Health Organization. Global tuberculosis report 2023. Geneva: World Health Organization; 2023. Available from: who.int.

[2].   World Health Organization. Global tuberculosis report 2022. Geneva: World Health Organization; 2022. Available from: who.int.

[3].   Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152. Available from: https://doi.org/10.1371/journal.pmed.0050152

[4].   Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–46. Available from: https://doi.org/10.1016/S1473-3099(09)70282-8

[5].   Baker MA, Harries AD, Jeon CY, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011;9:81. Available from: https://doi.org/10.1186/1741-7015-9-81

[6].   Restrepo BI. Diabetes and tuberculosis. Microbiol Spectr. 2016;4(6):10.1128/microbiolspec.TNMI7-0023-2016. Available from: https://doi.org/10.1128/microbiolspec.TNMI7-0023-2016

[7].   Tegegne BS, Mengesha MM, Teferra AA, et al. Association between diabetes mellitus and multidrug-resistant tuberculosis: a systematic review and meta-analysis. Syst Rev. 2018;7:161. Available from: https://doi.org/10.1186/s13643-018-0828-0

[8].   Liu Q, Li W, Xue M, et al. Diabetes mellitus and the risk of multidrug-resistant tuberculosis: a meta-analysis. Sci Rep. 2017;7:1090. Available from: https://doi.org/10.1038/s41598-017-01213-5

[9].   Nijland HM, Ruslami R, Stalenhoef JE, et al. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis. 2006;43(7):848–54. Available from: https://doi.org/10.1086/507543

[10].  Ruslami R, Nijland HM, Adhiarta IGN, et al. Pharmacokinetics of antituberculosis drugs in patients with tuberculosis and type 2 diabetes mellitus. Antimicrob Agents Chemother. 2010;54(3):1068–74. Available from: https://doi.org/10.1128/AAC.00447-09

[11].  World Health Organization. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: World Health Organization; 2011.

[12].  Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol. 2014;2(9):730–39. Available from: https://doi.org/10.1016/S2213-8587(14)70109-3

[13].  Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: a systematic review. PLoS One. 2017;12(4):e0175925. Available from: https://doi.org/10.1371/journal.pone.0175925

[14].  Alebel A, Wondemagegn AT, Tesema C, et al. Prevalence of diabetes mellitus among tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis. 2019;19:254. Available from: https://doi.org/10.1186/s12879-019-3892-8

[15].  Noubiap JJ, Nansseu JR, Nyaga UF, et al. Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2.3 million patients. Lancet Glob Health. 2019;7(4):e448–60. Available from: https://doi.org/10.1016/S2214-109X(18)30487-X

[16].  Lawson L, Muc M, Oladimeji O, et al. Tuberculosis and diabetes in Nigerian patients with and without HIV. Int J Infect Dis. 2017;61:121–25. Available from: https://doi.org/10.1016/j.ijid.2017.06.014

[17].  Ekeke N, Ukwaja KN, Chukwu JN, et al. Screening for diabetes mellitus among tuberculosis patients in southern Nigeria: a multi-centre implementation study. PLoS One. 2017;12(5):e0177907. Available from: https://doi.org/10.1371/journal.pone.0177907

[18].  Ogbera AO, Kapur A, Odeyemi K, et al. Screening for diabetes mellitus and human immunodeficiency virus infection in persons with tuberculosis. J Diabetes Metab Disord. 2015;14:45. Available from: https://doi.org/10.1186/s40200-015-0169-7

[19].  Uloko AE, Musa BM, Ramalan MA, et al. Prevalence and risk factors for diabetes mellitus in Nigeria: a systematic review and meta-analysis. Diabetes Ther. 2018;9(3):1307–16. Available from: https://doi.org/10.1007/s13300-018-0441-1

[20].  World Health Organization. WHO consolidated guidelines on tuberculosis: Module 3 – Diagnosis: rapid diagnostics for tuberculosis detection. Geneva: World Health Organization; 2021. Available from: who.int.

[21].  Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005–15. Available from: https://doi.org/10.1056/NEJMoa0907847

[22].  Steingart KR, Schiller I, Horne DJ, et al. Xpert MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2014;1:CD009593. Available from: https://doi.org/10.1002/14651858.CD009593.pub3

[23].  Zignol M, Dean AS, Alikhanova N, et al. Population-based resistance of Mycobacterium tuberculosis isolates to pyrazinamide and fluoroquinolones: results from a multicountry surveillance project. Lancet Infect Dis. 2016;16(10):1185–92. Available from: https://doi.org/10.1016/S1473-3099(16)30190-6

[24].  World Health Organization. WHO consolidated guidelines on tuberculosis: Module 4 – Treatment: drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2020. Available from: who.int.

[25].  Gautam S, Shrestha N, Mahato S, et al. Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis. Sci Rep. 2021;11:2113. Available from: https://doi.org/10.1038/s41598-021-81057-2

[26].  Faustini A, Hall AJ, Perucci CA. Risk factors for multidrug-resistant tuberculosis in Europe: a systematic review. Thorax. 2006;61(2):158–63. Available from: https://doi.org/10.1136/thx.2005.045963

[27].  Pradipta IS, Forsman LD, Bruchfeld J, et al. Risk factors of multidrug-resistant tuberculosis: a global systematic review and meta-analysis. J Infect. 2018;77(6):469–78. Available from: https://doi.org/10.1016/j.jinf.2018.10.004

[28].  Song WM, Li YF, Liu YX, et al. Diabetes mellitus and unfavourable treatment outcomes among tuberculosis patients: a meta-analysis. J Infect. 2019;79(6):493–02. Available from: https://doi.org/10.1016/j.jinf.2019.09.014

[29].  United States Agency for International Development. Global tuberculosis strategy 2023–2030. Washington (DC): USAID; 2023. Available from: usaid.gov.

[30].  Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: a systematic review and meta-analysis. PLoS One. 2017;12(11):e0187967. Available from: https://doi.org/10.1371/journal.pone.0187967

Abstract:

Under-five mortality (U5M) remains a critical public health challenge in sub-Saharan Africa, and Cameroon illustrates this complexity. This study analyzes six consecutive DHS and MIS surveys (1991, 1998, 2004, 2011, 2018, 2022), covering 39,763 live births and 3,132 under-five deaths across 31 years, to document national U5MR trends, age-specific dynamics, urban-rural differentials, and regional heterogeneity under complex survey design. Survey-weighted estimates with 95% confidence intervals revealed a 62.4% reduction in the national U5MR, from 85.7 per 1,000 live births (1991) to 32.2 per 1,000 (2022), following a non-monotonic trajectory with a statistically significant anomalous peak in 2004 (102.0%). Neonatal mortality remained essentially flat across 1991–2018 (28–32‰), constituting a 'neonatal squeeze' whereby the neonatal share of U5M rose from 37% (1991) to an estimated 87% (2022). The rural-to-urban mortality ratio peaked at 1.46 in 2011 before converging to 1.18 by 2022. Persistent regional heterogeneity was documented across all waves, with northern regions (Far North, North, Adamaoua, North-West) recording U5MR two to three times above the national average, while the West region consistently showed the most protective profile. These findings show that while absolute progress has been substantial, child survival gains in Cameroon remain profoundly uneven: the neonatal period now concentrates the remaining burden while northern regions continue to lag. Meeting SDG 3.2 targets by 2030 requires an urgent reorientation of child survival strategies toward facility-based neonatal care, universal skilled birth attendance, and geographically targeted investments in the four priority northern regions.

References:

[1].   UNICEF, WHO, World Bank Group, UN DESA. Levels and Trends in Child Mortality: Report 2023. New York: UNICEF; 2023. Available from: https://childmortality.org

[2].   United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development. Resolution A/RES/70/1. New York: United Nations; 2015. Available from: https://sdgs.un.org/2030agenda

[3].   République du Cameroun. Décret n°2008/376 du 12 novembre 2008 portant organisation administrative. Yaoundé; 2008.

[4].   Institut National de la Statistique (INS) et ICF. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé et Rockville: INS et ICF; 2020. Available from: https://dhsprogram.com/pubs/pdf/FR370/FR370.pdf

[5].   Institut National de la Statistique (INS) et ICF International. Enquête Démographique et de Santé et à Indicateurs Multiples du Cameroun 2011. Calverton: INS et ICF; 2012.

[6].   World Health Organization. World Malaria Report 2022. Geneva: WHO; 2022. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022

[7].   Mbock C, Kamga HLF, Nguefack-Tsague G. Factors associated with infant and child mortality in Cameroon: a multilevel analysis. Pan African Medical Journal. 2020;35(1):68. https://doi.org/10.11604/pamj.2020.35.68.21312

[8].   Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? The Lancet. 2005;365(9462):891-900. https://doi.org/10.1016/S0140-6736(05)71048-5

[9].   Institut National de la Statistique du Cameroun. Enquête Démographique et de Santé du Cameroun 1991. Yaoundé: INS; 1993.

[10].  Institut National de la Statistique et ORC Macro. Enquête Démographique et de Santé du Cameroun 1998. Yaoundé et Calverton: INS et ORC Macro; 1999.

[11].  Institut National de la Statistique et ORC Macro. Enquête Démographique et de Santé du Cameroun 2004. Calverton: ORC Macro; 2005.

[12].  Institut National de la Statistique et ICF International. Enquête Démographique et de Santé du Cameroun 2011. Calverton: INS et ICF; 2012.

[13].  Institut National de la Statistique et ICF. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé et Rockville: INS et ICF; 2020.

[14].  ICF. Cameroon Malaria Indicator Survey 2022. Rockville: ICF; 2023. Available from: https://dhsprogram.com

[15].  Croft TN, Marshall AMJ, Allen CK, et al. (Eds). Guide to DHS Statistics. DHS-7. Rockville: ICF; 2018. Available from: https://dhsprogram.com/pubs/pdf/DHSG1/Guide_to_DHS_Statistics_DHS-7.pdf

[16].  Lumley T. survey: Analysis of Complex Survey Samples. R package version 4.1.1. CRAN; 2023. Available from: https://cran.r-project.org/package=survey

[17].  Ministère de la Santé Publique du Cameroun. Stratégie Sectorielle de Santé 2016–2027. Yaoundé: MSP; 2016. Available from: https://www.minsante.cm

[18].  Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet. 2014;384(9940):347-70. https://doi.org/10.1016/S0140-6736(14)60792-3

[19].  Tih PM, Tih F, Anchang-Kimbi JK, et al. Trends and determinants of under-five mortality in Cameroon based on Demographic and Health Surveys 1991–2018. BMC Public Health. 2021;21(1):2213. https://doi.org/10.1186/s12889-021-12013-y

[20].  Pullum TW. An Assessment of the Quality of Data on Health and Nutrition in the DHS Surveys, 1993–2003. DHS Methodological Reports No. 6. Calverton: ICF; 2008.

Abstract:

Maternal micronutrient deficiencies remain a major public health challenge in Ethiopia and contribute to adverse maternal and newborn outcomes. Ethiopia introduced Multiple Micronutrient Supplementation (MMS) through routine antenatal care services and progressively expanded implementation nationwide. However, evidence regarding factors associated with implementation performance during large-scale program expansion remains limited. This study examined implementation and health-system factors associated with MMS achievement during national scale-up in Ethiopia. A longitudinal secondary analysis was conducted using routine MMS monitoring data collected between January 2023 and August 2026. The unit of analysis was the woreda-month observation. MMS achievement, defined as the percentage of pregnant women newly supplemented with MMS relative to the reported monthly target, was the primary outcome. Mixed-effects regression models with random intercepts for woredas were used to assess associations between MMS achievement and implementation factors. The analytical dataset included 2,268 implementation observations from 75 woredas across 13 regions, of which 1,724 (76.0%) had available MMS achievement data. Mean MMS achievement was 100.2% (SD 56.3), while the median was 94.6% (IQR 70.5–120.4). In adjusted analyses, community dialogue was associated with a 17.99-percentage-point higher MMS achievement (95% CI: 3.11–32.86; p = 0.018), and commodity availability was associated with a 23.50-percentage-point higher MMS achievement (95% CI: 14.08–32.92; p < 0.001). Health-worker training, supportive supervision, implementation status, reporting period, and regional comparisons were not independently associated with achievement after adjustment. Substantial between-woreda variation remained (ICC = 0.358). Commodity availability and community engagement were the strongest factors associated with higher MMS achievement. Strengthening supply-chain reliability, community engagement, and routine monitoring systems may improve MMS implementation performance during national scale-up in Ethiopia.

References:

[1].   World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: nutritional interventions update, multiple micronutrient supplements during pregnancy. Geneva: World Health Organization; 2020.

[2].   Keats EC, Haider BA, Tam E, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;3:CD004905.

[3].   Haider BA, Yakoob MY, Bhutta ZA. Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health. 2011;11(Suppl 3):S19.

[4].   Smith ER, Shankar AH, Wu LSF, Aboud S, Adu-Afarwuah S, Agustina R, et al. Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: an individual patient data meta-analysis from 17 randomized trials in low-income and middle-income countries. Lancet Glob Health. 2017;5(11):e1090-e1100.

[5].   Kawai K, Spiegelman D, Shankar AH, Fawzi WW. Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression. Bull World Health Organ. 2011;89(6):402-11.

[6].   World Health Organization. WHO recommendation on multiple micronutrient supplementation during pregnancy. Geneva: World Health Organization; 2021.

[7].   Federal Democratic Republic of Ethiopia, Ministry of Health. National Nutrition Program II (2016-2020). Addis Ababa: Ministry of Health; 2016.

[8].   Federal Democratic Republic of Ethiopia. National Food and Nutrition Strategy (2021-2030). Addis Ababa: Government of Ethiopia; 2021.

[9].   UNICEF Ethiopia. Multiple Micronutrient Supplements boost the health of pregnant women and their babies. Addis Ababa: UNICEF Ethiopia; 2023.

[10].  Marchant T, Alemayehu S, Asfaw E, Daba AK, Defar A, Opondo C, et al. Effect of prenatal multiple micronutrient supplementation on birth weight in Ethiopia: protocol for a pragmatic cluster-randomized trial. BMJ Open. 2022;12:e063757.

[11].  UNICEF. Maternal Nutrition Programming Guidance. New York: United Nations Children's Fund; 2022.

[12].  Tesfa AB, Defar A, Taye G, Daba AK, Alemayehu S, Tessema M, et al. Piloting multiple micronutrient supplementation within the routine antenatal care system in Ethiopia: insights from stakeholders. Matern Child Nutr. 2025;21:e70003.

[13].  United Nations University, UNICEF, World Health Organization. Composition of a multiple micronutrient supplement to be used in pilot programs among pregnant women in developing countries (UNIMMAP). New York: United Nations University Press; 1999.

[14].  Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-77.

[15].   Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-51.

[16].  Ethiopian Public Health Institute (EPHI), ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: EPHI and ICF; 2017.

[17].  Ethiopian Public Health Institute (EPHI), Federal Ministry of Health (FMoH), ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: EPHI, FMoH, and ICF; 2021.

[18].  Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347:f6753.

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[20].  World Health Organization. Data quality review: a toolkit for facility data quality assessment. Geneva: WHO; 2017.

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Abstract:

In malaria-endemic settings, a positive malaria result may explain fever while Lassa fever (LF) remains clinically possible. This study assessed LF-malaria co-infection, probable missed LF suspicion, and diagnostic delays in selected health facilities in Ondo State, Nigeria. A convergent mixed-methods design combined retrospective review of 463 LF and malaria records from 2021 – 2023 across 10 purposively selected facilities in five high-burden LGAs with nine key-informant interviews. Co-infection required positive LF and malaria laboratory results. Quantitative data were analysed using descriptive statistics, chi-square tests and logistic regression; qualitative findings were analysed thematically and integrated through a joint display. All 463 records were purposefully selected as confirmed LF cases. Of these, 297 (64.1%) had positive LF and malaria results. Malaria was suspected in 440 (95.0%) records, and 324 (70.0%) had prior malaria treatment. Probable missed LF suspicion occurred in 103 (22.2%) records. Malaria positivity was associated with missed suspicion (adjusted odds ratio [aOR] 5.30, 95% CI 2.13–13.19; p < 0.001). Interviews highlighted symptom overlap, malaria-first reasoning, treatment failure, restricted RT-PCR access, specimen-transport barriers, notification gaps and uneven refresher training. Overall, 386 (83.4%) patients recovered and 53 (11.4%) died; the case-fatality proportion among confirmed LF records was 11.4%. In this selected sample, malaria appeared to mask LF rather than establish an independent cause of mortality. Malaria confirmation should not close the LF detection pathway. Parallel assessment, timely LF specimen collection, reliable transport, effective surveillance communication and practical diagnostic algorithms may support earlier detection.

References:

[1].   Akinbodewa AA, Gbala MO, Ige OO, Bello O, Akinkunmi BF, Fabusuyi G. Lassa fever: knowledge deficits among nurses and non-nurses at a tertiary hospital in Ondo, southwest Nigeria. Magna Sci. Adv. Biol. Pharm. 2023;9(2):14-23. Available from: https://doi.org/10.30574/msabp.2023.9.2.0026

[2].   Chandra NL, Bolt H, Dan-Nwafor C, Ipadeola O, Ilori E, Namara G, et al. Factors associated with delayed presentation to healthcare facilities for Lassa fever cases, Nigeria 2019: a retrospective cohort study. BMC Infect Dis. 2021;21:143. Available from: https://doi.org/10.1186/s12879-021-05822-4

[3].   Ilori EA, Furuse Y, Ipadeola OB, Dan-Nwafor CC, Abubakar A, Womi-Eteng OE, et al. Epidemiologic and clinical features of Lassa fever outbreak in Nigeria, January 1-May 6, 2018. Emerg. Infect. Dis. 2019;25(6):1066-74. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6537738/

[4].   Ipadeola AF, Olasehinde GI, Akinnola OO, Kolawole OM, Ejikeme AR, Ipadeola OB. Factors associated with late presentation for Lassa fever treatment among symptomatic cases in Ondo State, Nigeria. PAMJ One Health. 2023;10:6. Available from: https://doi.org/10.11604/pamj-oh.2023.10.6.39071

[5].   Okokhere PO, Asogun DA, Okogbenin SA. The effect of malaria on the outcome of Lassa fever [conference abstract]. Int. J. Infect. Dis. 2010;14(Suppl 1):e333. Available from: https://doi.org/10.1016/j.ijid.2010.02.2233

[6].   Cadmus SI, Taiwo OJ, Akinseye VO, Cadmus EO, Famokun G, Fagbemi S, et al. Ecological correlates and predictors of Lassa fever incidence in Ondo State, Nigeria, 2017-2021: an emerging urban trend. Sci Rep. 2023;13:20855. Available from: https://doi.org/10.1038/s41598-023-47820-3

[7].   Asogun DA, Günther S, Akpede GO, Ihekweazu C, Zumla A. Lassa fever: epidemiology, clinical features, diagnosis, management and prevention. Infect. Dis. Clin. North Am. 2019;33(4):933-51. Available from: https://doi.org/10.1016/j.idc.2019.08.002

[8].   Ashcroft JW, Olayinka A, Ndodo N, Lewandowski K, Curran MD, Nwafor CD, et al. Pathogens that cause illness clinically indistinguishable from Lassa fever, Nigeria, 2018. Emerg Infect Dis. 2022;28(5):994-7. Available from: https://doi.org/10.3201/eid2805.211153

[9].   Rugarabamu S, Rumisha SF, Mwanyika GO, Sindato C, Lim HY, Misinzo G, et al. Viral haemorrhagic fevers and malaria co-infections among febrile patients seeking health care in Tanzania. Infect Dis Poverty. 2022;11:33. Available from: https://doi.org/10.1186/s40249-022-00959-z

[10].  Oguzie JU, Petros BA, Oluniyi PE, et al. Metagenomic surveillance uncovers diverse and novel viral taxa in febrile patients from Nigeria. Nat Commun. 2023;14:4693. Available from: https://doi.org/10.1038/s41467-023-40247-4

[11].  Babalola SO, Babatunde JA, Remilekun OM, Amaobichukwu AR, Abiodun AM, Jide I, et al. Lassa virus RNA detection from suspected cases in Nigeria, 2011-2017. Pan. Afr. Med. J. 2019;34:76. Available from: https://doi.org/10.11604/pamj.2019.34.76.16425

[12].  Raabe V, Koehler J. Laboratory diagnosis of Lassa fever. J. Clin Microbiol. 2017;55(6):1629-37. Available from: https://doi.org/10.1128/JCM.00170-17

[13].  Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv. Health Sci. Educ. Theory Pract. 2009;14(Suppl 1):27-35. Available from: https://doi.org/10.1007/s10459-009-9182-2

[14].  Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743-8. Available from: https://doi.org/10.1001/jama.1988.03410120089033

[15].  Ijarotimi IT, Ilesanmi OS, Aderinwale A, Abiodun-Adewusi O, Okon IM. Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo State, Nigeria. Pan Afr Med J. 2018;30:56. Available from: https://doi.org/10.11604/pamj.2018.30.56.13125

[16].  Nigeria Centre for Disease Control and Prevention. Lassa fever situation report: epidemiological week 13, 2024. 2024. Available from: https://www.ncdc.gov.ng/themes/common/files/sitreps/1aabc83ea46f825a772894b4a53ab870.pdf

[17].  Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134-56. Available from: https://doi.org/10.1111/1475-6773.12117

[18].  Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. Available from: https://doi.org/10.1191/1478088706qp063oa

[19].  Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care. 2007;19(6):349-57. Available from: https://doi.org/10.1093/intqhc/mzm042

[20].  von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. Available from: https://doi.org/10.1371/journal.pmed.0040296

[21].  Enable Lassa Research Programme (Enable 1.0) Consortium. Incidence of symptomatic Lassa virus infection in West African countries (Enable 1.0 Lassa Research Study): a prospective, multisite, cohort study. Lancet Glob Health. 2026;14(7):103945. Available from: https://doi.org/10.1016/S2214-109X(26)00090-2

[22].  Okeke IN, Manning RS, Pfeiffer T. Diagnostic schemes for reducing epidemic size of African viral hemorrhagic fever outbreaks. J. Infect. Dev. Ctries. 2014;8(9):1148-59. Available from: https://doi.org/10.3855/jidc.4636

[23].  Oloyede TA, Omar NA, Adedire EB, Tarfa MJ, Chikwanda M, Muhammad BA, et al. Detection timeliness and case fatality patterns of Lassa fever in Bauchi State, Nigeria: a descriptive epidemiological analysis, November 2024-February 2025. J. Interv. Epidemiol. Public Health. 2025;8(4):98. Available from: https://doi.org/10.37432/jieph-d-25-00171

[24].  Adejugbagbe AM, Sunday DD, Orimolade AO, Johnson OF, Fagbemi S, Isere EE, et al. Assessment of Lassa fever reporting among healthcare workers in a Southwest state, Nigeria. Discov Public Health. 2025;22:348. Available from: https://doi.org/10.1186/s12982-025-00744-x

Abstract:

Adolescents' journey toward Sexual and Reproductive Health Empowerment (SRHE) in many sub-Saharan African countries faces myriad hurdles. This study aimed to describe pathways to SRHE among Adolescent Girls in a resource-constrained setting in Cameroon's Southwest Region, which has been affected by a socio-political crisis since 2016. The study obtained ethical approval and used a concurrent triangulation and sequential exploratory mixed-methods design within a survey framework, combining quantitative and qualitative approaches. The study included 465 participants: adolescent girls, parents, health personnel, and key informants from traditional, educational, health, social, legal, women and gender empowerment, UN organizations, and civil society organizations. Researchers analyzed quantitative data using SPSS, while qualitative data underwent thematic analysis using ATLAS.ti and NVivo. The findings revealed that though adolescent girls were empowered, the impact was questionable as they still engaged in sex relatively early. Though they were generally aware and had access to either form of contraceptive methods, their willingness to use them was relatively low except for condoms. Among others, teenage pregnancy was relatively high. Critical predictors of early sex were the poverty / economic emancipation, the vulnerability of those with dead parents, from a single-mother home, or living with a friend, and the conflict and fragility context. To improve and sustain SRHE, stakeholders suggested early home-based education; comprehensive/intensified school-based education; intensified community-based education and awareness; and education through controlled mass media. SRH education mostly started in early adolescence.

References:

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[3]WHO. The sexual and reproductive health of younger adolescents: Research issues in developing countries: Background paper for a consultation. World Health Organization (WHO); 2011. Available from: https://www.who.int/publications/i/item/9789241501552

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[5]WHO. Adolescent health. WHO; 2019:Available from https://www.who.int/news-room/spotlight/coming-of-age-adolescent-health. Visited 25 March 2026,

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[7]Zeleke BM, Shimekaw B, Alamirew Z. Prevalence and associated factors of sexual violence among private college female students in Bahir Dar city, North Western Ethiopia.  Health 2023; 5(6), 1069-75. Available from: https://doi.org/10.4236/health.2013.56143

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[9]Kassa ZY, Tsegaye B, Abeje A. Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis. BMC international health and human rights. 2020; 20(1), 23. Available from: https://link.springer.com/article/10.1186/s12914-020-00242-y

[10]           Sally Lee et al (eds). Demystifying Mental Capacity: A guide for health and social care professionals. Sage; 2020. Available from: https://www.amazon.com/Demystifying-Mental-Capacity-professionals-Post-Qualifying/dp/1529712254

[11]           Ngowa JDK, Neng HT, Domgue JF, Nsahlai CJ, Kasia JM. Voluntary Induced Abortion in Cameroon: Prevalence, Reasons, and Complications. Open Journal of Obstetrics and Gynecology. 2015; 5, 475-80. Available from: http://dx.doi.org/10.4236/ojog.2015.59069

[12]           WHO. Global burden of disease 2004 update. WHO; 2008. Available from: https://www.who.int/publications/i/item/9789241563710

[13]           Gabriel E, Halle-Ekane G, Isah M, Wirsiy F, Lebaga M, Siysila N, Musi C, Chia N, Victor M. Prevalence and Associated Factors of Teenage Pregnancy among Secondary and High School Students in the Tiko Health District, South West Region, Cameroon. Journal of Biosciences and Medicines. 2020; 8, 99-113. Available from: https://www.scirp.org/journal/paperinformation?paperid=102810

[14]           Regional Delegation of Public Health for the Southwest region (RDPH-SWR). List of villages—report from the Regional Delegation of Public Health for the Southwest region. RDPH-SWR; 2021: Buea. Cited in https://www.researchgate.net/publication/405450991_The_Role_of_Community_Health_Workers_in_Bridging_the_Primary_Health_Care_Gap_A_Case_of_Tiko_Health_District_Cameroon

[15]           The World Bank. The Socio-Political Crisis in the Northwest and Southwest Regions of Cameroon: Assessing the Economic and Social Impacts. The World Bank; 2021: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/795921624338364910

[16]           Joseph J, Maon F, Uribe-Jaramillo MT, Katsos JE, Lindgreen A. Business, Conflict, and Peace: A Systematic Literature Review and Conceptual Framework. J. Manage. Stud. 2025; 62, 1779-810. Available from:  https://doi.org/10.1111/joms.13139

[17]           UNFPA. Making reproductive rights and sexual and reproductive health a reality for all: Reproductive Rights and Sexual and Reproductive Health Framework. United Nations Population Fund (UNFPA); 2008: Available from https://www.unfpa.org/resources/making-reproductive-rights-and-sexual-and-reproductive-health-reality-all

[18]           Gajjala R, Faniyi OM, Rahut D, Edwards E, Ford SE. Get the hammer out!: Breaking computational tools for feminist, intersectional “small data” research. JDSR. 2024; 6(2) 9-26. Available from: https://doi.org/10.33621/jdsr.v6i2.193

[19]           Amuyunzu-Nyamongo M, Biddlecom AE, Ouedraogo C, Woog V. Qualitative Evidence on Adolescents’ Views of Sexual and Reproductive Health in Sub-Saharan Africa: Occasional Report No. 16, January 2005. The Alan Guttmacher Institute; 2005. Available from: https://www.policyarchive.org/handle/10207/5888

[20]           Komuhangi A, Muhumuza A, Kasozi W, Okoboi S. Contextual Influences on Community-Based Peer-Led Sexual and Reproductive Health Education for Adolescent Girls and Young Women in Moroto District, Uganda: An Ethnographic Study. Texila International Journal of Public Health. 2024; ISSN: 2520-3134 DOI: 10.21522/TIJPH.2013.13.02. Art036

[21]           UNFPA WCARO. Adolescent and Youth Sexual and Reproductive Health and Rights Services: Key elements for implementation and scaling up services in West and Central Africa. United Nations Population Fund West and Central Africa Regional Office (UNFPA WCARO); 2026. Available from: https://wcaro.unfpa.org/sites/default/files/pub-pdf/EN-UNFPA-WCARO-MUSKOKA-AYSRHR-Brochure-WEB-1.pdf. Visited 26 March 2026.

[22]           Santhya KG, Jejeebhoy SJ. Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries. Global Public Health. 2015; 10(2), 189–21. Available from: https://doi.org/10.1080/17441692.2014.986169

[23]           Bih SC, Akoko RM, Kinni FNY, Nana C. Availability and Quality of Sexually Transmitted infection / Human Immunodeficiency Syndrome Services in Fako Division, Southwest Region of Cameroon. International Journal of Trend in Scientific Research and Development (ijtsrd). 2026; 10 (1).122-35. Available from: https://www.researchgate.net/publication/401152561_Availability_and_Quality_of_Sexually_Transmitted_Infections_Human_Immune_Deficiency_Syndrome_Services_in_Fako_Division_Southwest_Region_of_Cameroon

[24]           Bih SC, Njikam SOM, Nana C. Procreation/Negotiating Parenthood’s Challenges Faced by Persons Living with HIV/AIDS in the Southwest Region of Cameroon: Patients’ Perspectives. International Journal of Trend in Scientific Research and Development (ijtsrd). 2026; 10 (1), 92-21. Available from: https://www.researchgate.net/publication/401152827_Procreation_Negotiating_Parenthood's_Challenges_Faced_by_Persons_Living_with_HIVAIDS_in_the_Southwest_Region_of_Cameroon_Patients'_Perspectives

[25]           Aliyu US, Özdeser H, Çavuşoğlu B, Usman MA. Food security sustainability: A synthesis of the current concepts and empirical approaches for meeting SDGs. Sustainability. 2021; 13(21), 117-28. Available from: https://doi.org/10.3390/su132111728

[26]           Yibrehu MS, Mbwele B. Parent-adolescent communication on sexual and reproductive health: the qualitative evidence from parents and students of Addis Ababa, Ethiopia.  Reprod Health. 2020;17 (78). Available from: https://doi.org/10.1186/s12978-020-00927-6

[27]           Baku EA, Agbemafle I, Adanu R. Effects of parents' training on parents’ knowledge and attitudes about adolescent sexuality in Accra Metropolis, Ghana. Reproductive Health. 2017; 14(1), 1-14. Available from: https://doi.org/10.1186/s12978-017-0363-9

[28]           Agbeve AS. Sexual and Reproductive Health Education among Rural Families in Ghana: A Study in Adaklu, Volta Region. University of Cape Coast; 2020. Available from: https://ir.ucc.edu.gh/items/41639623-fff0-4809-affc-30482a5014b0

Abstract:

Women's empowerment is among the most studied determinants of reproductive health in low- and middle-income countries, yet quantitative reproductive health research continues to operationalise it through single proxies even though the construct is theoretically established as multidimensional. This reliance on unidimensional measurement misrepresents the construct and produces findings that are often inconsistent across settings. This review develops and defends a transparent, multidimensional framework for measuring women's empowerment from Demographic and Health Survey (DHS) data, grounded in Kabeer's resources, agency, and achievements model, and illustrates it using Cameroon DHS data. A structured narrative review informed the synthesis of six dimensions recurrent in reproductive health studies: economic, educational, sociocultural, reproductive, normative, and digital, each operationalised from standard DHS variables through a standardised additive scoring protocol. Measurement quality was assessed by distinguishing reflective from formative indices and by multicollinearity diagnostics. The framework was constructed on the 2018 Cameroon DHS (n = 4,449 partnered women aged 15–49 with a recent birth or pregnancy). The two reflective dimensions (educational, digital) met the α ≥ 0.70 threshold, the four formative dimensions were validated by construct coverage, and correlation and variance-inflation diagnostics confirmed that all six dimensions are statistically independent. Sub-dimension analysis revealed heterogeneity that a single index conceals, including a substantial digital access-and-use gap. A domain-differentiated additive framework is theoretically necessary, operationally achievable, and internally consistent within existing DHS infrastructure, preserving the dimension-specific effects essential for intervention design.

References:

[1].   Kabeer N. Resources, agency, achievements: reflections on the measurement of women's empowerment. Dev Change. 1999;30(3):435-64. https://doi.org/10.1111/1467-7660.00125

[2].   United Nations. Beijing Declaration and Platform for Action. Fourth World Conference on Women; 1995 Sep; Beijing. New York: United Nations; 1995. https://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf

[3].   Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One. 2010;5(6):e11190. https://doi.org/10.1371/journal.pone.0011190

[4].   Doku DT, Bhutta ZA, Neupane S. Associations of women's empowerment with neonatal, infant and under-5 mortality in low- and middle-income countries. BMJ Glob Health. 2020;5(1):e001558. https://doi.org/10.1136/bmjgh-2019-001558

[5].   Prata N, Fraser A, Huchko MJ, Gipson JD, Withers M, Lewis S, et al. Women's empowerment and family planning: a review of the literature. J Biosoc Sci. 2017;49(6):713-43. https://doi.org/10.1017/S0021932016000663

[6].   Pratley P. Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: a systematic review. Soc Sci Med. 2016;169:119-31. https://doi.org/10.1016/j.socscimed.2016.08.001

[7].   Malhotra A, Schuler SR. Women's empowerment as a variable in international development. In: Narayan D, editor. Measuring empowerment: cross-disciplinary perspectives. Washington (DC): World Bank; 2005. p. 71-88. https://doi.org/10.1037/e597202012-004

[8].   Vizheh M, Muhidin S, Behboodi Moghadam Z, Zareiyan A. Women empowerment in reproductive health: a systematic review of measurement properties. BMC Womens Health. 2021;21(1):424. https://doi.org/10.1186/s12905-021-01566-0

[9].   Yount KM, Peterman A, Cheong YF. Measuring women's empowerment: a need for context and caution. Lancet Glob Health. 2018;6(1):e29. https://doi.org/10.1016/S2214-109X(17)30459-X

[10].  Chowdhury S, Rahman MM, Haque MA. Role of women's empowerment in determining fertility and reproductive health in Bangladesh: a systematic literature review. AJOG Glob Rep. 2023;3(3):100239. https://doi.org/10.1016/j.xagr.2023.100239

[11].  Atake EH, Ali PG. Women's empowerment and fertility preferences in high fertility countries in sub-Saharan Africa: evidence from Cameroon. BMC Womens Health. 2019;19(1):54. https://doi.org/10.1186/s12905-019-0729-7

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Abstract:

The rapid growth of mobile data consumption has intensified pressure on limited radio spectrum resources, compelling mobile network operators to improve capacity, throughput, and Quality of Service (QoS) without acquiring additional spectrum. Spectrum refarming has emerged as a strategic solution that reallocates underutilized legacy spectrum to advance mobile technologies, thereby enhancing spectrum utilization and network performance. This study investigates the effectiveness of spectrum refarming in improving fourth-generation (4G) network capacity and QoS within AirtelTigo Ghana. A mixed-methods approach was adopted, combining technical drive test measurements, benchmarking of legacy network performance, network Key Performance Indicator (KPI) analysis, and a structured user perception survey. Drive tests were conducted across selected high-traffic urban locations to evaluate throughput, accessibility, coverage, and session stability, while a technical assessment of AirtelTigo's GSM 1800 MHz spectrum identified opportunities for reallocating a 5 MHz carrier for LTE deployment. The findings demonstrate that refarming the GSM 1800 MHz band enables the deployment of an LTE carrier that significantly improves downlink throughput, network capacity, and user experience without compromising legacy network performance. The results further indicate improvements in spectrum utilization, reduced network congestion, enhanced accessibility, and better overall QoS, leading to a more reliable and efficient mobile broadband service. The study concludes that spectrum refarming is a technically feasible and cost-effective modernization strategy for mobile network operators, particularly in spectrum-constrained developing markets, as it maximizes the value of existing spectrum assets while supporting growing broadband demand and delaying the need for costly acquisition of additional spectrum resources.

References:

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[3].   Pasarelska T. Analysis of radio frequency spectrum planning and allocation for the deployment of new modern broadband networks and technologies. Year book Telecommunication 2023; 10:79-88. Available from: https://doi.org/10.33919/TTelecomm.23.10.8

[4].   Barry K, Soumah S, Diallo MS, Camara MA, Diallo AY, Barry MA. Multi-parametric analysis of the coverage and quality of service (QoS) of 3G/4G networks in the sub-Saharan environment: The case of the Republic of Guinea. Sci J Energy Eng. 2025;13(3):154-66. Available from: https://doi.org/10.11648/j.sjee.20251303.16

[5].   Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. 6th ed. Thousand Oaks (CA): Sage Publications; 2023.

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[7].   Lin X, Viswanathan H. Dynamic spectrum refarming with overlay for legacy devices. IEEE Trans Wirel Commun. 2013;12(10):5282-95. Available from: https://doi.org/10.1109/TWC.2013.092313.130227

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Abstract:

Progress towards universal health coverage requires available resources to be purchased, allocated, and governed coherently. In the Democratic Republic of the Congo (DRC), analyses of health financing commonly focus on resource scarcity and reliance on out-of-pocket payments, while fragmentation of the purchasing function has received less attention. This analytical review examines fragmentation through three complementary dimensions: financing sources, provider-payment mechanisms, and the institutions that exercise or influence purchasing. A narrative synthesis of health-policy documents, institutional reports, and scientific literature was undertaken and informed by a qualitative comparison of six African country experiences. The analytical framework combines strategic purchasing, neo-institutional theory, and transaction-cost economics. The reviewed literature suggests that compartmentalised financial flows, parallel payment arrangements, and overlapping institutional responsibilities may increase coordination burdens, create unclear incentives for providers, and weaken accountability. The study proposes a three-dimensional model that makes these interactions visible and helps to organise reform options. It concludes that a transition towards more strategic purchasing in the DRC requires clearer purchasing governance, gradual harmonisation of payment arrangements, strengthened information systems, and explicit attention to equity. These priorities should accompany, rather than replace, the necessary expansion of resources for health.

References:

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[2].   Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91(8):602-11. doi:10.2471/BLT.12.113985.

[3].   Mathauer I, Dale E, Meessen B. Strategic purchasing for universal health coverage: key policy issues and questions. Health Syst Reform. 2019;5(1):20-33. doi:10.1080/23288604.2018.1557661.

[4].   World Health Organization. Strategic purchasing for UHC: unlocking the potential. Geneva: World Health Organization; 2019.

[5].   McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, et al. Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ. 2008;86(11):871-6. doi:10.2471/BLT.08.053413.

[6].   World Health Organization. The world health report: health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.

[7].   Sparkes SP, Kutzin J. A system-wide approach to analysing efficiency across health programmes. Health Syst Reform. 2019;5(3):183-94. doi:10.1080/23288604.2019.1581771.

[8].   North DC. Institutions, institutional change and economic performance. Cambridge: Cambridge University Press; 1990.

[9].   Williamson OE. The economic institutions of capitalism: firms, markets, relational contracting. New York: Free Press; 1985.

[10].  Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. Lancaster: Lancaster University; 2006.

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Abstract:

COVID-19 vaccine hesitancy became a major challenge affecting vaccination efforts across African countries during the COVID-19 pandemic. This systematic review examined sociocultural beliefs, trust in health systems, and misinformation dynamics influencing vaccine hesitancy across Africa. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Scopus, Web of Science, Google Scholar, African Journals Online (AJOL), and ScienceDirect were searched for studies published between 2020 and 2026. Additional reports were obtained from the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and Africa Centres for Disease Control and Prevention (Africa CDC). Studies addressing COVID-19 vaccine hesitancy among African populations were included. A total of 286 records were identified, with 38 studies meeting the inclusion criteria after screening and eligibility assessment. The review revealed that vaccine hesitancy across Africa was driven by multiple interconnected factors including misinformation spread through social media, mistrust in governments and healthcare systems, sociocultural and religious beliefs, fear of vaccine side effects, and concerns regarding vaccine safety. Misconceptions related to infertility, hidden political agendas, and harmful effects of vaccines were frequently reported. Healthcare worker hesitancy, poor public health communication, and socioeconomic inequalities further contributed to low vaccine confidence in several African settings. The review concludes that improving vaccine uptake in Africa requires culturally sensitive communication strategies, strengthened institutional trust, effective misinformation control, and stronger community engagement to improve confidence in future vaccination programs.

References:

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Abstract:

Tuberculosis (TB) remains a leading cause of infectious disease mortality worldwide, and Nigeria contributes disproportionately to the global burden. More than half of Nigerians with TB symptoms first seek care from private providers; the private sector’s contribution to national TB case notification has not been formally distilled. This review estimated the contribution following PRISMA 2020 and a registered protocol. Six databases and grey literature sources were searched from January 2000 to December 2023. Two reviewers screened records and assessed risk of bias using the Newcastle–Ottawa Scale, ROBINS-I, and JBI checklist. Proportions were pooled using the DerSimonian–Laird random-effects estimator. Heterogeneity was assessed with I², τ², and Cochran’s Q and explored through subgroup and meta-regression analyses; bias was evaluated using Egger’s test. Of 1,673 unique records screened, 28 studies met the eligibility criteria, and 18 studies (47,342 notifications) were included in the primary meta-analysis. The pooled private-sector contribution was 16.8% (95% CI 15.6–18.0; I² = 90.7%; τ² = 0.028), exceeding the WHO benchmark of 15%. Results withstood sensitivity checks. The study-level share did not change significantly over 2009–2023 (meta-regression p = 0.678). Contributions were higher in private hospitals (19.2%) and laboratories (21.0%) than in mixed portfolios (16.2%) or medicine-vendor channels (14.5%). No publication bias was detected (Egger p = 0.944). Engaged private providers account for one in six notified TB cases in Nigeria; sustaining and expanding this contribution requires an institutionalised public–private mix, predictable domestic financing, and the integration of TB notification into health insurance benefit packages.

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Abstract:

Surveillance is an imperative for health systems to thrive and respond to emerging and re-emerging diseases. It is even more important for planning and technical planning for public health emergencies. Having a system that integrates various components not only improves a country capability to prepare for such events but also, it provides a platform for continuous reporting and steady flow of information. A qualitative study conducted 14 key informant interviews with officers who play a pivotal role in the implementation of the Integrated Disease Surveillance System (IDSR) from eight districts of five provinces executed. Various common themes emerged, these were roles and oversight in implementation, enablers of IDSR, implementation challenges/barriers, intersectional coordination and recommendations for improvement and sustained use. A consensus emerged regarding the improvements in reporting, which after the IDSR is considered timelier, prompt, accurate and efficient. This implies that as a country, there has been an improvement in case detection and management. However, gaps still remain in capacity emanating from attrition of designated surveillance staff which threatens sustainability of implementation.

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Abstract:

Health facility documentation compliance is a perennial challenge in our public and private health facilities in Nigeria. Timely complete reporting is important for disease surveillance, for informing health planning and the most effective use of health resources, and for policy making at the national level. Non availability of complete, up-to-date and missing routine incidence data can have a major impact on public health. This paper thus presents a low-cost innovative Artificial Intelligence system for real time monitoring, enforcement and tracking of the upload of health facility’s daily report to a central server using a low-cost technology that comprises of a Telegram bot as the user interface and a no-code workflow automation platform n8n, PostgreSQL database and Google Drive. The facility is completed with state level location, session-based user authentication, file validation, automatic upload of documentation and real time confirmation of successful upload. A case study of 96 health facilities in several states of Nigeria confirmed real time compliance of health facility’s documentation up to 99% within 24 hours of implementation. These findings confirm that low-cost mobile friendly automation technology can be effective in improving health facility documentation in low resources settings.

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