Abstract:

This study examined the geospatial distribution of routine immunization coverage, zero-dose prevalence, and dropout patterns among children aged 0–23 months in Kwara State, Nigeria. A cross-sectional design was adopted, involving 1,173 caregiver–child pairs selected through a multi-stage sampling technique across six Local Government Areas and twelve wards. Data were collected using immunization card verification and household geospatial coordinates and analyzed using descriptive statistics and Geographic Information Systems (GIS). Findings revealed high coverage for vaccines administered at birth and early infancy, including BCG (95.3%), OPV0 (95.2%), HBV0 (93.7%), and Penta1 (92.6%), indicating strong initial access to immunization services. However, coverage declined progressively for subsequent doses: Penta3 (80.7%), MCV1 (79.4%), Yellow Fever (77.9%), and MCV2 (67.7%). Despite a relatively low zero-dose prevalence (7.4%), only 73.2% of children were fully immunized, highlighting significant gaps in continuity of care. Spatial analysis revealed pronounced clustering of immunization outcomes, with substantial disparities across and within LGAs and wards, including identifiable zero-dose hotspots in otherwise well-performing LGAs. The findings demonstrate that immunization inequities are driven by localized spatial and systemic factors, emphasizing the need for targeted, data-driven interventions to improve retention and achieve equitable immunization coverage.

References:

Abstract:

Disaster and emergency preparedness in hospitals is a critical public health priority, particularly in developing countries where resource constraints and governance challenges hinder resilience. This study assessed preparedness in Botswana’s two largest referral hospitals Princess Marina in Gaborone and Nyangabgwe in Francistown using a mixed method design that integrated quantitative surveys and hospital records. A sample of 209 healthcare workers was analyzed to evaluate disaster plans, staff training, infrastructure adequacy, and resource allocation. Results revealed significant disparities: Princess Marina consistently scored higher in staff training (mean 6.8 vs. 5.9) and protocol availability (mean 7.5 vs. 6.8), while Nyangabgwe demonstrated weaker institutional coordination and lower staff engagement. Overall, 64.1% of respondents at Princess Marina reported adequate preparedness compared to 31.6% at Nyangabgwe. Logistic regression confirmed staff training (AOR = 3.707, p = 0.001) and governance (AOR = 6.286, p = 0.002) as the strongest predictors of preparedness. Findings highlighted systemic challenges including limited simulation drills, fragmented communication, and inadequate resource allocation. The study concludes that Botswana’s referral hospitals remain underprepared for large-scale emergencies, with governance and staff capacity emerging as decisive factors. Recommendations include strengthening disaster plans, institutionalizing regular drills, enhancing interdisciplinary training, and integrating systems thinking into national health strategies. By providing empirical insights into hospital resilience, this research contributes to public health scholarship and offers evidence-based guidance for policymakers seeking to improve disaster risk reduction in Botswana and across sub-Saharan Africa.

References:

[1].   Farah B, Pavlova M, Groot W. Hospital disaster preparedness in sub-Saharan Africa: a systematic review of English literature. BMC Emerg Med. 2023;23(1). https://doi.org/10.1186/s12873-023-00843-5

[2].   Pawar N, Gumashta R, Gupta G, Mahore R, Gumashta J. Domain-specific need assessment for hospital disaster preparedness: a systematic review and critical interpretative synthesis. Int J Disaster Risk Reduct. 2024;106:104437. https://doi.org/10.1016/j.ijdrr.2024.104437

[3].   World Health Organization. Health Emergency and Disaster Management Framework. Geneva: WHO; 2019. https://apps.who.int/iris/bitstream/handle/10665/326106/9789241516181-eng.pdf

[4].   Mulungu C, Mindu T, Mulungu K. Effectiveness of online counselling during COVID-19 in Zambia: clients' and therapists' perspectives. BMC Psychol. 2024;12(1). https://doi.org/10.1186/s40359-024-01614-y

[5].   Blackie IR, Maphosa F. Botswana’s response to the outbreak of the Coronavirus (COVID-19): lessons for disaster preparedness and management. Dev South Afr. 2023;40(3). https://doi.org/10.1080/0376835X.2022.2054401

[6].   Tshitenge ST, Nthitu JM. COVID-19 frontline primary health care professionals’ perspectives on health system preparedness and response to the pandemic in the Mahalapye Health District, Botswana. Afr J Prim Health Care Fam Med. 2022;14(1). https://doi.org/10.4102/phcfm.v14i1.3166

[7].   Khirekar J, Badge A, Bandre GR, Shahu S. Disaster preparedness in hospitals. Cureus. 2023;15(12). https://doi.org/10.7759/cureus.50073

[8].   McNab D, McKay J, Shorrock S, Luty S, Bowie P. Development and application of systems thinking principles for quality improvement. BMJ Open Qual. 2020;9(1). https://doi.org/10.1136/bmjoq-2019-000714

[9].   Khan MF, Mahmood M, Hasrat MN, Javed B, Javed O. Perception, preparedness and response of health care personals towards COVID-19 pandemic in Azad Jammu & Kashmir, Pakistan: a cross sectional interview-based study. Clin Epidemiol Glob Health. 2021;11:100783. https://doi.org/10.1016/j.cegh.2021.100783

[10].  Khan Y, O’Sullivan T, Brown A, Tracey S, Gibson J, Généreux M, et al. Public health emergency preparedness: a framework to promote resilience. BMC Public Health. 2018;18(1). https://doi.org/10.1186/s12889-018-6250-7

[11].  Mulungu C, Kankoloto E, Kapungwe M. Facility preparedness for recurring cholera epidemics: a case of Matero and Kanyama sub-districts, in Lusaka. Int J Res Innov Soc Sci. 2024;8(7). https://doi.org/10.47772/IJRISS.2024.807103

[12].  Samuel G, Mulalu MI, Moalafhi DB, Stephens M. Evaluation of national disaster management strategy and planning for flood management and impact reduction in Gaborone, Botswana. Int J Disaster Risk Reduct. 2022;74:102939. https://doi.org/10.1016/j.ijdrr.2022.102939

[13].  World Health Organization. Health Emergency and Disaster Risk Management (H-EDRM) framework. Geneva: WHO; 2020. https://mpipsyl.disco.mpg.de/Record/MPIPL_cat.PL000144484?sid=1252867

[14].  Von Bertalanffy L. Organismic psychology and systems theory. Worcester (MA): Clark University Press; 1968.

[15].  Nabukeera M. Effects of COVID-19 on local government revenue and expenditure in Uganda. Islam Univ J Soc Sci. 2021;1(1). https://doi.org/10.1177/1525822X05279903

[16].  Ministry of Health. Integrated Health Service Plan: A Strategy for Changing the Health Sector for Healthy Botswana 2010-2020. Gaborone: Ministry of Health; 2024. https://www.moh.gov.bw/Publications/policies/Botswana%20IHSP%20Final%20HLSP.pdf

[17].  Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1). https://doi.org/10.1007/s11135-017-0574-8

[18].  Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4). https://doi.org/10.1007/s11135-017-0574-8

[19].  Jacobs-Wingo JL, Schlegelmilch J, Berliner M, Airall-Simon G, Lang W. Emergency preparedness training for hospital nursing staff, New York City, 2012–2016. J Nurs Scholarsh. 2019;51(1). https://doi.org/10.1111/jnu.12425

[20].  Walles S, Chona EZ, Ndile ML, Ramadhani FB. Knowledge, attitude and practices of health care providers towards disaster and emergency preparedness in Mtwara, Tanzania. Rwanda J Med Health Sci. 2023;6(3). https://doi.org/10.4314/rjmhs.v6i3.4

[21].  Kiteng’u PM. Organizational factors influencing preparedness of Tier 3 Catholic hospitals for health service delivery during influx of patients in Nairobi County, Kenya [dissertation]. Kenya: KeMU; 2022. http://repository.kemu.ac.ke/handle/123456789/1354

[22].  Farokhzadian J, Mangolian Shahrbabaki P, Farahmandnia H, Taskiran Eskici G, Soltani Goki F. Nurses’ challenges for disaster response: a qualitative study. BMC Emerg Med. 2024;24(1). https://10.1186/s12873-023-00921-8

[23].  Gowing JRWK, Elmer SL, Cummings EA. Disaster preparedness among health professionals and support staff: what is effective? An integrative literature review. Prehosp Disaster Med. 2017;32(3):321-8. https://doi.org/10.1017/S1049023X1700019X

[24].  Shapira S, Friger M, Bar-Dayan Y, Aharonson-Daniel L. Healthcare workers’ willingness to respond following a disaster: a novel statistical approach toward data analysis. BMC Med Educ. 2019;19(1). https://doi.org/10.1186/s12909-019-1561-7

[25].  d’Almeida AG, Coopersmith CM. Disaster management–preparation and planning for acute care facilities. Curr Opin Crit Care. 2024;30(3). https://doi.org/10.1097/MCC.0000000000001151

[26].  Obubu M, Chuku N, Ananaba A. Bed space, referral capacity and emergency response of the healthcare facilities in Lagos state: a key to improving healthcare. MOJ Public Health. 2023;12(1):67-72. https://doi.org/10.15406/mojph.2023.12.00412

[27].  Seid FY, Gete BC, Endeshaw AS. Challenges of pre-hospital emergency care at Addis Ababa Fire and Disaster Risk Management Commission, Addis Ababa, Ethiopia: a qualitative study. BMC Health Serv Res. 2024;24(1). https://doi.org/10.1186/s12913-024-11292-6

[28].  Rehman J, Sohaib O, Asif M, Pradhan B. Applying systems thinking to flood disaster management for a sustainable development. Int J Disaster Risk Reduct. 2019;36:101101. https://doi.org/10.1016/j.ijdrr.2019.101101

[29].  Mwanza KE, Stassen W, Pigoga JL, Wallis LA. The views and experiences of Zambia's emergency medicine registrars in South Africa: lessons for the development of emergency care in Zambia. Afr J Emerg Med. 2021;11(1). https://doi.org/10.1016/j.afjem.2020.08.002

[30].           Soucat A. Financing common goods for health: fundamental for health, the foundation for UHC. Health Syst Reform. 2019;5(4). https://doi.org/10.1080/23288604.2019.1671125

Abstract:

Parent-adolescent communication can support safer sexual decision-making, but discussions about condom use may be shaped by culture, religion, gender norms, and migration-related experiences. Objectives: This qualitative pilot study explored attitudes and practices regarding communication about condom use among West African parents living in Copenhagen, Denmark. Twelve West African immigrant parents were recruited from churches and worship centres through snowball sampling. In-depth interviews were conducted using an open-ended guide, audio-recorded, transcribed, and analysed thematically using an inductive approach. Direct parent-adolescent communication about condom use was limited; only two participants reported discussing condom use explicitly with their adolescent children. Six themes emerged: limited direct condom communication; intergenerational silence and lack of parental modelling; religious and cultural preference for abstinence, morality, and discipline; parental discomfort and uncertainty about timing; gendered parental roles; and negotiation between Danish openness and West African cultural identity. Parents recognised the protective value of condoms but often preferred indirect communication focused on abstinence, morality, religious teaching, and general warnings about pregnancy, sexually transmitted infections, and HIV. Fathers appeared more likely to discuss condom use directly, while mothers more often addressed broader sexuality, puberty, relationships, and moral conduct. The study provides pilot evidence on how West African immigrant parents in Copenhagen navigate communication about condom use with their adolescent children within overlapping cultural, religious, gendered, and migration-related contexts.

References:

[1].   World Health Organization Regional Office for Europe. Alarming decline in adolescent condom use, increased risk of sexually transmitted infections and unintended pregnancies, reveals new WHO report. Copenhagen: WHO Regional Office for Europe; 2024. Available from: https://www.who.int/europe/news/item/29-08-2024-alarming-decline-in-adolescent-condom-use--increased-risk-of-sexually-transmitted-infections-and-unintended-pregnancies--reveals-new-who-report

[2].   UNESCO, UNAIDS, UNFPA, UNICEF, UN Women, World Health Organization. International technical guidance on sexuality education: an evidence-informed approach. Revised ed. Paris: UNESCO; 2018. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000260770

[3].   Widman L, Choukas-Bradley S, Noar SM, Nesi J, Garrett K. Parent-adolescent sexual communication and adolescent safer sex behavior: a meta-analysis. JAMA Pediatr. 2016;170(1):52-61. https://doi.org/10.1001/jamapediatrics.2015.2731

[4].   Widman L, Choukas-Bradley S, Helms SW, Golin CE, Prinstein MJ. Sexual communication between early adolescents and their dating partners, parents, and best friends. J Sex Res. 2014;51(7):731-741. https://doi.org/10.1080/00224499.2013.843148

[5].   Usonwu I, Ahmad R, Curtis-Tyler K. Parent-adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis. Reprod Health. 2021;18(1):202. https://doi.org/10.1186/s12978-021-01246-0

[6].   Pichon M, Howard-Merrill L, Wamoyi J, Buller AM, Kyegombe N. A qualitative study exploring parent-daughter approaches for communicating about sex and transactional sex in Central Uganda: implications for comprehensive sexuality education interventions. J Adolesc. 2022;94(6):880-891. https://doi.org/10.1002/jad.12071

[7].   Okpalaku CJ, Ogubuike C. Exploring barriers to parent-adolescent sexual-risk communication among adolescents in Port Harcourt Nigeria: adolescents' and parents' perspective. PLOS Glob Public Health. 2025;5(1). https://doi.org/10.1371/journal.pgph.0003148

[8].   Mileti FP, Mellini L, Sulstarova B, Villani M, Singy P. Exploring barriers to consistent condom use among sub-Saharan African young immigrants in Switzerland. AIDS Care. 2019;31(1):113-116. https://doi.org/10.1080/09540121.2018.1526371

[9].   Statistics Denmark. Immigrants and their descendants. Copenhagen: Statistics Denmark; 2026. Available from: https://www.dst.dk/en/Statistik/emner/borgere/befolkning/indvandrere-og-efterkommere

[10].  Agyei FB, Kaura DK, Bell JD. Perspectives of parents and adolescents on sexual and reproductive health information communication in Ghana. J Public Health Afr. 2025;16(1):845. https://doi.org/10.4102/jphia.v16i1.845

[11].  Ndugga P, Kwagala B, Wandera SO, Kisaakye P, Mbonye M, Ngabirano F. “If your mother does not teach you, the world will...”: a qualitative study of parent-adolescent communication on sexual and reproductive health issues in border districts of eastern Uganda. BMC Public Health. 2023;23(1):678. https://doi.org/10.1186/s12889-023-15562-6

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

[13].  Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods. 2017;16(1):1-13. https://doi.org/10.1177/1609406917733847

[14].  Naeem M, Ozuem W, Howell K, Ranfagni S. A step-by-step process of thematic analysis to develop a conceptual model in qualitative research. Int J Qual Methods. 2023;22:1-18. https://doi.org/10.1177/16094069231205789

[15].  O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. https://doi.org/10.1097/ACM.0000000000000388

[16].  Health Behaviour in School-aged Children. A focus on adolescent sexual health in Europe, central Asia and Canada: Health Behaviour in School-aged Children international report from the 2021/2022 survey. Copenhagen: WHO Regional Office for Europe; 2024. Available from: https://iris.who.int/handle/10665/378547

[17].  Aliyu TK. Situational context of home-based sexual education in urban slums of Ibadan, Nigeria: evidence from a qualitative study. PLOS One. 2024;19(6). https://doi.org/10.1371/journal.pone.0304200

[18].  World Health Organization. Comprehensive sexuality education. Geneva: World Health Organization; 2026. Available from: https://www.who.int/news-room/fact-sheets/detail/comprehensive-sexuality-education

[19].  Liversage A, Søndenbroe KI. Etniske minoriteter, værdier og ligestilling: viden til brug for Kommissionen for den Glemte Kvindekamp. Copenhagen: VIVE; 2023.

[20].  Gutu B, Mahimbo A, Percival N, Demant D. Effect of parent-based sexual health education on parent-adolescent communication and adolescent sexual behavior: a systematic review and meta-analysis. Perspect Sex Reprod Health. 2025. https://doi.org/10.1111/psrh.70029

[21].  Challa S, DeLong SM, Wilson K, et al. A review of comprehensive sexuality education interventions in low- and middle-income countries. Lancet Child Adolesc Health. 2023;7(4):312-324.

[22].  Nwatu NP. An exploration of parenting practices and adaptation of Nigerian immigrant parents in Denmark [master’s thesis]. Aalborg: Aalborg University; 2023.

[23].  Konstantinou E, Koutavelis E, Lähteenmäki E, Duarte Lopes S, Natsia M, Rennit M, Savola E, Lagiou A, Sakellari E. Migrants’ perceptions and needs in sexual health education: a focus group study. Sex Cult. 2025;29:1635-1658. https://doi.org/10.1007/s12119-024-10307-y

Abstract:

The COVID-19 pandemic exposed a critical disconnect between formal preparedness metrics and operational response capacity, particularly in low- and middle-income countries.  This study examines the structural, institutional, and socio-political determinants shaping Bangladesh’s preparedness and response and identifies priorities for resilience-oriented reform. A determinants-based evidence synthesis was conducted, integrating systematic review methods, thematic synthesis, and political economy analysis. The study analysed 393 sources, including peer-reviewed literature, government documents, international agency reports, and grey literature. Findings were interpreted using a composite framework combining International Health Regulations (IHR 2005) core capacities, health system resilience theory (absorb–adapt–transform), and governance analysis. Bangladesh entered the pandemic with moderate preparedness (SPAR 63% in 2019; JEE 48% in 2016) but significant structural constraints, including centralized diagnostics, limited and uneven critical care capacity, subnational disparities, and low public trust. Early response effectiveness was constrained by under-detection, limited surge capacity, coordination challenges, and the socioeconomic limits of sustained public health and social measures. However, strong adaptive capacity was demonstrated through rapid laboratory expansion, vaccination scale-up, digital service delivery, and emergency financing mobilisation. These gains mitigated but did not resolve underlying systemic vulnerabilities. Pandemic preparedness should therefore be conceptualized as a dynamic systems capability. Strengthening resilience in Bangladesh requires governance reform, decentralized surveillance, equitable surge capacity, institutionalized risk communication, sustainable domestic financing, and integration of social protection into preparedness systems.

References:

[1].   Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-2. Doi:10.1016/S0140-6736(15)60755-3. PMID: 25987159.

[2].   Hanefeld J, Mayhew S, Legido-Quigley H, et al. Towards an understanding of resilience in health systems. Health Policy Plan. 2018;33(3):355-67. Doi:10.1093/heapol/czx183.

[3].   Kandel N, Chungong S, Omaar A, Xing J. Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries. Lancet. 2020;395(10229):1047-53. Doi:10.1016/S0140-6736(20)30553-5.

[4].   El-Saharty S, Sparkes S, Barroy H. Bangladesh health financing profile. Washington (DC): World Bank; 2015. Doi:10.1596/978-1-4648-0557-3.

[5].   World Health Organization. Joint external evaluation of IHR core capacities of Bangladesh. Geneva: World Health Organization; 2016. Available from: https://www.who.int/publications/i/item/WHO-HSE-GCR-2016.23

[6].   World Health Organization. State Party Self-Assessment Annual Reporting (SPAR): Bangladesh. Geneva: World Health Organization; 2019. Available from: https://extranet.who.int/e-spar

[7].   Rahman MS, Azad MAK, Hasan MM, et al. COVID-19 epidemic in Bangladesh among rural and urban residents: an observational study. BMC Infect Dis. 2021;21:1055. Doi:10.1186/s12879-021-06731-8.

[8].   Faruq MO, Uddin MS. Critical care bed capacity of Bangladesh: a pre and post COVID-19 pandemic survey. Bangladesh Crit Care J. 2022;10(2):88-98. https://doi.org/10.3329/bccj.v10i2.62200

[9].   Truelove S, Abrahim O, Altare C, Lauer S, Grantz K, Azman A, Spiegel P. The potential impact of COVID-19 in refugee camps in Bangladesh. PLoS Med. 2020;17(6). https://doi.org/10.1371/journal.pmed.1003144

[10].  Ministry of Health and Family Welfare. National preparedness and response plan for COVID-19, Bangladesh. Dhaka: Government of Bangladesh; 2020.

[11].  Directorate General of Health Services. COVID-19 daily situation reports, Bangladesh. Dhaka: Government of Bangladesh; 2020-2021.

[12].  Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. Doi:10.1136/bmj.n71.

[13].  Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45. Doi:10.1186/1471-2288-8-45.

[14].  World Health Organization. COVID-19 strategic preparedness and response plan. Geneva: WHO; 2020.

[15].  Paez A. Grey literature: an important resource in systematic reviews. J Med Libr Assoc. 2017;105(3):221-24. Doi:10.5195/jmla.2017.246.

[16].  Alam ME, et al. Public trust in COVID-19 prevention and responses between government and private sectors in Bangladesh. Risk Manag Healthc Policy. 2021;14:3077-95.

[17].  Gómez-Ochoa SA, Franco OH, Rojas LZ, et al. COVID-19 in health-care workers: a living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol. 2021;190(1):161-75. Doi:10.1093/aje/kwaa191.

[18].  World Bank. Bangladesh COVID-19 emergency response and pandemic preparedness project. Washington (DC): World Bank; 2020.

[19].  Ahmed F, Islam AKN, Pakrashi D, Rahman T, Siddique A, Sayeed KA. Determinants and dynamics of food insecurity during COVID-19 in rural Bangladesh. Food Secur. 2021;13:767-83.

[20].  Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(6). Doi:10.1016/S2214-109X(21)00079-6.

[21].  World Health Organization. COVID-19 vaccination coverage and booster strategies: Bangladesh country brief. Geneva: World Health Organization; 2022.

[22].  Traore T, Shanks S, Haider N, et al. How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach. Lancet. 2023;401(10383):673-87.

Abstract:

Community participation is a key pillar of primary healthcare and a major lever for improving health indicators (Haldane et al., 2019). In the Democratic Republic of Congo, Community Action Units (CACs) have been established to strengthen this engagement, although their effectiveness remains insufficiently documented. This study aimed to evaluate the effect of revitalizing community health centers (CHCs) on the use of health services in the province of South Kivu. A cross-sectional analytical study was conducted with 408 CHCs distributed across six health zones. The data were analyzed using statistical methods including paired t-tests, correlation analyses and multivariate regression, with a significance threshold set at p < 0.05. The results show that the CACs were, on average, composed of 7.6 members, with a male predominance (71%). A statistically significant improvement was observed for some indicators, notably family planning (+109.6%, p < 0.001) and prenatal consultations (+47.78%, p = 0.003), while no significant effect was observed on vaccination coverage (p = 0.906). The main determinants identified include awareness-raising activities and members' education levels. These results suggest that community health workers contribute to improving behaviour-sensitive indicators, but that their impact remains limited by the structural constraints of the healthcare system.

References:

[1].   World Health Organization. Declaration of Alma-Ata. Geneva: WHO; 1978.

[2].   World Health Organization. Astana Declaration on Primary Health Care. Geneva: WHO; 2018.

[3].   Haldane V, et al. Community participation in health services: a systematic review. PLoS One. 2019.

[4].   Rifkin SB. Examining the links between community participation and health outcomes. Health Policy Plan. 2014.

[5].   George AS, et al. Community participation in health systems research. Health Policy Plan. 2015.

[6].   Erku DA, et al. Community engagement initiatives in primary health care. PLoS One. 2023.

[7].   Altare C, et al. Health services in conflict-affected settings. Confl Health. 2020.

[8].   Behl R, et al. Rebuilding child health in South Kivu. Confl Health. 2022.

[9].   Cleland J, et al. Contraception and health. Lancet. 2012.

[10].  Lassi ZS, Bhutta ZA. Community-based interventions. Cochrane Database Syst Rev. 2015.

[11].  Ministry of Health, Democratic Republic of Congo. CAC Manual. Kinshasa: Ministry of Health; 2016.

[12].  Falisse JB, et al. Community governance in fragile settings. PLoS Glob Public Health. 2023.

[13].  Ngongo N, et al. Community health worker programs in Africa. PLoS Glob Public Health. 2024.

[14].  Kasongo B, et al. Community engagement in South Kivu. Research Square. 2024.

[15].  South J, Phillips G. Evaluating community engagement. J Epidemiol Community Health. 2014.

[16].  World Health Organization. Immunization Agenda 2030. Geneva: WHO; 2019.

[17].  Ubillos-Landa S, et al. Community animation programs. Appl Psychol Health Well Being. 2020.

[18].  Arghittu A, Castiglia P, Dettori M. Family medicine and primary healthcare: the past, present and future. Healthcare (Basel). 2023;11. https://doi.org/10.3390/healthcare11152128

[19].  Gholipour K, Shokri A, Tabrizi JS, Iezadi S, Naghibi D, Bidarpoor F. Barriers to community participation in primary health care of district health: a qualitative study. BMC Prim Care. 2023;24(1). https://doi.org/10.1186/s12875-023-02062-0

[20].  Kafflouman KS, Soulama F, Kalumendo R, Ouoba B, Songa JA, Kinda M, et al. Evaluation of post-training monitoring of CHWs. Texila Int J Public Health. 2023;11(3):294-304.

[21].  Mabetha D, Ojewola T, Van Der Merwe M, Mabeka R, Goosen G, Sigudla J, Hove J, Witter S, D'Ambruoso L. Realising radical potential: building community power in primary health care through Participatory Action Research. Int J Equity Health. 2023;22(1). https://doi.org/10.1186/s12939-023-01894-7

Abstract:

Information and communication technologies (ICT) have enabled the emergence of telemedicine. They were first introduced in Anglo-Saxon medical literature in 1974. At the dawn of the 21st century, a global revolution in telemedicine took place, leading to the development of thousands of programmes. Although the use of telemedicine has been slow in Africa, it is clear that the need for it has been felt since the 1990s. Subsequently, some African countries (Benin, Senegal) began to use telemedicine. During our numerous missions within medical humanitarian projects in Africa (Democratic Republic of Congo, Cameroon, Ethiopia, Niger, etc.), we observed the use of telemedicine in hospitals by healthcare professionals. Using a semi-structured questionnaire, a cross-sectional analytical survey was conducted among healthcare professionals working or having worked in a medical humanitarian project in Africa over the past five years (September 2019 to September 2024). Of the 51 healthcare professionals interviewed, 88.23% reported using telemedicine. During our study, we found a significant association between gender (p-value = 0.033), cultural background (p-value = 0.020), and the variables in our research model (perceived benefits, perceived barriers, incentive to act, and self-efficacy).

References:

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[2].      Ajzen I, Fishbein M. A Bayesian analysis of attribution processes. Psychol Bull. 1975;82:261-77. https://doi.org/10.1037/h0076477

[3].      Astruc A, Sarfati S, Halioua B. Telemedicine: the beginning of the story. Presse Med Form. 2020;1(5):551-57. https://doi.org/10.1016/j.lpmfor.2020.08.008

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Abstract:

Antimicrobial resistance (AMR) presents a growing global health crisis, disproportionately affecting fragile and humanitarian health systems. This study assessed the determinants of Antimicrobial Stewardship (AMS) implementation in Cox's Bazar, Bangladesh, a region hosting one of the world's largest refugee populations. Using the World Health Organization (WHO) AMS Core Elements framework, the study evaluated leadership, governance, accountability, workforce, and monitoring systems influencing AMS practice within refugee and host-community health facilities. A cross-sectional facility-based assessment was conducted between January and June 2024 across 35 health facilities. Data were collected using the WHO AMS checklist adapted into a KoboCollect tool and analyzed using SPSS version 27. Descriptive statistics summarized facility characteristics, while bivariate and multivariate logistic regression models identified factors associated with higher AMS implementation scores. Only 31.4% of facilities demonstrated moderate AMS readiness, with primary health centers (PHCs) scoring higher than static health facilities (SHFs) and health posts (HPs). Leadership commitment (AOR = 2.41; 95% CI: 1.26–4.61), presence of dedicated AMS teams (AOR = 3.05; 95% CI: 1.49–6.23), and access to diagnostic laboratories (AOR = 2.88; 95% CI: 1.14–5.73) were significant predictors of effective stewardship practices. AMS implementation in Cox's Bazar remains nascent, constrained by leadership, laboratory, and data system limitations. Strengthening institutional governance, workforce capacity, and multisectoral coordination is crucial to optimizing antibiotic use in humanitarian health systems.

References:

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Abstract:

mergency response systems are essential elements of the resilience of society, especially with the rise of natural disasters, health emergencies, technological accidents, and complicated humanitarian crises. These systems play a key role in emergency preparedness and serves as the first line of defense to save lives, prevent injuries, and limit property damage during a crisis. With clear and coordinated actions, these systems help the community respond quickly and effectively to unexpected events like natural disasters, medical emergencies, or security threats. The paper will discuss the roles of structured training programs, well-established command-and-control structures, and simulation-based exercises in disaster preparedness and response capacity building. The study employed a qualitative methodology approach by analyzing evidence based on existing literature reviews to establish the best practices and gaps that remained unaddressed in emergency management, public health, and safety science research. The results indicated that standardized incident command systems, integrated training and routine multi-agency simulation drills are an effective way of improving coordination, decision-making, and operational readiness.

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Abstract:

Citizen participation is a cornerstone of primary healthcare, as enshrined in the Alma-Ata and Astana Declarations. In the Democratic Republic of Congo, Community Action Centers (CACs) were established to strengthen community involvement in the health system. However, little empirical data documents their effectiveness. This descriptive cross-sectional evaluative study examined 408 CACs in the South Kivu province. Data were collected using a structured questionnaire and analyzed using descriptive statistics, supplemented by chi-square and Fisher's exact tests at the 5% significance level. The results show that each CAC has an average of 7 to 8 members, predominantly male (71%), and covers approximately 321 households (2,249 inhabitants). Their participation in community health activities is almost universal: household enumeration (99.8%), home visits (99.8%), and case referrals (99.8%). Organizationally, functionality is high: 100% hold monthly meetings and 99.8% have a community action plan. However, limitations persist: 69% report a lack of material resources and 98.8% have no income-generating activities. The revitalization of Community Action Committees (CACs) has significantly strengthened community participation and local health governance in South Kivu. Nevertheless, their sustainability remains compromised by material constraints and limited economic empowerment. These results underscore the importance of supporting CACs with appropriate resources and self-financing mechanisms to consolidate their role in the health system.

References:

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[21].  Malenga T, Griffiths F, Van Den Berg M, Phiri KS, Manda-Taylor L, Umar E. Community animation and malaria control. Glob Health. 2020;16(1):25.

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[24].  Kafflouman KS, Soulama F, Kalumendo R, Ouoba B, Songa JA, Kinda M, et al. Evaluation of post-training monitoring of CHWs. Texila Int J Public Health. 2023;11(3):294-304.

Abstract:

The COVID-19 pandemic exposed systemic weaknesses in national health security, particularly in low- and middle-income countries with limited surge capacity and complex governance structures. In Bangladesh, one of the world’s most densely populated settings, these vulnerabilities were evident in delayed case detection, strained health service capacity during peak transmission, and unequal access to care. This study presents a systematic assessment of Bangladesh’s health security preparedness and response to the COVID-19 pandemic using a mixed-methods synthesis of 393 sources, including peer-reviewed studies, government reports, and international agency publications. Analysis was guided by the International Health Regulations (IHR 2005) framework and health system resilience principles. Pre-pandemic readiness was moderate (SPAR 63% in 2019; JEE 48% in 2016), and diagnostic capability was initially limited to a single PCR laboratory. Although testing capacity expanded to more than 200 facilities by mid-2021, overall testing remained low (13.6 per 1,000 population) and positivity rates remained high (14.8%), suggesting underdetection. Critical care capacity was also limited, with 1,169 ICU beds nationwide and a concentration in urban areas. During the Delta surge, oxygen demand exceeded 200 tons per day, and the case fatality rate reached 2.46%. Despite these constraints, vaccination coverage exceeded 74% by the end of 2022. Persistent challenges included healthcare worker infections (9.3%), coordination inefficiencies, misinformation, and inequities affecting vulnerable populations. Strengthening national health security in Bangladesh will require sustained investment in surveillance, laboratory systems, critical care infrastructure, coordination mechanisms, risk communication, and equitable service delivery for effective preparedness and response

References:

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Abstract:

South Sudan’s health system is still extremely reliant on donor funding, and calls into question the sustainability of core health services in light of their existence in fragile areas and conflict settings. This study explored the impact of donor financing on the sustainability of health services in the Greater Mundri Counties of Western Equatoria State, South Sudan, as well as on infrastructure, community stakeholder engagement, and health resource management, using donor-funded resources. We used a descriptive cross-sectional mixed-methods approach utilizing quantitative surveys in conjunction with qualitative key informant interviews and focus-group discussions to gather insights from health workers, community representatives, local health administrators. Quantitative data were analyzed using STATA 14 and qualitative results analyzed using thematic analysis to complement the statistical data. The results revealed a positive association for donor-driven financing (r = 0.242, p = 0.007) and donor-supported infrastructure (r = 0.207, p = 0.022) with perceived health-service sustainability while community stakeholder engagement demonstrated only a weak and non-significant relationship (r = 0.100, p = 0.273). Effective use of available health resources was the most strongly associated with sustainability (r = 0.368, p < 0.001) Multivariate regression indicated that sustainability depended mainly on donor funding and resource efficiency, while donor reliance became insignificant when factors were controlled. To ensure long-term sustainability, the focus should be on improving resource management and financial accountability, and on developing local capabilities to reduce dependence on donor funding.

References:

[1].   Widdig H, Tromp N, Lutwama GW, Jacobs E. The political economy of priority-setting for health in South Sudan: A case study of the health pooled fund. Int J Equity Health. 2022;21:68. https://doi.org/10.1186/s12939-022-01665-w

[2].   Qaddour A, Yan L, Wendo D, Elisama L, Lindahl C, Spiegel P. Leadership and governance, financing, and coordination and their impact on the operationalization of health interventions in the humanitarian-development nexus in South Sudan. PLoS One. 2025;20(5). https://doi.org/10.1371/journal.pone.0312788

[3].   Apeagyei AE, Lidral-Porter B, Patel N, Solorio J, Tsakalos G, Wang Y, et al. Financing health in sub-Saharan Africa 1990–2050: Donor dependence and expected domestic health spending. PLOS Glob Public Health. 2024;4(8):e0003433.

[4].   Karamagi H, Njuguna D, Kidane SN, Djossou H, Kipruto H, Seydi ABW, et al. Financing health system elements in Africa: A scoping review. PLoS One. 2023;18(9). https://doi.org/10.1371/journal.pone.0291371

[5].   Kabongo WNS, Mbonigaba J. Public health spending in Sub-Saharan Africa: Exploring transmission mechanisms using the latent growth curve mediation model. Health Econ Rev. 2024;14(1):14. https://doi.org/10.1186/s13561-023-00472-5

[6].   World Health Organization. Public financing for health in Africa: From Abuja to the SDGs [Internet]. Geneva: WHO; 2016 [cited 2021 Jan 17]. Available from: https://apps.who.int/iris/bitstream/handle/10665/249527/WHOHIS-HGF-Tech.Report-16.2-eng.pdf?sequence=1

[7].   Ogbuoji O, Bharali I, Nonvignon J, Yamey G. How can middle-income countries successfully transition away from international health aid? PLoS Med. 2025;22(11).

[8].   Asante A, Wasike WSK, Ataguba JE. Health financing in Sub-Saharan Africa: From analytical frameworks to empirical evaluation. Appl Health Econ Health Policy. 2020;18(6):743. https://doi.org/10.1007/s40258-020-00618-0

[9].   Ibrahim ME, Saulnier DD, Blanchet K. Short-term aid or long-term gains? Harnessing Sudan’s humanitarian response for the resilience of its health system. Lancet Glob Health. 2024;12(7). https://doi.org/10.1016/s2214-109x(24)00128-1

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[15].  Son B, Roscoe S, Sodhi MS. Dynamic capabilities of global and local humanitarian organizations with emergency response and long-term development missions. Int J Oper Prod Manag. 2024. https://doi.org/10.1108/ijopm-12-2022-0778

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[20].  Hussein SA, Ali A, Osman MM, Ibrahim AM, Adem R, Hassan MM, et al. Prolonged multispectral aid-driven reliance on health systems and governance post-conflict era in Somalia. Trop Med Health. 2026;54(1):10. https://doi.org/10.1186/s41182-025-00861-y

Abstract:

Breast cancer (BC) and cervical cancer (CC) remain significant public health challenges in Nigeria, particularly in rural communities with limited access to screening services. This cross-sectional study assessed knowledge, attitudes, perceptions, and practices related to BC and CC screening among 333 consenting women aged ≥30 years in rural communities of the Federal Capital Territory, Nigeria, between October and December 2024. Data were collected using a semi-structured questionnaire, with scores below the mean categorized as poor knowledge, negative attitude, and poor practice. Data management was conducted using REDCap, and analyses were performed using Stata MP version 18, with statistical significance set at p < 0.05. The mean age of participants was 39.95 ± 9.02 years, and 59.8% were aged below 40 years. Good knowledge of BC screening was observed in 57.0% of participants, whereas 77.0% demonstrated poor knowledge of CC screening. Positive attitudes toward BC and CC screening were reported by 57.0% and 63.7% of participants, respectively. Higher educational attainment and Igbo ethnicity were significantly associated with good knowledge of BC and CC screening, while younger age and Yoruba ethnicity were associated with better CC screening practices. Despite generally positive attitudes, substantial gaps in knowledge, particularly regarding CC screening, persist. Strengthening community-based health education, integrating cancer screening into primary healthcare services, and implementing culturally appropriate interventions are essential policy measures to improve screening uptake and promote early detection in rural Nigerian populations.

References:

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[2].   World Health Organization. Human papillomavirus (HPV) and cervical cancer. Geneva: World Health Organization; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer.

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[4].   Olayide A, Isiaka A, Ganiyu R, Samuel O, Halimat A, Olalekan O, et al. Breast cancer treatment and outcomes in Nigeria: a systematic review and meta-analysis. Asian Pac J Cancer Care. 2023;8(3):591-8. https://doi.org/10.31557/apjcc.2023.8.3.591-598.

[5].   Ola OI, Okunowo AA, Habeeb MY. Mortality risk stratification based on comorbidity status among cervical cancer patients in Lagos, Nigeria. Int Health. 2025;17. https://doi.org/10.1093/inthealth/ihaf008.

[6].   Olasehinde O, Alatise O, Omisore A, Wuraola F, Odujoko O, Romanoff A, et al. Contemporary management of breast cancer in Nigeria: insights from an institutional database. Int J Cancer. 2021;148(12):2906-14. https://doi.org/10.1002/ijc.33484.

[7].   Feng Y, Spezia M, Huang S, Yuan C, Zeng Z, Zhang L, et al. Breast cancer development and progression: risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis. 2018;5(2):77-106. https://doi.org/10.1016/j.gendis.2018.05.001.

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[11].  Okolie EA, Aluga D, Anjorin S, Ike FN, et al. Addressing missed opportunities for cervical cancer screening in Nigeria: a nursing workforce approach. Ecancermedicalscience. 2022;16:1373.

[12].  Omisore AD, Olalekan O, Wuraola FO, Sutton EJ, et al. Improving access to breast cancer screening and treatment in Nigeria: the triple mobile assessment and patient navigation model (NCT05321823). Study protocol. 2023.

[13].  Rocha NSS, Clara BM, Luz LMM, Martins MRO. Knowledge, attitudes and practices of cervical cancer screening among female students in Cabo Verde. Ecancermedicalscience. 2024;18:1689.

[14].  Kinteh B, Kinteh SLS, Jammeh A, Touray E, Barrow A. Breast cancer screening: knowledge, attitudes, and practices among female university students in the Gambia. Biomed Res Int. 2023;2023:9239431. https://doi.org/10.1155/2023/9239431.

[15].  Okaba E. Knowledge, attitude and practice concerning cervical cancer screening among reproductive-age women in Yenagoa, Bayelsa State. Niger Med J. 2024;65(4):512-23. https://doi.org/10.60787/nmj-v65i3-492.

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[18].  Okoroiwu GIA, Ubosi NI, Aliyu SM, Eya CP. Knowledge, attitude and practice of exclusive breastfeeding among mothers in Abuja, Nigeria. J Appl Sci Environ Manag. 2021;25(1):127-32. https://doi.org/10.4314/jasem.v25i1.18.

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[20].  Tilaki KH, Auladi S. Awareness, attitude, and practice of breast cancer screening among women in Northern Iran. Iran J Cancer. Year not stated.

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[25].  Chaka B, Sayed AR, Goeieman B, Rayne S. Knowledge and attitudes relating to cervical and breast cancer among women in Ethiopia. BMC Public Health. 2018;18:1072. https://doi.org/10.1186/s12889-018-5958-8.

[26].  Abdou A, Van Hal G, Dille I. Awareness, attitudes and practices of women in relation to breast cancer in Niger. Heliyon. 2020;6(7). https://doi.org/10.1016/j.heliyon.2020.e04316.

[27].  Olowokere AE, Onibokun AC, Oluwatosin OA. Breast cancer knowledge and screening practices among rural Nigerian women. J Public Health Epidemiol. 2012;4(9):238-45.

[28].  Nde FP, Assob JC, Kwenti TE, Njunda AL, Tainenbe TR. Knowledge, attitude and practice of breast self-examination among female undergraduates in Cameroon. BMC Res Notes. 2015;8:43.

[29].  Casmir EC, Anyalewechi NE, Onyeka IS, Agwu AC, Regina NC. Knowledge and practice of breast self-examination among female undergraduates in Nigeria. Health. 2015;7:1134.

[30].  Sakwa GO, Bukhala P, Kwena Z, Kipmerewo M. Knowledge, attitude and practices in cervical cancer screening in Kakamega County, Kenya. J Health Med Nurs. 2021;7(5):51-66.

[31].  Atnafu DD, Khatri R, Assefa Y. Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis. Health Res Policy Syst. 2024;22:21. https://doi.org/10.1186/s12961-023-01094-3.

[32].  Terefe Y, Gaym A. Knowledge, attitude and practice of cervical cancer screening among reproductive health clients in Ethiopia. Ethiop J Reprod Health. 2008;2:14-17.

[33].  Tadesse A, Tafa MS, Demissie HF. Knowledge, attitude and practice toward cervical cancer screening among Ethiopian university students. Int J Breast Cancer. 2022;2022:2490327. https://doi.org/10.1155/2022/2490327.

[34].  Lu J, Ren H, Liu Y, Wang Y, Rong Y, Wang Y, et al. Knowledge, attitude, and willingness toward breast magnetic resonance imaging screening among women at high risk of breast cancer in Beijing, China. BMC Public Health. 2024;24:2909. https://doi.org/10.1186/s12889-024-20370-7.

[35].  Bamidele OO, Egonu CC, Oladejo RA. Knowledge and screening practices for breast cancer among women of reproductive age. Int J Community Med Public Health. 2024;11(4):1437-42.

[36].  Al-Mousa DS, Spuur K, Attar R, Kleib I, Alakhras M. Knowledge, attitudes, and practices related to breast cancer screening among Jordanian university employees. Radiography. 2024;30(1):258-64. https://doi.org/10.1016/j.radi.2023.11.004.

[37].  Tebeu PM, Mihindou J, Ngou-Milama E, Kouanfack C, Mavoungou C, Essiben F, et al. Knowledge, attitudes and practices among midwives on cervical cancer screening in Brazzaville, Republic of Congo. Pan Afr Med J. 2020;36:88.

[38].  Tibenderana JR, Kessy SA, Mlaponi DF, Mwaitete NL, Mtenga JE. Predictors of breast cancer screening among women of reproductive age in Tanzania. PLoS One. 2024;19(11). https://doi.org/10.1371/journal.pone.0298996.

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Abstract:

By 2025, UNAIDS mandates that 95% of PLHIV know their status, 95% of those diagnosed receive ART, and 95% on ART achieve viral suppression — within all populations and geographies. Cameroon, with 480,232 PLHIV as of 2022, has demonstrated measurable progress, yet a sub-population-disaggregated synthesis remains absent from the literature. A PRISMA 2020-compliant systematic review and meta-analysis of studies published between 2017 and 2023 was conducted across six electronic databases and grey literature sources. Of 2,199 records identified, 136 met inclusion criteria, with 89 contributing to meta-analysis. Proportions were logit-transformed and pooled using random-effects models. The first 95 improved from 55.6% (95% CI: 51.2–59.9%) at CAMPHIA 2017–2018 baseline to approximately 90% by Spectrum 2023 estimates. The second 95 reached approximately 99% among diagnosed PLHIV nationally, reflecting successful operationalisation of the Universal Treat-All policy. The third 95 progressed from 80.0% to approximately 89%, remaining below target. Viral load monitoring coverage was critically low at 24.3%, virologic failure affected 20.6% on ART, and only 13.2% of HIV health centres provided key population-specific services. Cameroon demonstrates strong national cascade progress, particularly in the first and second 95s. The primary remaining barrier is inadequate viral load monitoring and failure management underlying the third-95 deficit. Targeted investment in viral load scale-up, adolescent-specific care, and key population service delivery is required to meet the UNAIDS equity mandate within all populations.

References:

[1].   UNAIDS. 2021 Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. New York: United Nations; 2021. Available from: https://www.unaids.org

[2].   WHO AFRO. Cameroon making progress in the fight against HIV. Brazzaville: WHO Regional Office for Africa; 2023. Available from: https://www.afro.who.int/countries/cameroon

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Abstract:

Rational antibiotic prescribing is crucial in paediatric healthcare to combat antimicrobial resistance. Children under five years face the highest risk of morbidity and mortality from infections, and account for a significant proportion of antimicrobial use. This study assessed antibiotic use among hospitalised children under five years at two tertiary paediatric hospitals in Zambia. A prospective audit was conducted on 385 eligible inpatient files at the University Teaching Hospitals – Children’s Hospital (UTHs-CH) and Arthur Davison Children’s Hospital (ADCH). Demographic data, prescribing patterns, antibiotic classes, and WHO AWaRe classifications were analysed. Of the 385 patients, 56.7% were male, with a mean age of 6.21 months among children under two years, who formed the majority (61.9%). Antibiotic prescribing prevalence was 81.3% overall, significantly higher at ADCH (88.8%) than UTH-CH (73.2%, p < 0.0001). Most prescriptions were single-agent therapies (77.1%), with treatment duration ranging from 1 to 18 days (mean 9.5 days). A total of 388 antibiotic prescriptions were recorded, equating to 133.7 Days of Therapy (DOT)/100 patient-days. Intravenous administration dominated (89.4%). The most commonly prescribed antibiotics were benzyl penicillin (42.8%) and ceftriaxone (34.5%). ADCH favoured "Access" group antibiotics (68.5%), whereas UTH-CH predominantly prescribed "Watch" group agents (66.3%). No antibiotics from the "Reserve" group were prescribed. There was statistically significant variation in antibiotic choice and prescribing frequency between the two hospitals across several wards. This audit reveals high antibiotic prescribing rates with significant inter-hospital and inter-departmental variation. There is an urgent need to strengthen antimicrobial stewardship programmes tailored to paediatric care in Zambia.

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Abstract:

Food safety has long been a subject of research, with street food forming a weak link in food safety supervision. While street food offers convenience and livelihood for the majority of low-income earners, it is associated with food-borne illnesses. This calls for educating street food vendors on how to maintain food hygiene and safety. On this background, this study evaluates the effectiveness of public health-based hygiene education on behavioral attitudes of Botswana street vendors towards safer food handling. The study deploys mixed research methods where interviews were used to gather qualitative data and online survey questionnaires collected quantitative data from about 100 street food vendors in Gaborone, Botswana. Qualitative data are analysed using thematic analysis, while quantitative data are analysed using descriptive and inferential statistics. Analysis of research findings showed that public health hygiene education is associated with street food vendors' knowledge and awareness of safe food handling practices, such as handwashing with soap, food protection, utensil hygiene, and storage awareness. Gender, educational level, income, regular inspections, and access to water were identified as factors affecting food hygiene practices. Additionally, the study found that public health-based hygiene education is associated with the behavioural attitudes of street food vendors in Gaborone. More importantly, the research established that public health-based hygiene education is associated with behavioural attitudes of Botswana’s street food vendors towards safer food handling practices. The study suggests suitable recommendations to improve street food safety in Gaborone.

References:

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Abstract:

Adolescent mothers (10–19 years) form a vulnerable group implicated in yearly child bearing worldwide. The consequences surrounding teenage motherhood is a crucial public health concern. Adolescent mothers face numerous challenges which affect their mental health. Such situation can be magnified in conflict zones. This study aims to explore the challenges, resilience, coping strategies and support system of teenage mothers in Limbe and Buea Health Districts. A community-based qualitative study was conducted in both Limbe and Buea health district. 60 teenage mothers from the two health districts were recruited. Focus group discussion (FGD) and in-depth interview (IDI) were conducted using an interview guide. Proceedings were recorded, transcribed and analysed using thematic analysis with the support of AtlasTi 5.2. The findings revealed the challenges faced by teenage mothers that ranged from financial difficulties to attempt to suicide. Their adaptive coping ranged from hard working to change of environment while the maladaptive coping comprised social withdrawal, substance abuse and promiscuity. Their support system was weak and unsustainable, ranging from community to parental care. This study enabled us to know the challenges faced by teenage mothers, their coping ability and resilience as well as the support system. To provide optimal support, it is crucial to develop community-specific initiatives, utilize local resources, enhance talent development, and increase community involvement; this will ensure the comprehensive development of the teenage mothers

References:

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[22].  Lotse CW. Exploring Experiences of Pregnant Adolescents and Their Utilization of Reproductive Health Services in Ho West District, Ghana - A Salutogenic Approach. 2016.

[23].  United Nations Statistics Division’s Open SDG Data Hub. Global sustainable development platform. 2022. https://sdg.tracking-progress.org/indicator/3-7-2-adolescent-birth-rate/

[24].  Yussif AS, Lassey A, Ganyaglo GYK, Kantelhardt EJ, Kielstein H. The long-term effects of adolescent pregnancies in a community in Northern Ghana on subsequent pregnancies and births of the young mothers. Reprod Health. 2017;14(1):178-. https://doi.org/10.1186/S12978-017-0443-X

[25].     Boateng AA, Botchwey COA, Adatorvor BA, Baidoo MA, Boakye DS, Boateng R. A phenomenological study on recurrent teenage pregnancies in Effutu Municipality, Ghana: the experiences of teenage mothers. BMC Public Health. 2023;23(1). https://doi.org/10.1186/S12889-023-15074-3

Abstract:

Antimicrobial resistance (AMR) poses a significant threat to global health, particularly in fragile and humanitarian settings where governance structures are weak and health systems are overstretched. Antimicrobial Stewardship (AMS) programs are key interventions for rational antibiotic use, yet they remain underdeveloped in such contexts. This study explored governance, leadership, and integration challenges affecting AMS implementation within the Cox's Bazar humanitarian health system in Bangladesh, one of the world's largest refugee response settings. A qualitative, exploratory design was adopted using data from 18 Key Informant Interviews (KIIs) and 6 Focus Group Discussions (FGDs) with program managers, clinicians, pharmacists, laboratory specialists, and NGO representatives across 12 health facilities. Data were transcribed, coded, and thematically analyzed using NVivo 12. The WHO Health System Building Blocks and Systems Resilience Framework guided analysis. Five overarching themes emerged: leadership commitment and accountability gaps; fragmented coordination across agencies; weak integration of AMS with IPC and One Health approaches; limited laboratory and data systems; and donor-driven short-term priorities. Participants emphasized that improved interagency governance, institutional leadership, and donor alignment are critical for embedding AMS into humanitarian response frameworks. AMS implementation in fragile humanitarian contexts like Cox's Bazar is constrained by systemic governance gaps, limited leadership accountability, and poor cross-sectoral integration. Strengthening stewardship requires a coordinated, One Health-aligned governance model embedded within national AMR frameworks and sustained by donor harmonization.

References:

[1].   Nour M, Ismail A, Osman R. Antimicrobial resistance and unregulated antibiotic use in humanitarian crises. Int J Infect Dis. 2021;108:473-80. https://doi.org/10.1016/j.ijid.2021.05.063

[2].   Bhattacharya S, Siddiqui S, Rahman MM. Health-system performance and antimicrobial use in Rohingya refugee camps, Bangladesh. BMC Public Health. 2023;23(1):1457.

[3].   Directorate General of Health Services (DGHS), World Health Organization (WHO). Health Sector Bulletin – Cox's Bazar Response Q1 2024. Dhaka and Geneva; 2024.

[4].   Cox's Bazar Health Sector. Cox's Bazar Health Sector Bulletin – May 2024. 2024. https://rohingyaresponse.org

[5].   World Health Organization (WHO). Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: A practical toolkit. Geneva: WHO; 2019.

[6].   Centers for Disease Control and Prevention (CDC). Core elements of hospital antibiotic stewardship programs. Atlanta, GA: CDC; 2017.

[7].   Khan MS, Rego S, Hassan R. Implementing antimicrobial stewardship in fragile health systems: Challenges and innovations from humanitarian contexts. J Glob Health. 2022;12:03045. https://doi.org/10.7189/jogh.12.03045

[8].   Moulin E, Tadesse E, Berhane Y. Strengthening antimicrobial stewardship in low-resource and crisis-affected settings. BMJ Glob Health. 2023;8(2).

[9].   Chatterjee A, Mohanty S, Bhatt N. AMR in conflict-affected countries of South and Southeast Asia: A systematic review. J Infect. 2023;86(3):231-40.

[10].  Klein EY, Milkowska-Shibata M, Tseng KK, Sharland M, Gandra S, Laxminarayan R. Assessment of WHO antibiotic consumption data in 76 countries, 2000–2018. Lancet Infect Dis. 2021;21(1):107-15. https://doi.org/10.1016/S1473-3099(20)30332-7

[11].  Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and health systems in fragile settings: A review of the evidence. Health Policy Plan. 2017;32(3):356-73. https://doi.org/10.1093/heapol/czw170

[12].  Truppa C, Singh NS, Blanchet K. Health-systems resilience in fragile and conflict-affected settings: A systematic scoping review. Confl Health. 2024;18(1):3. https://doi.org/10.1186/s13031-023-00560-7

[13].  Reid MJA, Vallières E, Ousman K. Health-system fragility and antimicrobial stewardship: Challenges in sub-Saharan Africa. BMJ Glob Health. 2023;8(4). https://doi.org/10.1136/bmjgh-2022-010512

[14].  Larsson DGJ, Fick J. Environmental resistance selection and the global spread of AMR. Nat Commun. 2023;14(1):1234.

[15].  Ministry of Health and Family Welfare (MoHFW). National Action Plan for Antimicrobial Resistance Containment. 2017–2022, extended to 2025. Dhaka: Government of Bangladesh; 2023.

[16].  World Health Organization (WHO). AWaRe antibiotic book: Practical guide on the safe, effective and responsible use of antibiotics. Geneva: WHO; 2021.

[17].  World Health Organization (WHO). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2023. Geneva: WHO; 2023.

[18].  World Health Organization (WHO). Monitoring the building blocks of health systems: A handbook of indicators. Geneva: WHO; 2010.

[19].  Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the SDG era: Time for a revolution. Lancet Glob Health. 2018;6(11). https://doi.org/10.1016/S2214-109X(18)30386-3

[20].  Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4th ed. Sage; 2018.

[21].  UNHCR, Government of Bangladesh (GoB). Joint Government of Bangladesh–UNHCR Population Factsheet: June 2024. 2024. https://data.unhcr.org/en/country/bgd

[22].  Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS One. 2020;15(5). https://doi.org/10.1371/journal.pone.0232076

[23].  Berger R. Now I see it, now I don't: Researcher's position and reflexivity in qualitative research. Qual Res. 2015;15(2):219-34. https://doi.org/10.1177/1468794112468475

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

[25].  Lincoln YS, Guba EG. Naturalistic inquiry. Sage; 1985.

[26].  World Health Organization (WHO). Ethical standards for research during public health emergencies. Geneva: WHO; 2020.

[27].  Pauwels I, Versporten A, Ashiru-Oredope D, Costa SF, Maldonado H, Porto APM, et al. Implementation of hospital antimicrobial stewardship programmes in low- and middle-income countries: A multi-professional perspective. Antimicrob Resist Infect Control. 2025;14(1):26. https://doi.org/10.1186/s13756-025-01541-6

[28].  Al-Chami N, Makhoul M, Raad F. Antimicrobial prescribing patterns in refugee health settings in Lebanon and Jordan. J Infect Public Health. 2022;15(8):908-15. https://doi.org/10.1016/j.jiph.2022.05.010

[29].  Kiggundu R, Ouko J, Tadesse E. Digital transformation for antimicrobial stewardship in East Africa. Afr J Health Syst. 2022;11(4):202-14.

[30].  Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet. 2022;399(10325):629-55. https://doi.org/10.1016/S0140-6736(21)02724-0

Abstract:

The preponderance of antiretroviral therapy has significantly curtailed HIV-related morbidity and mortality globally but maintaining favourable treatment outcomes in conflict-affected and fragile settings remains a daunting challenge. South Sudan represents one of the most fragile health system environments globally, yet qualitative evidence examining how frontline providers experience and navigate the determinants of HIV treatment outcomes remains scarce. This study aims to explore health system, social, cultural, and economic pathways affecting antiretroviral treatment outcomes among people living with HIV receiving care at primary health care facilities in Central Equatoria State. This study involves key informant interviews with health care providers and facility managers across six primary health care centres delivering antiretroviral therapy services and the data was analyzed using reflexive thematic analysis. Six interrelated themes emerged: uneven patient load and service pressures; complex patient needs and under-recognized mental health issues; cultural beliefs and pluralistic health-seeking practices; stigma, disclosure, and social relationships; economic precarity as a cross-cutting constraint; and health system strategies, innovations, and structural limitations. Providers described how these factors interact to shape adherence, retention, and continuity of care, often in ways that extend beyond individual patient behaviour. The findings highlight the need for HIV programmes in fragile settings to adopt integrated, system-sensitive approaches that address social and economic vulnerabilities alongside biomedical treatment.

References:

[1].   UNAIDS. Global HIV & AIDS statistics: 2023 fact sheet [Internet]. 2023. Available from: https://www.unaids.org

[2].   Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era. Lancet Glob Health. 2018;6(11):e1196-e1252.

[3].   World Bank. South Sudan economic update: Poverty and vulnerability in a fragile state. Washington (DC): World Bank Group; 2022.

[4].   Gilson L, Barasa E, Nxumalo N, Cleary S, Goudge J, Molyneux S, et al. Everyday resilience in district health systems. Health Policy Plan. 2020;35(9):1081-1090.

[5].   Sheikh K, Abimbola S, Gilson L. A systems perspective on health policy implementation. Health Policy Plan. 2022;37(Suppl 1):i1-i5. https://doi.org/10.1093/heapol/czac019.

[6].   OCHA. South Sudan humanitarian needs overview. New York: United Nations Office for the Coordination of Humanitarian Affairs; 2023.

[7].   World Health Organization. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care. Geneva: WHO; 2021.

[8].   Lehmann U, Gilson L. Actor interfaces and practices of power in health systems. Health Policy Plan. 2020;35(Suppl 2):ii1-ii6. https://doi.org/10.1093/heapol/czaa145.

[9].   Bloom G, Wilkinson A, Tomson G, Awor P, Zhang X, Topp SM. Addressing health system constraints in low-income and fragile settings. Health Policy Plan. 2021;36(Suppl 1):i1-i6. https://doi.org/10.1093/heapol/czaa182.

[10].  Kouamé GM, Larmarange J, Sakarovitch C, N’guessan R, Coulibaly A, Danel C, et al. HIV care outcomes in conflict-affected settings. J Int AIDS Soc. 2020;23(4):e25463. https://doi.org/10.1002/jia2.25463.

[11].  Spiegel PB, Bennett C, Hering H. HIV and conflict: A double emergency. Lancet. 2021;397(10282):2025-2027.

[12].  Patel P, Kelly J, Bhandari S, Amouzou A, Agho K. HIV service delivery in humanitarian settings. BMJ Glob Health. 2021;6(Suppl 5):e005149.

[13].  Ford N, Migone C, Calmy A, Kerschberger B, Kanters S, Nsanzimana S, et al. Benefits and risks of rapid initiation of antiretroviral therapy. AIDS. 2022;36(1):1-10. https://doi.org/10.1097/QAD.0000000000003084.

[14].  Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533-544. https://doi.org/10.1007/s10488-013-0528-y.

[15].  Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-597. https://doi.org/10.1080/2159676X.2019.1628806.

[16].  Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies. Qual Health Res. 2016;26(13):1753-1760. https://doi.org/10.1177/1049732315617444.

[17].  Kallio H, Pietilä AM, Johnson M, Kangasniemi M. Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954-2965. https://doi.org/10.1111/jan.13031.

[18].  Braun V, Clarke V. Thematic analysis: A practical guide. London: SAGE Publications; 2021.

[19].  Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research. Int J Qual Health Care. 2007;19(6):349-357. https://doi.org/10.1093/intqhc/mzm042.

[20].  Brandt R. The mental health of people living with HIV/AIDS in Africa: A systematic review. Afr J AIDS Res. 2009;8(2):123-133. https://doi.org/10.2989/AJAR.2009.8.2.1.853.

[21].  World Health Organization. Guidelines on mental health at work. Geneva: WHO; 2022.

[22].  Moshabela M, Sips I, Barten F. Needs assessment for home-based care and the role of traditional health practitioners in HIV care. BMC Public Health. 2016;16:234.

[23].  Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma. BMC Med. 2017;17:7. https://doi.org/10.1186/s12916-018-1246-9.

[24].  Pantelic M, Steinert JI, Park J, Mellors S, Murau F. Management of a spoiled identity: Systematic review of interventions to address HIV-related stigma. AIDS. 2020;34(Suppl 1):S1-S15. https://doi.org/10.1097/QAD.0000000000002433.

[25].  Weiser SD, Palar K, Frongillo EA, Tsai AC, Kumbakumba E, DePee S, et al. Longitudinal assessment of food insecurity and ART adherence. AIDS. 2014;28(5):763-772. https://doi.org/10.1097/QAD.0000000000000133.

[26].  Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV: A systematic review. Am J Public Health. 2016;106(1):e1-e23. https://doi.org/10.2105/AJPH.2015.302905.

[27]. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: WHO; 2016.

Abstract:

Routine immunization is a fundamental public health strategy for preventing vaccine-preventable diseases and reducing childhood morbidity and mortality; however, coverage levels in many parts of Nigeria remain below recommended targets. This study assessed routine immunization performance in Kogi State using a five-year retrospective analysis of data obtained from the District Health Information Software 2 (DHIS2) across 21 Local Government Areas. Secondary data on antigen-specific coverage, dropout rates, and fully immunized child indicators were analyzed alongside key health system variables guided by the World Health Organization health system framework. Descriptive statistics were used to evaluate trends over time, while chi-square and logistic regression analyses were conducted to identify determinants of immunization performance. The findings revealed a steady increase in coverage for all antigens during the study period; however, Penta3 and measles coverage remained below the 90% benchmark. Significant disparities were observed across LGAs, and dropout rates between vaccine doses exceeded acceptable thresholds, indicating challenges in service continuity. Health system factors, including regular immunization sessions, availability of trained health workers, quality of data reporting, functional cold chain systems, and supportive supervision, were identified as significant predictors of routine immunization performance. The study concludes that strengthening key health system components is essential for improving immunization coverage and achieving equitable outcomes across all LGAs in Kogi State.

References:

[1].   World Health Organization. Immunization coverage. Lancet. 2023;401(10379):1001-10.

[2].   United Nations Children's Fund. State of the World's Children 2022. New York: UNICEF; 2022.

[3].   Gavi, The Vaccine Alliance. Global immunization progress report. Vaccine. 2023;41(12):1890-5. https://doi.org/10.1016/j.vaccine.2023.02.015

[4].   National Primary Health Care Development Agency. National routine immunization coverage survey. Abuja, Nigeria: NPHCDA; 2022.

[5].   National Bureau of Statistics. Multiple Indicator Cluster Survey 2021. Abuja, Nigeria: NBS; 2022.

[6].   Antai D. Inequitable childhood immunization uptake in Nigeria. Int J Health Geogr. 2020;11(1):1-10. https://doi.org/10.1186/1476-072X-11-1

[7].   Measure Evaluation. District Health Information Software 2 (DHIS2) overview. Health Policy Plan. 2020;35(6):765-72. https://doi.org/10.1093/heapol/czz123

[8].   Nicol E, Bradshaw D, Phillips T, Dudley L. Human factors affecting data quality. BMC Health Serv Res. 2019;19(1):1-9.

[9].   AbouZahr C, Boerma T. Health information systems: the foundations. Lancet. 2020;386(9991):2063-73. https://doi.org/10.1016/S0140-6736(15)60171-4

[10].  World Health Organization. Monitoring the building blocks of health systems. Geneva: WHO Press; 2010.

[11].  Peters D, Garg A, Bloom G, Walker D, Brieger W, Rahman M. Implementation research. BMJ. 2013;347:f6753. https://doi.org/10.1136/bmj.f6753

[12].  Brown D, Burton A, Gacic-Dobo M, Karimov R, Vandelaer J. Global immunization coverage trends. Vaccine. 2019;37(2):237-45. https://doi.org/10.1016/j.vaccine.2018.11.001

[13].  Oku A, Oyo-Ita A, Glenton C, Fretheim A, Eteng G, Ames H, Muloliwa A, Kaufman J, Hill S. Factors affecting immunization. BMC Public Health. 2017;17(1):1-12.

[14].  Bangura J, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization. Vaccine. 2020;38(2):1-8. https://doi.org/10.1016/j.vaccine.2019.10.088

[15].  Wiysonge C, Uthman O, Ndumbe P, Hussey G. Interventions to improve immunization coverage. Cochrane Database Syst Rev. 2019;(6):CD008145. https://doi.org/10.1002/14651858.CD008145.pub3

[16].  Gera R, Shah D, Garner P, Richardson M, Sachdev H. Strategies for increasing vaccination coverage. Cochrane Database Syst Rev. 2019;(5):CD003941. https://doi.org/10.1002/14651858.CD003941.pub3

[17].  Adeyinka D, Oladimeji O, Adeyinka F, Aimakhu C. Uptake of childhood immunization in Nigeria. BMC Public Health. 2019;9(1):1-8. https://doi.org/10.1186/1471-2458-9-381

[18].  Fatiregun A, Okoro A. Maternal determinants of immunization. Afr J Med Med Sci. 2018;47(2):45-52.

[19].  Oladokun R, Lawoyin T. Determinants of immunization coverage in Nigeria. Niger J Paediatr. 2021;48(3):1-9.

[20].  Iwu A, Duru C, Uwakwe K, Diwe K, Chineke H, Merenu I. Knowledge and uptake of immunization. Pan Afr Med J. 2020;35:12.

[21].  Ozawa S, Yemeke T, Evans D, Pallas S, Wallace A, Lee B. Defining hard-to-reach populations. Vaccine. 2021;39(45):6787-93. https://doi.org/10.1016/j.vaccine.2021.09.023

[22].  World Health Organization. Immunization Agenda 2030: a global strategy. Bull World Health Organ. 2021;99(5):1-10.

Abstract:

The human immunodeficiency virus (HIV) target and progressively impairs the function of the immune system leading to significant morbidity and mortality if untreated. Nigeria remains among the top countries with the highest burden of pediatric HIV infection. Despite the country’s achievements, coverage for Prevention of Mother to Child Transmission (PMTCT) is less than 33 per cent. The highest in the world. The purpose of this study is to determine the prevalence of HIV among HIV exposed infants whose mothers are receiving antiretroviral therapy (ART) across Military treatment facilities in Nigeria. The study was a retrospective cross-sectional analysis of secondary data from 13 military health facilities across 11 states in Nigeria. Mother–infant pair data sets from January 2022 to December 2024 were extracted and analyzed. Key variables included are Maternal/infant antiretroviral (ARV) services, viral load status of mothers at 32-36 gestation age/birth, early infant diagnosis (EID), and final infant HIV status. These parameters were reviewed/evaluated to identify predictors of mother-to-child transmission MTCT of HIV across the study sites. The prevalence of HIV among 552 HIV-exposed infants was 0.4%, with 49.28% male and 50.72% female. Among infants who did not receive ARV within 72 hours, 9.1% were HIV positive, while 0.2% of those who received ARV within 72 hours were HIV positive. The prevalence of HIV infection among infants born to HIV-positive mothers was lower than the national estimate of 2.7 and the global plan on breastfeeding mothers.

References:

[1].   Awoyemi AA, Olusegun EO. HIV epidemiology in Nigeria. 2018:1-8. Available from: https://www.researchgate.net/publication/301250559_HIV_epidemiology_in_Nigeria

[2].   Babatunde A, Bidemi HE, Martha O, Ahmad A, Nicaise N, Patrick D, et al. Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria. 2022;17(2):1-12. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8843197/

[3].   Destaye GK, Worknesh AB, Ayenew A. The prevalence of HIV-positive infants born to HIV-positive mothers attended at the University of Gondar Specialized Hospital anti-retroviral therapy services, Northwest Ethiopia. 2018;26(12):135-40. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7105366/

[4].   Cohen J. Mother-to-child transmission of HIV can be easily prevented, but in this country, many pregnant women don't even know they are infected. 2018. Available from: https://www.science.org/content/article/nigeria-has-more-hiv-infected-babies-anywhere-world-it-s-distinction-no-country-wants

[5].   Okusanya BO, Nweke CI, Akeju DO, Ehiri J. Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria. BMC Health Serv Res. 2023;23:1038:3-5. Available from: https://doi.org/10.1186/s12913-023-09824-7

[6].   Feleke H, Astawesegn ID, Haider M, Virginia S, Elizabeth C. Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: mixed methods systematic review and meta-analysis. PLoS One. 2024:1-32. Available from: https://doi.org/10.1371/journal.pone.0300606

[7].   Mulu LD, Muthupandian S, Haftamu H, Atsebaha GK, Nesredin FM, Alefech AG, et al. HIV prevalence and risk factors in infants born to HIV-positive mothers, measured by dried blood spot real-time PCR assay in Tigray, Northern Ethiopia. 2019;19(1):257. Available from: https://pubmed.ncbi.nlm.nih.gov/31349803/

[8].   Veneranda M, Bwana L, Mboera EG, Sayoki GM, Edgar S, Charles M. Prevalence and predictors of HIV infection among under five-year children born to HIV-positive mothers in Muheza District, North-Eastern Tanzania. 2022;4(1):29-35. Available from: https://easci.eahealth.org/easci/article/view/56

[9].   Benjamin O, Harriet N, Richards L, Moses O, Winnie K, Felix B. Breakthrough mother-to-child transmission of HIV in a low-health facility in Uganda. Sci Med. 2023;8(1):153-6. Available from: https://www.sciencedirect.com/science/article/pii/S2772707623000838

[10].  Destaye GK, Worknesh AB, Ayenew A. The prevalence of HIV-positive infants born to HIV-positive mothers attended at the University of Gondar Specialized Hospital anti-retroviral therapy services, Northwest Ethiopia. 2018. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7105366/

[11].  Gebrehiwot AT, Emawayish ZD. Prevalence of HIV infection and associated factors among infants born to HIV-positive mothers in health institutions, northwest Ethiopia. 2021;18(1):1-7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9373172/

[12].  Zelalem B, Fantu A, Molla G, Mulugeta T. Prevalence of HIV and associated factors among infants born to HIV-positive women in Amhara Region, Ethiopia. Int J Clin Med. 2014;5:464-74. Available from: https://www.researchgate.net/scientific-contributions/Fantu-Abebe-2109293994

[13].  Fasil M, Blen T, Ewenat GH, Yohannes G. Outcome of HIV-exposed infants towards prevention of mother-to-child transmission (PMTCT) program and its associated factors in selected health facilities of Addis Ababa, Ethiopia, 2020: a retrospective cross-sectional study. Pediatr Neonatol. 2024;65:457-63. Available from: https://doi.org/10.1016/j.pedneo.2023.07.009

[14].  Elyanu PJ. Outcomes of HIV-exposed infants before and after implementing Option B+ prevention of mother-to-child HIV transmission guidelines in Mulago Hospital, Uganda: a retrospective cohort study [dissertation]. Texas Medical Center; 2016. AAI10131758. Available from: https://digitalcommons.library.tmc.edu/dissertations/AAI10131758

[15].  Derebe G, Biadgilign S, Trivelli M, Hundessa G, Robi ZD, Gebre-Mariam M, Misrak M. Determinant and outcome of early diagnosis of HIV infection among HIV-exposed infants in southwest Ethiopia. BMC Res Notes. 2014;7:1. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4045956/

[16].  Kassaw MW, Abebe AM, Abate BB, Tlaye KG, Kassie AM. Mother-to-child HIV transmission and its associations among exposed infants after Option B+ guidelines implementation in the Amhara regional state referral hospitals, Ethiopia. Int J Infect Dis. 2020;95:268-75. Available from: https://doi.org/10.1016/j.ijid.2020.03.006 PMID: 32247052

[17].  National Agency for the Control of AIDS. National HIV strategy for adolescents and young people 2016-2020. Abuja: NACA; 2016. Available from: https://www.naca.gov.ng/wp-content/uploads/2017/07/National-HIV-Strategy-For-Adolescents-and-Young-People.pdf

[18].  Valère M, Nelly K, Mefo N, Pascal F. Mother-to-child transmission of HIV after Option B+ in low-income environment. Open J Obstet Gynecol. 2018;12:1163-75. Available from: https://www.scirp.org/pdf/OJOG_2018101716445861.pdf

[19].  Shen R, Achenbach J, Shen Y, Palaia J, Rahkola JT, Nick HJ, et al. Mother-to-child HIV-1 transmission events are differentially impacted by breast milk and its components from HIV-1-infected women. PLoS One. 2015;10(12):1-16.

[20].  Smith MM, Kuhn L. Exclusive breast-feeding: does it have the potential to reduce breast-feeding transmission of HIV-1? Nutr Rev. 2000;58(11):333-40. Available from: https://doi.org/10.1111/j.1753-4887.2000.tb01830.x PMID: 11140904

[21].  Hampanda K. Vertical transmission of HIV in Sub-Saharan Africa: applying theoretical frameworks to understand social barriers to PMTCT. ISRN Infect Dis. 2013:1-5.

[22].  Ebelechuku F, Ugochukwu CU, Onubogu ES, Edokwe UE, Kenneth NO, Esther NU, Stanley KO. A review and analysis of outcomes from prevention of mother-to-child transmission of HIV infant follow-up services at a pediatric infectious diseases unit of a major tertiary hospital in Nigeria: 2007-2020. Int J Matern Child Health AIDS. 2021;10(2):269-79. Available from: www.mchandaids.org

[23].  Yetunde T, Chirdan OO, Danjuma AB, Lucy I. Situational analysis of orphans and vulnerable children in urban and rural communities of Plateau State. Ann Afr Med. 2015;14(1):18-24. Available from: https://pubmed.ncbi.nlm.nih.gov/25567691/

[24].  Gaitho D, Kinoti F, Mwaniki L, Kemunto D, Ogoti V, Njigua C, et al. Factors associated with the timely uptake of initial HIV virologic test among HIV-exposed infants attending clinics within a faith-based HIV program in Kenya: a cross-sectional study. BMC Public Health. 2021;21(1):1-7.

[25].  Kebede B, Gebeyehu A, Jain S, Sun S, Haubrich R. Delay in early infant diagnosis and high loss to follow-up among infants born to HIV-infected women in Ethiopia. World J AIDS. 2014;4(4):402.

[26].  Wudineh F, Damtew B. Mother-to-child transmission of HIV infection and its determinants among exposed infants on care and follow-up in Dire Dawa City, Eastern Ethiopia. AIDS Res Treat. 2016:1-6. Available from: https://doi.org/10.1155/2016/3262746 PMID: 26989507.

[27].  Iloh KK, Iloh ON, Ikefuna AN, Ibeziako NS, Ubesie AC, Emodi IJ. Determinants of mother-to-child transmission of HIV despite PMTCT interventions in Enugu, Nigeria. S Afr J Child Health. 2007;9(2):49-52.

[28].  Tsehay AK. Factors associated with HIV-positive sero-status among exposed infants attending care at health facilities in Bahir Dar administration, Ethiopia: evidence from medical records. Cogent Med. 2019;6(1):1623754.

[29].  Berhan Z, Abebe F, Gedefaw M, Tesfa M, Assefa M, Tafere Y. Risk of HIV and associated factors among infants born to HIV-positive women in Amhara Region, Ethiopia: a facility-based retrospective study. BMC Res Notes. 2014;7(1):876. Available from: https://doi.org/10.1186/1756-0500-7-876 PMID: 25475398

[30].  Anoje C, Aiyenigba B, Suzuki C, Badru T, Akpoigbe K, Odo M, et al. Reducing mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria. BMC Public Health. 2012;12(1):184. Available from: https://doi.org/10.1186/1471-2458-12-184 PMID: 22410161

[31].  National Agency for the Control of AIDS. Assessing Nigeria's efforts in ending mother-to-child transmission of HIV. Abuja: NACA. Available from: https://naca.gov.ng/assessing-nigerias-efforts-in-ending-mother-to-child-transmission-of-hiv/

[32].  United Nations Children's Fund. Maternal and newborn health disparities in Nigeria: key facts. New York: UNICEF; 2015. p. 2-7.

[33].  United Nations Children's Fund. How UNICEF is supporting the Government of Nigeria to improve immunization coverage and provide access to quality healthcare.

[34].  Federal Ministry of Health. National guidelines for HIV prevention, treatment and care 2020. Abuja: Federal Ministry of Health; 2020. p. 6-91.

[35].  Statista. Number of AIDS-related deaths among adults aged 15 years and above in select African countries in 2023. Available from: https://www.statista.com/statistics/814712/aids-adult-deaths-number-african-countries/#statisticContainer

[36].  Statista. Number of AIDS-related deaths among children in select African countries in 2023. Available from: https://www.statista.com/statistics/1305199/aids-child-deaths-number-african-countries

[37].  Joint United Nations Programme on HIV/AIDS. Fact sheet 2024: latest global and regional HIV statistics. Geneva: UNAIDS; 2024. Available from: https://www.unaids.org/en/resources

[38].  Joint United Nations Programme on HIV/AIDS. Countdown to zero: global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011-2015. Geneva: UNAIDS; 2011. Available from: https://www.unaids.org/sites/default/files/media_asset/20110609_JC2137_Global-Plan-Elimination-HIV-Children_en_1.pdf

[39].  National Agency for the Control of AIDS. National policy on HIV & AIDS 2020. Abuja: NACA; 2020. Available from: https://naca.gov.ng/national-policy-on-hiv-aids-2020/

[40].  National Agency for the Control of AIDS. NAIIS fact sheet. Abuja: NACA; 2019. Available from: https://www.naca.gov.ng/wp-content/uploads/2019/03/NAIIS-PA-NATIONAL-FACTSHEET-FINAL.pdf

Abstract:

Malaria is a major public health challenge in Nigeria, as it remains one of the leading causes of morbidity and mortality in Sub-Saharan Africa, causing over 500,000 deaths annually among children under five and pregnant women in Nigeria. Long-lasting Insecticide Nets (LLINs) are among the most cost-effective measures to prevent the disease. Ensuring LLINs are affordable, accessible, and effectively utilised requires efficient distribution systems and continuous community engagement. Despite substantial human, material, and financial resources allocated to achieve universal LLIN coverage, distribution and utilisation still face major hurdles that hinder progress towards the World Health Organisation's recommendation of one LLIN for every two people. This research examines the distribution, ownership, and usage patterns of long-lasting insecticide-treated nets, with a particular focus on coverage, access, and effective utilisation. The study was conducted in the Orhionmwon Local Government Area of Edo State, Nigeria. Both quantitative and qualitative methods were utilised. In the quantitative approach, 450 households were surveyed using a semi-structured questionnaire, while the qualitative approach involved in-depth interviews with key community resource persons. Results were analysed using SPSS software. The study was expected to last six months. Although mass distribution has been successful and LLIN ownership is high, actual use remains poor, with more than half of the distributed nets not utilised. This underscores the importance of continued community sensitisation and behaviour-change initiatives to promote the use of LLINs.

References:

[1].   World Health Organization. This year's World Malaria Report at a glance. 2018. Available from: who.int/news/19-11-2018.

[2].   Lagos State Ministry of Health. Malaria control program. 2022. Available from: https://lagosministryofhealth.org/malaria-control-program

[3].   Severe Malaria Observatory. Malaria in Nigeria: statistics and facts. 2024. Available from: https://www.severemalaria.org/countries/nigeria

[4].   World Health Organization Regional Office for Africa. Methods for achieving universal coverage with LLINs in malaria control. 2014. Available from: https://www.afro.who.int

[5].   Malaria Policy Advisory Committee to the WHO. MPAC to WHO: conclusions and recommendations for the September 2013 meeting. Malar J. 2013;12:456. Available from: https://malariajournal.biomedcentral.com/article

[6].   World Health Organization Regional Office for Africa. Achieving universal coverage with long-lasting insecticide-treated nets in malaria control. 2014.

[7].   United States Embassy in Nigeria. Nigeria malaria report sheet 2011. 2011.

[8].   Centers for Disease Control and Prevention. Malaria impact worldwide. 2024. Available from: https://www.cdc.gov/malaria/php/impact

[9].   European Alliance Against Malaria. Malaria and poverty are intimately connected. Malaria Consortium; 2007.

[10].  Onwujekwe O, Etiaba E, Uguru N, Adjagba A, Uzochukwu B. Toward making efficient use of household resources for appropriate prevention of malaria: investigating households' ownership, use and expenditures on ITNs and other preventive tools in South East Nigeria. BMC Public Health. 2014;14(1):315. Doi:10.1186/1471-2458-14-315.

[11].  World Health Organization. Indoor residual spraying: an operational manual for IRS for malaria transmission, control, and elimination. 2024. Available from: https://who.int/poblications/item/978924008398

[12].  World Health Organization. Malaria rapid diagnostic test performance: results of WHO product testing of malaria RDTs, round 4. 2012. Available from: https://www.who.int/malaria/publications/I/item/9789241504720

[13].  London School of Hygiene and Tropical Medicine. Implementation of seasonal malaria chemoprevention: a report of two meetings, Praia 7-8 May 2012 and Dakar 7-8 June 2012. 2013.

[14].  World Health Organization. Updated WHO recommendations for malaria chemoprevention among children and pregnant women. 2022.

[15].  Sydney B, Diego G, Michael H, Sarah Z, Maria SP. Understanding the current state of the art LLIN and potential for sustainable alternatives. PubMed Central. 2022;2.

[16].  World Health Organization. WHO publishes recommendations on the two new types of insecticide-treated nets. 2023.

[17].  Zhuang K. Fighting malaria with long-lasting insecticidal nets (LLIN). Baymro. 2022 Dec. Available from: https://baymrosafety.com/llins/

[18].  Saleh JEA, Alemu W, Uchenna A, Saddiq A, Mpazanje R, Audu B. Quality assurance tool in public health campaign: a look at the 2017 LLIN replacement in Nigeria. Open Access Libr J. 2018;5:e4701.

[19].  Pulkki-Brännström AM, Wolff C, Brännström N, Skordis-Worrall J. Cost and cost-effectiveness of LLIN: a model-based analysis. Malar J. 2012;10:5. PMID:22475679.

[20].  Ntuku HM, Ruckstuhl L, Julo-Réminiac JE, Umesumbu SE, Bokota A, Tshefu KA, Langeler C. Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo. Malar J. 2017;16:22. https://doi.org/10.1186/s12936-016-1671-1

[21].  Eweka R, Osagiede K. Edo State Government achieves 88% distribution rate of LLINs. Nigeria Observer. 2017 Aug 19.

[22].  Arroz JAH, Candrinho B, Pedro S, et al. Planning and implementation of a countrywide campaign to deliver over 16 million long-lasting insecticidal nets in Mozambique. Malar J. 2018;17:254. https://doi.org/10.1186/s12936-018-2406-2

[23].  Kilian A, Boulay M, Koenker H, et al. How many mosquito nets are needed to achieve universal coverage? Recommendations for the quantification and allocation of long-lasting insecticidal nets for mass campaigns. Malar J. 2010;9:330. https://doi.org/10.1186/1475-2875-9-330

[24].  World Health Organization. Achieving and maintaining universal coverage with long-lasting insecticidal bed nets for malaria control. 2017. Available from: WHO.int/I/item/WHO-HTM-GMP/2017.20

[25].  Networks. LLIN distribution. Available from: https://www.networksmalaria.org/networks/llin-distribution

[26].  National Population Commission, ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF International; 2014. p. 201-14.

[27].  World Health Organization. Reinvigorated global efforts needed to curb rising malaria threat. 2004.

[28].  City Population. Orhionmwon Local Government Area population statistics. 2022.

[29].  Araoye MO. Sample size determination. In: Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex Publishers; 2003. Chap 6, p.118.

[30].  Hiruy HN, Irish SR, Abdelmenan S, Wuleo Y, Irish SR, et al. Durability of long-lasting insecticidal nets (LLINs) in Ethiopia. Malar J. 2023;22:109. https://doi.org/10.1186/s12936-023-04540-3

Abstract:

Inadequate infant and young child feeding practices remain a major public health challenge in Burkina Faso. This study aimed to assess mothers’ and fathers’ knowledge and perceptions of complementary feeding and child malnutrition among parents of children aged 6–23 months in the Boulmiougou health district (Central Region). An exploratory qualitative study was conducted using focus group discussions with 61 mothers and 35 fathers. A semi-structured interview guide explored knowledge of the recommended age of food introduction, meal frequency, dietary diversity, cultural beliefs, and perceptions of malnutrition. Results show that 54.1% of mothers correctly identified six months as the recommended age for introducing complementary foods, and 73.8% recognized the importance of dietary diversification. However, 59.6% were unaware of the recommended meal frequency for children aged 6–8 months, and 57.4% for those aged 9–23 months. Traditional beliefs, socio-economic constraints, and limited nutrition education were identified as major barriers to optimal feeding practices. Fathers largely perceived their role as financial providers, with minimal direct involvement in feeding. Misconceptions about the causes and treatment of malnutrition were common among both parents. The findings highlight the need for culturally adapted, family-centered nutrition interventions that strengthen parental knowledge and promote greater paternal involvement in child feeding practices.

References:

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[2].   United Nations Children's Fund. Cinq enfants sur six âgés de moins de deux ans ne reçoivent pas un apport nutritionnel suffisant pour assurer leur croissance et le développement de leur cerveau. New York: UNICEF; 2016.

[3].   Ministère de la Santé et de l’Hygiène Publique. Enquête Nutritionnelle Nationale 2024. Ouagadougou: Ministère de la Santé et de l’Hygiène Publique; 2024.

[4].   Ministère de la Santé, de l’Hygiène Publique et du Bien-être. Enquête Nutritionnelle Nationale 2021. Ouagadougou: Ministère de la Santé; 2021.

[5].   United Nations Children's Fund. Fed to Fail: 2021 Child Nutrition Report. New York: UNICEF; 2021.

[6].   Plateforme Nationale d’Information pour la Nutrition. Cartographie des données en nutrition au Burkina Faso. Ouagadougou: PNIN; 2020.

[7].   Ministère de la Santé du Burkina Faso. Annuaire Statistique 2022. Ouagadougou: Ministère de la Santé; 2022.

[8].   Institut National de la Statistique et de la Démographie. Cinquième Recensement Général de la Population et de l’Habitation du Burkina Faso. Ouagadougou: INSD; 2019.

[9].   Institut National de la Statistique et de la Démographie, ICF International. Enquête Démographique et de Santé et à Indicateurs Multiples du Burkina Faso 2010. Calverton: INSD et ICF International; 2012.

[10].  Mounkaïla AAI, Ibrahim AS, Adam T, Seini HS, Idi AM. Connaissances, attitudes et pratiques des mères d’enfants âgés de 6 à 24 mois en matière d’alimentation de complément dans la commune de Liboré au Niger. EWASH-TI. 2022;6(2):817-26.

[11].  Kouton SE, Hounkpatin WA, Ballogou VY, Lokonon JH, Soumanou MM. Caractérisation de l’alimentation des jeunes enfants âgés de 6 à 36 mois en milieu rural et urbain du Sud-Bénin. J Appl Biosci. 2017;110:10831-40.

[12].  Molo Bieteke IA. Connaissances, attitudes et pratiques des mères d’enfants de 6 à 59 mois en matière de nutrition dans le village du Point G [thèse de médecine]. Bamako: Université des Sciences, des Techniques et des Technologies de Bamako; 2014.

[13].  Abdoulaye Malam Boukar G. Connaissances, attitudes et pratiques des mères d’enfants âgés de 0 à 24 mois de la Commune Urbaine de Mainé Soroa sur l’Allaitement Maternel Exclusif [mémoire de nutrition]. Niger: Institut Supérieur de la Santé Publique; 2016.

[14].  Mitchodigni IM, Hounkpatin WA, Ntandou-Bouzitou G, Avohou HT, Termote C, Kennedy G, Hounhouigan DJ. Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6-23 months in Southern Benin. Food Secur. 2017;9(5):1117-30.

[15].  Tshite FN, Ndianabo MJ. Mise au point d’une farine précuite à base de maïs (Zea mays) et de soja (Glycine max) par la méthode traditionnelle. Int J Biol Chem Sci. 2015;9(6):2608-22.

[16].  Layade AA, Adeoye IB. Fruit and vegetable consumption among students of tertiary institutions in Oyo State. Russ J Agric Soc Econ Sci. 2014;30(6):3-8.

[17].  Nago ES, Lachat CK, Huybregts L, Roberfroid D, Dossa RA, Kolsteren PW. Food, energy and macronutrient contribution of out-of-home foods in school-going adolescents in Cotonou, Benin. Br J Nutr. 2010;103(2):281-8.

[18].  Kimani-Murage EW, Madise NJ, Fotso JC, Kyobutungi C, Mutua MK, Gitau TM, Yatich N. Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi, Kenya. BMC Public Health. 2011;11:396.

[19].  Wood KM, Qureshi K. Facilitators and barriers for successful breastfeeding among migrant Chuukese mothers on Guam. SAGE Open Nurs. 2017;3:1-10.

[20].  Matsuyama A, Karama M, Tanaka J, Kaneko S. Perceptions of caregivers about health and nutritional problems and feeding practices of infants: a qualitative study on exclusive breast-feeding in Kwale, Kenya. BMC Public Health. 2013;13:525.

[21].  Wolkanto AA, Gemebo TD, Dake SK, Hailemariam TG. Fathers’ involvement in complementary feeding of children in Damot Woyde District, South Ethiopia: a community-based cross-sectional study. BMC Nutr. 2023;9:8.

[22].  Bogale SK, Cherie N, Bogale EK. Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: cross-sectional study. PLoS One. 2022;17(11).

[23].  Allotey D, Flax VL, Ipadeola AF, Kwasu S, Adair LS, Valle CG, Bose S, Martin SL. Fathers’ complementary feeding support strengthens the association between mothers’ decision-making autonomy and optimal complementary feeding in Nigeria. Curr Dev Nutr. 2022;6(7).

[24].  Saaka M, Awini S, Kizito F, Hoeschle-Zeledon I. Fathers’ level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana. Public Health Nutr. 2023;26(4):771-80.

[25].  Martin SL, Matare CR, Kayanda RA, Owoputi I, Kazoba A, Kerr RB, et al. Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania. Matern Child Nutr. 2021;17(Suppl 1).

[26].  Dulal S, Prost A, Karki S, Merom D, Shrestha BP, Bhandari B, et al. Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey. BMC Public Health. 2022;22:1721.

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Abstract:

The Clinical Laboratory plays a crucial and multifaceted role in the management of diseases and the implementation of prevention strategies by delivering timely, precise, accurate and reliable diagnostic information essential for effective patient care and disease surveillance. This study was designed to evaluate the quality management system in selected laboratories across Nigeria. It was done from April 2017 to April 2019. The analytical cohort study focused on nine laboratories drawn from various geopolitical zones in the country. Each group of laboratories (cohorts 1, 2, and 3) was chosen for their similarities in key aspects such as facility type and services rendered, ensuring comparability throughout the assessment process. To gauge performance, baseline and follow up evaluations were carried out by quality management system (QMS) auditors utilizing the standardized WHO-AFRO/SLIPTA checklist. At baseline assessment, all cohorts had lower scores than the target mark for documentation and record-keeping. This trend was consistent across management review, organizational structure, personnel competency, equipment functionality, audits and facility safety. Cohort 2 achieved the highest performance (p<0.05). Overall performances were comparable, but cohorts 1 and 2 outperformed cohort 3 in documentation and record keeping. All cohorts improved at follow-up, though cohort 3, without intervention, fell short of standard scores (p<0.05), except information management (p=0.078). Cohort 1 increased by 61.67 points, cohorts 2 and 3 by 58.67 and 28.00 points. Implementation of QMS and SLMTA is recommended for accreditation.

References:

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[2].   World Health Organization Regional Office for Africa. Strengthening public health laboratories in the WHO African region: A critical need for disease control. In: 58th Session of the WHO Regional Committee for Africa (AFR/RC58/R2); 2008; Yaounde.

[3].   Panteghini M. The future of laboratory medicine: Understanding the new pressures. Clin Biochem Rev. 2004;25(4):207-15.

[4].   Wians FH. Clinical laboratory tests. Which, why, and what do the results mean? Lab Med. 2009;40:105-13. http://dx.doi.org/10.1309/LM4O4L0HHUTWWUDD.

[5].   Gershy-Damet GM, Rotz P, Cross D, Belabbes EH, Cham F, Ndihokubwayo JB, et al. The World Health Organization African Region Laboratory Accreditation Process: Improving the Quality of Laboratory Systems in the African Region. Am J Clin Pathol. 2010;134(3):393-400. https://doi.org/10.1309/AJCPTUUC2V1WJQBM.

[6].   Peter TF, Rotz PD, Blair DH, Khine AA, Freeman RR. Impact of laboratory accreditation on patient care and the health system. Am J Clin Pathol. 2010;134:550-5. doi:10.1309/AJCPH1SKQ1HNWGHF.

[7].   Nkengasong JN. A shifting paradigm in strengthening laboratory health systems for global health: acting now, acting collectively, but acting differently. Am J Clin Pathol. 2010;134(3):359-60. http://dx.doi.org/10.1309/AJCPY5ASUEJYQ5RK.

[8].   Abimiku AG. Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience. Am J Clin Pathol. 2009;131:875-86.

[9].   Audu RA, Sylvester IU, Onwuamah CK, Salu OB, Ige F. Experience with a quality management system in a clinical laboratory in Nigeria. Afr J Lab Med. 2011;1:1-5.

[10].     Rabinovitch A. The College of American Pathologists Laboratory Accreditation Program. Accred Qual Assur. 2002;7:473-6. doi:10.1007/s00769-002-0537-0.

[11].     Mario P, Giuseppe L. Uncertainty, quality, safety and accreditation in laboratory medicine. Padova, Italy: Department of Laboratory Medicine, University Hospital of Padova; 2017.

[12].     Guy-Michel G, Philip R, David C, et al. The World Health Organization African Region Laboratory Accreditation Process: Improving the Quality of Laboratory Systems in the African Region. Am J Clin Pathol. 2010;134(3):393-400. https://doi.org/10.1309/AJCPTUUC2V1WJQBM.

[13].     Makokha E, Ondondo R, Kimani D, Gachuki T, Basiye F, Njeru M, et al. Enhancing accreditation outcomes for medical laboratories on the Strengthening Laboratory Management Toward Accreditation programme in Kenya via a rapid results initiative. Afr J Lab Med. 2022;11(1):8. https://doi.org/10.4102/ajlm.v11i1.1614.

[14].     Andiric LR, Massambu CG. Laboratory Quality Improvement in Tanzania. Am J Clin Pathol. 2015;143:566-72. doi:10.1309/AJCPAB4A6WWPYIEN.

[15].     Maruta T, Motebang D, Mathabo L, Rotz P, Wanyoike J, Peter T. Impact of mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Afr J Lab Med. 2012;1(1):8. https://doi.org/10.4102/ajlm.v1i1.6.

[16].     Tanko R, Aninagyei E, Baffour AG. Assessment of Clinical Laboratory using WHO AFRO-SLIPTA Quality Standards in a Referral Hospital Laboratory in Ghana. 2021. https://doi.org/10.21203/rs.3.rs-322208/v1.

[17].     Bouchet N. ISO 15189:2012: What changes for African laboratories? Afr J Lab Med. 2015;4(1):325. doi:10.4102/ajlm.v4i1.325.

[18].     Mokobela K, Moatshe M, Modukanele M. Accelerating the spread of laboratory quality improvement efforts in Botswana. Afr J Lab Med. 2014;3(2):207. doi:10.4102/ajlm.v3i2.207.

[19].     Ndihokubwayo JB, Maruta T, Ndlovu N, Moyo S, Yahaya AA, Coulibaly SO, et al. Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation. Afr J Lab Med. 2016;5(1):280. doi:10.4102/ajlm.v5i1.280.

[20].     International Organization for Standardization. Medical laboratories – Requirements for quality and competence (ISO 15189:2022). 2022.

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[22].     International Organization for Standardization. Information technology – Security techniques – Information security management systems – Overview and vocabulary (ISO/IEC 27000:2018). 2018.

Abstract:

Breast cancer is a leading cause of cancer-related mortality in the Caribbean; however, access to mammography services in rural Guyana has historically been limited. On March 21, 2025, the Public Hospital Suddie commissioned a Siemens digital mammography unit, marking the first public breast imaging service in Region Two. This retrospective descriptive study analysed all mammography examinations performed at the facility from March 2025 to February 2026 (N = 170). Demographic variables, clinical indications, and Breast Imaging Reporting and Data System (BI-RADS) categories were captured. Overall, 130 (76.5%) examinations were screening, and 40 (23.5%) were diagnostic. The median patient age was 50 years, and 97.6% of patients were women. East Indian women comprised the largest ethnic group (54.4%), reflecting regional demographics. BI-RADS findings ranged from negative (BI-RADS 1:23.5%) and benign (BI-RADS 2:30.6%) to highly suspicious (BI-RADS 5:1.2%). The recall rate for screening was 1.5%, and 25.0% of diagnostic cases yielded suspicious or highly suspicious findings. Monthly utilisation peaked at 55 cases in October 2025, demonstrating strong and growing community uptake. These findings confirm the operational feasibility of decentralised digital mammography in a resource-limited rural public hospital and demonstrate a meaningful shift toward preventive, rather than reactive, healthcare-seeking behaviour among eligible women. Expansion of this model to other underserved regions, supported by robust referral pathways and linkages to digital cancer registries, is strongly recommended.

References:

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[2].   International Agency for Research on Cancer (IARC). GLOBOCAN 2022: Guyana fact sheet (v 1.1). World Health Organization; 2024. Available from: https://gco.iarc.fr/today/data/factsheets/populations/328-guyana-fact-sheets.pdf.

[3].   National Cancer Registry, Ministry of Health, Guyana. Breast Cancer Screening and Diagnosis Progress Report 2024. Georgetown (Guyana): Ministry of Health; 2024.

[4].   World Cancer Research Fund International. Breast cancer statistics. World Cancer Research Fund; 2024. Available from: https://www.wcrf.org/cancer-trends/breast-cancer-statistics/.

[5].   World Health Organization. Global Breast Cancer Initiative framework: A step-by-step guide to saving lives. Geneva: WHO; 2023.

[6].   American College of Radiology. ACR BI-RADS Atlas: Breast imaging reporting and data system. 5th ed. Reston (VA): American College of Radiology; 2013.

[7].   Caribbean Public Health Agency (CARPHA). Caribbean countries are urged to close the gap as it relates to breastfeeding. Caribbean Today; 2024. Available from: https://www.caribbeantoday.com/sections/health/caribbean-countries-urged-to-close-the-gap-as-it-relates-to-breastfeeding.

[8].   Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries. Lancet. 2002;360(9328):187-95. https://doi.org/10.1016/S0140-6736(02)09454-0.

[9].   Pan American Health Organization (PAHO). Breast cancer in the Americas: Key facts and trends. Washington (DC): PAHO/WHO Regional Office for the Americas; 2023. Available from: https://www.paho.org/en/topics/breast-cancer.

[10].  American Cancer Society. Global cancer facts & figures. 5th ed. Atlanta (GA): American Cancer Society; 2024. Available from: https://www.cancer.org/research/cancer-facts-statistics/global.html.

[11].  Guyana Chronicle. Protecting breastfeeding means protecting maternal and child health. Guyana Chronicle; 2025. Available from: https://guyanachronicle.com/2025/05/22/protecting-breastfeeding-means-protecting-maternal-child-health/.

[12].  Lee CI, Lehman CD, Bassett LW. Rotations in radiology: Breast imaging. New York: Oxford University Press; 2018.

[13].  Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YCT, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599-614. https://doi.org/10.1001/jama.2015.12783.

[14].  Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F. Cancer statistics for the year 2020: An overview. Int J Cancer. 2019;149(4):778-89. https://doi.org/10.1002/ijc.33588.

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[16].  Massat NJ, Sasieni PD, Dobson M, Guishard M, Kirwan CC. The cost-effectiveness of mammographic screening: A systematic review. Eur J Cancer. 2016;52:30-46. https://doi.org/10.1016/j.ejca.2015.09.022.

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Abstract:

Housing conditions are increasingly recognized as important social determinants of mental health; however, empirical evidence from rapidly transforming high-income contexts characterized by persistent structural inequalities remains limited. This study examined the association between housing adequacy conditions and mental health among low-income households awaiting relocation under a national housing intervention programme in Guyana. A cross-sectional analysis was conducted using baseline data collected from 127 principal applicants approved for a Core Home subsidy under the Adequate Housing and Urban Accessibility Programme (GY-L1031) between July 2025 and April 2026. Data was obtained through structured interviews incorporating the Adequate Housing and Demographic Survey and the Short Form-12 Health Survey (SF-12). Mental health impairment was defined as a Mental Component Summary (MCS-12) score ≤45. Associations were assessed using chi-square tests and multivariable logistic regression within a hierarchical modeling framework. The mean MCS-12 score was 42.3 ± 10.5, and the prevalence of mental health impairment was 59.8% (95% CI: 51.2–68.5). Sociodemographic variables were not significantly associated with mental health impairment (p > 0.05). In contrast, housing adequacy was a significant predictor. Participants without access to improved sanitation had higher odds of mental health impairment (AOR = 8.62, 95% CI: 1.80–41.6; p = 0.007), as did those lacking security of tenure (AOR = 2.86, 95% CI: 1.31–6.21; p = 0.008). These findings suggest that improvements in housing conditions may play a critical role in addressing mental health disparities, and longitudinal analyses following relocation are needed to assess causal impacts.

References:

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Abstract:

Complementary feeding is a major public health issue in Burkina Faso, where only a small proportion of children aged 6 to 23 months receive adequate nutrition. Healthcare workers, as the primary advisors to mothers, play a key role in promoting optimal feeding practices for infants and young children. This study assessed healthcare workers’ knowledge of complementary feeding in the Boulmiougou health district of. Burkina Faso, where optimal infant feeding practices remain suboptimal. A descriptive cross-sectional study was conducted in September 2024 across ten health facilities. Forty-six healthcare workers were interviewed using a pre-tested structured digital questionnaire. Data were analyzed using STATA and covered key indicators including age of complementary food introduction, continued breastfeeding, dietary diversity, meal frequency, and recommended feeding practices. Although 95.7% of participants correctly identified six months as the recommended age for initiating complementary feeding, only 69.6% recognized the recommendation to continue breastfeeding until 24 months or beyond. Knowledge of dietary diversity was limited, as no participant correctly identified all recommended food groups. Furthermore, recommendations regarding meal frequency for children aged 9–23 months were poorly understood. Only 36.9% of respondents demonstrated adequate knowledge of optimal complementary feeding practices. These findings suggest substantial knowledge gaps among healthcare workers, likely associated with insufficient continuing education and supervision. Strengthening capacity-building programmes is essential to improve infant feeding practices and child nutrition outcomes.

References:

[1].   UNICEF. Nourrir à l’échec ? La crise de l’alimentation des enfants en début de vie. New York: UNICEF; 2021.

[2].   World Health Organization, UNICEF. ProPAN Process for the Promotion of Child Feeding: Field Manual. Geneva: World Health Organization; 2013.

[3].   Pan American Health Organization. Guiding Principles for Complementary Feeding of the Breastfed Child. Geneva: World Health Organization; 2016. Available from: https://www.who.int/publications/i/item/9275124604

[4].   Ministère de la Santé, de l’Hygiène Publique et du Bien-être. Enquête Nutritionnelle Nationale. Burkina Faso: Ministère de la Santé; 2021.

[5].   World Health Organization, UNICEF. Infant and Young Child Feeding. 2013. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

[6].   Kere IWZ, Hama-Ba F, Sankara S, Bougma S, Zoungrana B, Ouedraogo M, et al. Factors associated with exclusive breastfeeding among mothers of children aged 0 to 12 months and father's perceptions of exclusive breastfeeding practice in the Central Region of Burkina Faso: case of the Boulmiougou Health District. Food Nutr Sci. 2024;15(11):1170-91. doi:10.4236/fns.2024.1511072.

[7].   Institut National de la Statistique et de la Démographie. Cinquième Recensement Général de la Population et de l’Habitation. Burkina Faso: INSD; 2019.

[8].   Institut National de la Statistique et de la Démographie, Ministère de la Santé. Enquête Démographique et de Santé: Rapport sur les Indicateurs Clés. Burkina Faso; 2021.

[9].   Ministère de la Santé et de l’Hygiène Publique. Enquête Nutritionnelle Nationale (ENN 2024). Burkina Faso; 2024. Available from: https://nutrition.bf/fr/node/949

[10].           Ministère de la Santé du Burkina Faso. Annuaire Statistique 2022. Burkina Faso: Ministère de la Santé du Burkina Faso; 2022.

[11].  Surve SV, Kyatam S, Bhavya MK, Begum S, Kulkarni RN. Awareness and Knowledge of Frontline Workers on Infant and Young Child Feeding (IYCF) Practices: A Qualitative Study from Palghar-Maharashtra, India. Indian J Med Res. 2025;162(4). Available from: https://doi.org/10.25259/IJMR_986_2025

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[13].  Gemede HF, Ayele K, Demisew M. Maternal Knowledge and Practices on Complementary Feeding and Associated Factors in Sedal District, Western Ethiopia. Food Sci Nutr. 2025;13(5):e70286. Available from: https://doi.org/10.1002/fsn3.70286

[14].  Ministère de la Santé. Plan de Passage à l’Échelle de la Promotion des Pratiques Optimales d’Alimentation du Nourrisson et du Jeune Enfant au Burkina Faso (2013–2025). Burkina Faso: Ministère de la Santé; 2013.

[15].  Kayastha P, Mathema S, Chikanbanjar V, Manandhar SR. Impact of training program to nurses regarding complementary feeding in infant and young children: an educational interventional study. Birat J Health Sci. 2022;7(3):1857-60. doi:10.3126/bjhs.v7i3.52637.

[16].  Kanteng G, et al. Connaissances, Attitudes et Pratiques des Professionnels de Santé Œuvrant en République Démocratique du Congo sur la Prise en Charge Nutritionnelle des Enfants Atteints du Paludisme. Rev Med Sante Publique. 2022;5(1):32-43.

[17].  Bocoum B. Évaluation des Connaissances et Attitudes des Professionnels de Santé du CHU Gabriel Touré Relatives à l’Allaitement Maternel [mémoire de fin d’études]. Bamako: Université des Sciences, des Techniques et des Technologies de Bamako; 2021. Available from: https://www.bibliosante.ml/handle/123456789/4857

[18].  Sarybay U, Kabibolla S, Adilmetova G, Nassyrov R, Meyerbekova A, Sarría-Santamera A, et al. Level of Nutrition Competencies among Healthcare Professionals and Medical Students in Kazakhstan. BMJ Nutr Prev Health. 2025;8(1):e000972. Available from: https://doi.org/10.1136/bmjnph-2024-000972

[19].  Ma YN, Nguyen LT, Ha ST, Aiga H. Determinants of Clinical Nutrition Knowledge, Attitudes, and Practices of the Nutrition Workforce in Vietnam's Public Hospitals. Hum Resour Health. 2025;23:127. Available from: https://doi.org/10.1186/s12960-025-01014-2

[20].  Matek Sarić M, Sorić T, Sarić A, Smoje P, Rozić A, Matković M, et al. Healthcare and Non-Healthcare Professionals’ Knowledge about Nutrition in Older Adults: A Cross-Sectional Study. BMC Public Health. 2025;25(1):1-9. Available from: https://doi.org/10.1186/s12889-025-21557-2

Abstract:

Sexually transmitted infections (STIs) during pregnancy remain a significant public health challenge in low-resource settings, contributing to adverse maternal and neonatal outcomes such as preterm birth, low birth weight, stillbirth, and neonatal infections. Routine antenatal screening is a proven intervention to detect and treat curable STIs, yet coverage in low- and middle-income countries (LMICs) is highly variable and often suboptimal. This desk research article synthesizes existing evidence on barriers to routine antenatal STI screening, examining policy gaps, health system constraints, provider-level challenges, patient and community factors, and diagnostic limitations. The study draws on prevalence data from sub-Saharan Africa and other LMICs, highlighting that curable STIs particularly Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and syphilis remain prevalent, often asymptomatic, and underdiagnosed. Real datasets are used to illustrate trends in prevalence and screening coverage, and tables and charts provide visual representation of these findings. The analysis identifies critical gaps, including fragmented policies, inadequate diagnostic infrastructure, limited provider training, stockouts of test kits, stigma, and financial barriers that impede routine screening. The article concludes by recommending multi-level strategies to improve antenatal STI screening, including policy integration, expansion of point-of-care diagnostics, health system strengthening, provider capacity building, and community engagement. These measures are essential to reduce maternal and neonatal morbidity and mortality attributable to STIs in low-resource settings.

References:

[1].   World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021. Geneva: World Health Organization; 2021.

[2].   Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012. PLoS One. 2015;10(12):e0143304. https://doi.org/10.1371/journal.pone.0143304

[3].   Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiané SG, et al. Global burden of curable sexually transmitted infections and associated adverse outcomes. Lancet Glob Health. 2019;7(4):e436-47.

[4].   Smith J, Luo Z. Social and cultural determinants of antenatal STI screening uptake. Sex Transm Infect. 2022.

[5].   Hamilton A, et al. HIV self-testing uptake strategies. Front Public Health. 2021;9:594298. https://doi.org/10.3389/fpubh.2021.594298

[6].   Wi T, Lahra MM, Ndowa F, Bala M, Dillon J-AR, Ramon-Pardo P, Eremin SR, Bolan G, Unemo M. Antimicrobial resistance in Neisseria gonorrhoeae. PLoS Med. 2019;16(12):e1002928. https://doi.org/10.1371/journal.pmed.1002928

[7].   Lawn S, et al. Syndromic management versus point-of-care testing for sexually transmitted infections. Glob Health Action. 2020;13(1):1787060.

[8].   Lawn S, Korenromp E, Newman L. Antenatal STI prevalence and implications. BMJ Glob Health. 2020;5(1):e002123.

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[12].  Dassah ET, et al. Rapid point-of-care tests in Ghana. BMC Health Serv Res. 2018;18:2935. https://doi.org/10.1186/s12913-018-2935-y

[13].  Eshun-Wilson I, et al. HIV self-testing strategies. Clin Infect Dis. 2021;73(9):e3243-50. https://doi.org/10.1093/cid/ciab029

[14].  Hakizimana T, et al. Syphilis prevalence in Uganda. Int J Microbiol. 2023;2023:2971065. https://doi.org/10.1155/2023/2971065

[15].  Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, Elorrio EG, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, et al. High-quality health systems in the Sustainable Development Goals era. Lancet Glob Health. 2018;6(11):e1196-252. https://doi.org/10.1016/S2214-109X(18)30386-3

[16].  Moseley P, et al. Congenital syphilis resurgence. Lancet Infect Dis. 2024. https://doi.org/10.1016/S1473-3099(23)00314-6

[17].  Rowe AK, et al. Improving healthcare provider practices in low- and middle-income countries. Lancet Glob Health. 2018;6(11):e1163-75. https://doi.org/10.1016/S2214-109X(18)30398-X

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[25].  Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, Marrazzo JM, Sonder GJB, Schwebke JR, Hoornenborg E, Peeling RW, Philip SS, Low N, Fairley CK. Sexually transmitted infections: Challenges ahead. Lancet Infect Dis. 2017;17(8):e235-79. https://doi.org/10.1016/S1473-3099(17)30310-9

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Abstract:

Africa has received significant investment towards laboratory professionals’ in-service training programs to ensure they are up to date with the latest developments and competencies in response to the evolving medical landscape. These training programs are also vital for staff retention and motivation. However, it is essential to evaluate their effectiveness to assess if trainees have gained the required skills and knowledge, identify areas of curriculum improvement, strengthen delivery methods and demonstrate a change of behaviour within the workplace, which results in improved service delivery. Failure to evaluate training activities results in failure to identify gaps in knowledge or skills, wastage of resources on ineffective activities and the inability to justify continued investment. Incorporating evaluation into in-service training programs strengthens continuous improvement, accountability and databased decision making for future planning. Literature was reviewed from January 2010 to December 2025 from Scopus, Google Scholar and PubMed, focusing on the following themes: in-service training, evaluation frameworks, African countries and medical laboratory professionals. Results from this review show that while there are some evaluation processes conducted for in-service laboratory training programs in different African countries, there is limited use of standardised models, which results in fragmented evaluation processes that produce limited data for decision-making processes.

References:

[1].   Adekoya A, Okezue MA, Menon K. Medical laboratories in healthcare delivery: A systematic review of their roles and impact. Multidiscip Digit Publ Inst Laboratories. 2025;2(1):8. https://doi.org/10.3390/laboratories2010008

[2].   Maruta T, Mataka A, Moyo S. Training of medical laboratory professionals in Africa region: A perspective of the practicing laboratory professionals. Texila Int J Acad Res. 2025;12(02):24. https://www.texilajournal.com/v2/academic-research/article/3087-training-of-medical

[3].   Sundararajan R, Ponticiello M, Nansera D, Jeremiah K, Muyindike W. Interventions to increase HIV testing uptake in global settings. PubMed Central. 2022;19(3):184. https://pmc.ncbi.nlm.nih.gov/articles/PMC9110462/

[4].   Kiwanuka SN, Namuhani N, Akulume M, Kalyesubula S, Bazeyo W, Kisakye AN. Uganda’s laboratory human resource in the era of global health initiatives: Experiences, constraints and opportunities - An assessment of 100 facilities. Hum Resour Health. 2020;18(1):13. https://pubmed.ncbi.nlm.nih.gov/32070361/

[5].   Bapir NSM. Barriers faced by pre-service teacher trainees in their practicum experience. Cihan Univ Erbil J Humanit Soc Sci. 2025;9(1):143-151. https://journals.cihanuniversity.edu.iq/index.php/cuejhss/article/view/1330

[6].   Kasvosve I, Ledikwe JH, Phumaphi O, Mpofu M, Nyangah R, Motswaledi MS. Continuing professional development training needs of medical laboratory personnel in Botswana. Hum Resour Health. 2014;12(1):46-58. https://pubmed.ncbi.nlm.nih.gov/25134431/

[7].   Ambu-Saidi B, Fung CY, Turner K, Lim ASS. A critical review on training evaluation models: A search for future agenda. J Cogn Sci Hum Dev. 2024;10(1):142-170. https://publisher.unimas.my/ojs/index.php/JCSHD/article/view/6336

[8].   Khan D, Ali S. Training evaluation models: Comparative analysis. Res J Soc Sci Econ Rev. 2022;3(4):51-63. https://ojs.rjsser.org.pk/index.php/rjsser/article/view/522

[9].   Topno H. Evaluation of training and development: An analysis of various models. IOSR J Bus Manag. 2012;5(2):16-22. https://iosrjournals.org/iosr-jbm/papers/Vol5-issue2/B0521622.pdf

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Abstract:

The UNAIDS 95-95-95 targets must be achieved within all populations and geographies, not merely at national averages. Cameroon’s national cascade data mask profound sub-population disparities that this study systematically characterises. A systematic review of peer-reviewed and grey literature from 2017 to 2023 was conducted following PRISMA 2020 guidelines. Data from 136 included studies were synthesised to quantify cascade performance across key sub-populations: adolescents (10–24 years), men who have sex with men (MSM), female sex workers (FSW), pregnant and breastfeeding women (PBFW), and populations in conflict-affected regions. Structural determinants were identified through thematic synthesis of governance, service delivery, stigma, and legal environment data. Young people aged 15–24 achieved only 20.7% HIV status awareness at CAMPHIA 2017–18 — over 40 percentage points below adult women. ART coverage among MSM and FSW was 0–25% across study sites, while only 13.2% of HIV health centres provided key population-specific services. Adolescents achieved pooled viral load suppression (VLS) of 53.3–67%, some 28 percentage points below the adult average. Young MSM achieved 34% VLS and young FSW 43%. The Stigma Index 2.0 (2024) documented 14.75% care abandonment among PLHIV. The conflict-affected North-West region paradoxically achieved 93.5% adult VLS through intensive differentiated service delivery, while children’s VLS reached only 80%.  Cameroon’s sub-population cascade disparities reflect structural exclusions — driven by stigma, criminalisation, inadequate youth-specific care, and VL monitoring deficits — requiring targeted legal, policy, and programmatic interventions.

References:

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Abstract:

Obesity is an escalating public health burden across the Caribbean, underpinning rising rates of type 2 diabetes, cardiovascular disease, and preventable mortality. Guyana is embedded within this regional trend yet lacks a robust body of country-specific peer-reviewed evidence on adult obesity prevalence and determinants. This systematic review with narrative synthesis examined peer-reviewed English-language studies published between January 2015 and December 2025 involving adults aged ≥ 18 years in Guyana or Caribbean settings that reported obesity prevalence, adiposity indicators, or obesity determinants, in accordance with PRISMA 2020 and PRISMA-S guidelines. Twenty studies from Jamaica, Barbados, Haiti, Suriname, Puerto Rico, Trinidad and Tobago, Eastern Caribbean cohorts, and Guyana were included. Combined overweight and obesity exceeded 55% in Jamaica by 2016. Women bear a disproportionate share of obesity risk across settings, with Haitian women exhibiting a prevalence ratio 5.7 times that of men. Ultra-processed foods contributed 40.5% of the mean daily energy intake in Barbados and sugar-sweetened beverage consumption was linked to an estimated 15,000 adults with overweight and obesity cases and US$23.1 million in healthcare costs annually in Trinidad and Tobago. Weight misperception was associated with 85% lower odds of attempting to lose weight in the Eastern Caribbean. Guyana-specific peer-reviewed adult obesity data remain sparse. The evidence supports multilevel public health actions that combine strengthened surveillance, food-system reform, fiscal measures, gender-sensitive programming, and the integration of obesity prevention into primary care and urban policy.

References:

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Abstract:

Maternal mortality is a critical public health challenge in Nigeria, despite global and regional progress. The first six weeks following childbirth represent the most vulnerable phase for maternal survival, as it requires close monitoring. However, postnatal care (PNC) remains the weakest component of the maternal care continuum in Nigeria. This review entailed how access to, quality, and use of postnatal care services influence maternal mortality in Nigeria. It also assessed trends in maternal care to show progress or a signal of a growing crisis. This review used peer-reviewed articles, national surveys, policy papers, and global reports from 2010 to 2024. Andersen’s behavioral model and the three delays model were also used. These models analyzed how factors like delays in seeking care contribute to maternal and postnatal mortality, emphasizing how such delays endanger mothers' lives. Data triangulation was achieved through quantitative and mixed methods approaches and policy reviews, which bolstered analytical rigor. The analysis of the 2018 national demographic and health survey data across geopolitical zones revealed consistently low PNC use, ranging from 10.9% to 23%, with prominent north–south disparities. The low PNC coverage in the Northwest (10.9%) and Northeast (13%) regions coincided with the highest maternal mortality ratio (MMR) among all regions. In contrast, the Southwest had higher PNC uptake and fewer deaths. Addressing the gaps in policy implementation is an emergency, as postnatal care remains the weakest and most unstable pathway in the maternal health care spectrum in Nigeria.

References:

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