Urogenital schistosomiasis affects >112 million people in Africa south of the Sahara, with 56 million women suffering from female genital schistosomiasis. Community knowledge, attitudes, and practices (KAP) are essential for sustained control, but no systematic review has synthesized KAP evidence across the region. We estimated the pooled prevalence of good knowledge, positive attitudes, and good preventive practices to inform the WHO 2030 NTD Roadmap. We searched PubMed, Scopus, Web of Science, African Journals Online, and WHO Global Index Medicus from inception to 21 November 2025. Cross-sectional studies reporting quantitative KAP data from Africa south of the Sahara were included. Two independent reviewers performed screening, data extraction, and JBI risk-of-bias assessment. Random-effects meta-analyses, subgroup analyses, meta-regression, sensitivity analyses, and publication bias tests were conducted. GRADE certainty was assessed. Twenty-one studies (total 9,681 participants) contributed to the knowledge analysis; 15 studies (total 8,205 participants) to the attitude analysis; and 16 studies (total 8,538 participants) to the practice analysis. Note that participants from studies reporting multiple outcomes are counted separately in each analysis. Regional pooled estimates ranged from 46.45% to 69.76% (knowledge), 52.33% to 61.88% (attitudes), and 39.71% to 56.43% (practices). Continent-wide estimates were 51.73% (knowledge), 57.40% (attitudes), and 45.12% (practices), but are heavily weighted towards West Africa. Extreme heterogeneity (I² = 98-99%) limits confidence; individual study ranges: 23.3-91.2% (knowledge), 22.7-82.9% (attitudes), 13.9-85.4% (practices). A descriptive attitude-practice gap of 12.28 percentage points was observed. No publication bias was detected. Meta-regression suggested a tentative decline in preventive practices over time (p=0.024), but this finding is hypothesis-generating given persistent high heterogeneity; no temporal trends were observed for knowledge or attitudes. GRADE certainty was low due to serious inconsistency. KAP towards urogenital schistosomiasis in Africa south of the Sahara remains suboptimal, with less than half of at-risk individuals adopting preventive behaviors. The wide range of findings highlights the need for context-specific interventions. Behavior change communication, school- and reproductive-health education, and WASH investments are urgently needed. Restriction to English-language articles is a major limitation.
Lessons and best practices from outbreaks during 2022-25 in Africa were not comprehensively documented or shared to inform future outbreak responses. We conducted a narrative review of published articles and outbreak response reports of mpox, cholera, Ebola virus disease, and Marburg virus disease and captured experts' perspectives and lessons. We analysed and presented the data in themes. Evidence indicates that effective responses are built on routine investments maintained between outbreaks, particularly in decentralised laboratories, digital surveillance systems, community structures, and clinical trial readiness. The institutionalisation of response mechanisms through national public health institutes, incident management systems, and emergency operations centres reflects a maturing continental preparedness architecture, reinforced by rapid regional solidarity, south-south cooperation, and timely partner support. National political leadership was crucial in mobilising resources and ensuring public compliance, whereas innovations such as expanded genomic surveillance, timely deployment of investigational countermeasures, mobility-aware outbreak control, and improved early-warning systems strengthened responses to outbreaks. The successful control of these recent outbreaks highlights the importance of strengthening preparedness, institutionalising response systems, and fostering coordinated, Africa-led health security frameworks to support resilient and sustainable outbreak response.
The ability to estimate abundances of multiple wildlife species within an area is valuable for both conservation and ecological inquiry. Spatially explicit capture-recapture (SCR) methods are commonly used to obtain reliable population size estimates, particularly for low-density and individually identifiable carnivore species. However, estimating abundance within multi-species communities poses a methodological challenge as survey designs and analytical tools are primarily tailored for single target species. Here, we present a dataset of spatially referenced individual encounter histories of six carnivore species with varying space requirements (lion, Panthera leo; leopard, Panthera pardus; spotted hyena, Crocuta crocuta; cheetah, Acinonyx jubatus; serval, Leptailurus serval; large-spotted genet, Genetta tigrina). These data were collected in a South African game reserve using a camera trap array optimized for multi-species density estimation using SCR methods. This dataset will be a valuable resource for studying spatial processes among potentially interacting carnivores without the common pitfalls that come with by-catch data of non-target species, and will provide a much-needed case study for the further development of multi-species statistical method development.
Adolescents living with HIV (ALHIV) face barriers to accessing sexual and reproductive health (SRH) services, negatively affecting their health and quality of life. These challenges are particularly pronounced in sub-Saharan Africa (SSA), where HIV prevalence, unintended pregnancies and child marriage remain high. This review aimed to map interventions designed to improve SRH access for ALHIV in SSA, applying Levesque's framework to identify facilitators and barriers from supply-side and demand-side perspectives. Review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, EMBASE and Web of Science were searched, alongside institutional grey literature, for English and French language studies published between 2010 and 2024. Studies were included if they focused on ALHIV aged 10-19 years in SSA, regardless of HIV acquisition mode and used experimental, quasi-experimental, qualitative or observational designs. Two independent reviewers screened studies in Covidence, extracted data on study design, population, intervention components and delivery settings and mapped barriers and facilitators using Levesque's framework. Findings were synthesised narratively. of 6835 records screened, 14 studies met inclusion criteria. Interventions ranged from comprehensive strategies addressing financial, infrastructural and psychological barriers to targeted approaches like education and stigma reduction, implemented across schools, clinics, communities and digital platforms. Most studies emphasised service acceptability, with 13 of 14 highlighting cultural relevance, while approachability, physical accessibility and affordability received less attention. Key barriers included fear of HIV disclosure and stigma, whereas facilitators, including peer support, community outreach and digital platforms, enhanced engagement, trust and comfort with SRH services. Improving access to SRH services for ALHIV in SSA requires adolescent-friendly, integrated, context-specific interventions that combine stigma reduction, peer and community engagement, digital innovations and financial support to overcome barriers and improve SRH outcomes. Open Science Framework (https://doi.org/10.17605/OSF.IO/7PBEW).
Systemic lupus erythematosus (SLE) is associated with increased mortality compared with the general population, with outcomes influenced by ethnicity and organ involvement. Data from the Middle East and North Africa (MENA) remain limited, particularly regarding long-term survival and mortality predictors. To estimate and compare all-cause mortality and survival rates among adult patients with SLE in the MENA region and identify predictors of mortality. A systematic review and meta-analysis of cohort studies reporting survival and mortality in patients with SLE in the MENA region was conducted. Eligible studies were identified through a comprehensive database search and screened according to PRISMA guidelines. Data on treatment exposures and clinical predictors of mortality were extracted. Twelve cohort studies, including 3,478 adults with SLE from five MENA countries (Türkiye, Iran, Egypt, Israel, and Tunisia), were analyzed. The pooled all-cause mortality rate was 9.9% (95% CI: 7.2%-14.0%; I² = 89.7%). Survival remained high at 5 years (93.9%) and 10 years (90.0%), but declined at 15 years (85.5%) and 20 years (71.7%), with long-term estimates highly sensitive to single-study exclusion. Leave-one-out analysis slightly increased survival estimates and reduced heterogeneity. Major mortality predictors included renal involvement, cardiovascular disease, infections, hypertension, diabetes, hematologic abnormalities, and male sex. Higher cumulative corticosteroid and cyclophosphamide exposure was linked to increased mortality, whereas hydroxychloroquine and azathioprine appeared protective. Infection was the leading cause of death, followed by active disease, renal failure, and cardiovascular complications. Patients with SLE in the MENA region show high short-term survival, but long-term outcomes remain variable. Mortality is mainly driven by renal, cardiovascular, and infectious complications, with treatment exposure contributing to risk. These findings highlight the need for multicenter registries, standardized reporting, and strategies to reduce infection burden and optimize nephritis care.
Helicobacter pylori (H. pylori) infection is highly prevalent in Zambia, with an estimated population prevalence of 79%. However, data on eradication treatment outcomes in routine clinical practice are lacking. We conducted a single-arm cohort study in Lusaka, Zambia, to evaluate the effectiveness of empirical H. pylori eradication therapy using stool antigen testing (SAT). Symptomatic patients with confirmed H. pylori infection were treated empirically with clarithromycin-, tinidazole-, and omeprazole-based regimens. Eradication was assessed using SAT at least four weeks after completion of therapy. Demographic and clinical factors associated with treatment outcomes were analysed using multivariate logistic regression in Stata version 15. Of 331 patients tested, 216 (65%) were positive for H. pylori infection. Post-treatment SAT results were available for 139 (64%) patients, of whom 93 (67%) were female. The median age was 43 years (interquartile range: 36-54). Overall, eradication was achieved in 85 patients, yielding a treatment success rate of 61%. Multivariate analysis demonstrated that a history of prior eradication attempts (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.04-0.60) was independently associated with treatment failure. In contrast, the occurrence of dysgeusia during therapy (OR 3.20, 95% CI: 1.20-8.70) and prior proton pump inhibitor use (OR 5.30, 95% CI: 1.40-19.80) were associated with higher odds of eradication. The effectiveness of empirical clarithromycin-based therapy for H. pylori infection in Zambia is suboptimal and falls below internationally recommended targets. These findings underscore the need to reassess empirical treatment strategies, particularly among patients with previous eradication attempts, and highlight the importance of locally informed antibiotic selection.
[This corrects the article DOI: 10.1371/journal.pone.0252182.].
Sub-Saharan Africa carries a disproportionate burden of hepatocellular carcinoma, yet clinical guidelines used on the African sub-continent are extrapolated from high-income countries. The presentation, treatment and outcomes of hepatocellular carcinoma between liver referral centres in South Africa and Sweden were compared to examine the limitations of applying high-income countries-derived guidelines in sub-Saharan Africa. This was a comparative cohort study of adult patients with hepatocellular carcinoma treated from 2012 to 2023 in a referral centre in South Africa and Sweden respectively. Main outcome was overall survival. Secondary outcome was treatment-specific survival. Of 959 patients included 455 and 504 were treated in South-Africa and Sweden respectively. Patients in South Africa were younger (median 50 vs. 71 years, P<0.001) and predominantly had hepatitis B virus-related hepatocellular carcinoma (60% vs. 3.6%, P<0.001). They presented with more advanced liver dysfunction, more frequent metastases and had more advanced BCLC stages. Curative-intended therapies (ablation, liver resection, liver transplantation) were offered to 9.2% and 42.5% of patients respectively (P<0.001). One, three, and five-year survival were 17.8%, 7.7% and 5.3%, respectively versus 58.9%, 35.3% and 26.2% respectively (P<0.001). Survival was consistently lower in the patients in South Africa when comparing treatment-specific cohorts. Marked disparities in disease presentation, access to treatment and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes.
Mapping current vaccinology courses is critical for identifying educational gaps, refining program content, and increasing international cooperation to achieve a competent and well-coordinated global vaccination effort. This scoping review investigates the availability and content of vaccinology courses throughout the world, with a focus on Africa where there is a need for strengthened immunization systems and workforce capacity. Eight vaccinology courses, including short professional training and university certificate programs, were offered in Africa, including Morocco, Senegal, Uganda, Kenya, Ethiopia, Rwanda, Ghana, South Africa, and Zimbabwe. Our findings indicated that the percentages of vaccinology modules significantly vary between Africa and other continents, specifically: introduction to immunology, epidemiology, biology of pathogens, vaccine types, vaccine pharmacology, clinical research methodology, pharmacovigilance and vaccine safety, health economics, immunization programs, vaccine manufacture, the role of international organizations in vaccine development, vaccine advocacy, and vaccine cold chain management. By analyzing and comparing specific characteristics of the courses, our results also found multiple gaps and potential challenges related to target population, course objectives, method of course delivery, course contents, duration of course, training, practical sessions delivery, course costs, and funding constraints.
Ticks are major ectoparasites and vectors of pathogens affecting humans, livestock, and wildlife. They harbor diverse microbial communities that may influence tick biology and interactions with microorganisms; however, functional information on tick-associated microbiomes remains limited, particularly in North Africa. In this pilot study, we applied a metaproteomic approach based on high-resolution tandem mass spectrometry to characterize bacterial communities associated with three tick species collected in Algeria: Rhipicephalus sanguineus sensu lato, Hyalomma aegyptium, and Hyalomma dromedarii. Peptide spectra were assigned to taxa using a two-step database search strategy based on NCBInr, and bacterial composition and relative abundance were compared across tick species and sampling locations. A total of 40 bacterial genera belonging to 32 families and four phyla were identified. Microbiome composition differed significantly between tick genera and collection locations, suggesting an influence of species-specific and geographical factors on microbial community structure. Dominant genera included Streptomyces, Bacillus, Clostridium, Escherichia, Flavobacterium, Paenibacillus, and Providencia. Peptides related to Coxiella spp. were frequently detected, consistent with previous reports of Coxiella-like endosymbionts in ticks. This pilot study provides a first metaproteomic characterization of tick-associated communities in Algeria. The results reveal species- and location-associated differences in microbial composition and highlight the potential of metaproteomics for exploring tick-associated microbiomes in North Africa.
Brain health disorders (BHDs) remain a concern for people with HIV (PWH) despite antiretroviral therapy access and viral suppression. The contribution of HIV to brain health is often obscured by comorbidities in high-income settings which are less prevalent in sub-Saharan Africa. Neurofilament light chain (NfL), a biomarker of axonal injury, may offer insight into underlying mechanisms. 338 virally-suppressed PWH and 250 people without HIV (PWoH) completed a Research Domain Criteria-informed battery assessing cognitive, sensorimotor, and social processing systems. Demographically-adjusted norms were derived from PWoH. Serostatus differences in impairment (≥ 1SD below the mean) were examined using multivariable logistic regression. Additional models examined associations between NfL (plasma, cerebrospinal fluid [CSF]) and task performance. PWH were similar to PWoH in age (43.9 vs. 43.5yrs), sex (female, 54 vs. 46%), and education (6.1 vs. 5.8yrs). PWH had higher odds of impairment in the cognitive control and attention (Color Trails, Symbol Digit) and sensorimotor (Grooved Pegboard) domains. Plasma NfL was associated with sensorimotor impairment in both groups. Similar trends held in CSF NfL but did not reach statistical significance, likely due to sample size (n = 85). Cognitive and sensorimotor difficulties are common in PWH in Rakai, independent of typical Western confounders. The profile of impairment differs from reports in high-income settings where declarative memory deficits are often observed. NfL was associated with sensorimotor impairment, suggesting that NfL may capture ongoing axonal injury and motor system vulnerability in PWH and PWoH. These findings suggest NfL's potential as a biomarker of sensorimotor impairment in sub-Saharan Africa.
Dialysis-related amyloidosis (DRA) results from β2-microglobulin accumulation in patients on long-term hemodialysis, typically manifesting after 5-10 years. While well-documented in developed countries, reports from sub-Saharan Africa remain scarce. We report a 45 year-old Burkinabe man with 8 years of maintenance hemodialysis who presented with severe diffuse bone pain and inflammatory polyarthralgia affecting shoulders, hips, knees, and wrists. Physical examination revealed diffuse spinal tenderness and restricted painful joint mobility with bilateral positive Patrick's and key signs. Laboratory investigations showed elevated C-reactive protein and markedly elevated serum β2-microglobulin, with negative rheumatoid factor, anti-CCP antibodies, and antinuclear antibodies. MRI demonstrated characteristic band-like vertebral infiltration with preserved disc spaces and extensive nodular involvement of the sacrum, iliac wings, and proximal femurs. Despite unavailable bone biopsy, probable DRA diagnosis was established based on prolonged low-flux hemodialysis, markedly elevated β2-microglobulin, characteristic imaging, and exclusion of alternative diagnoses including AL and AA amyloidosis. Treatment with celecoxib 200 mg daily achieved significant improvement at 1 month follow-up. This case highlights probable DRA as an important cause of diffuse bone pain in younger African dialysis patients. Clinicians should maintain high suspicion for DRA in patients with polyarticular symptoms after long-term dialysis, utilizing β2-microglobulin measurement and MRI for diagnosis when histological confirmation is unavailable.
Ambient fine particulate matter (PM2.5) pollution (APMP) is a leading global mortality risk factor. Its long-term trends, drivers and future burden trajectories in emerging economies remain inadequately understood. This study provides the first systematic assessment of spatiotemporal patterns, key drivers and projections to 2050 of APMP-attributable health loss in BRICS countries (Brazil, Russia, India, China and South Africa) from 1990 to 2023, benchmarked against global and Group of Seven (G7) trends. Using Global Burden of Disease 2023 data, this study analysed APMP-attributable deaths and disability-adjusted life years (DALYs) via absolute numbers and age-standardised rates. The multidimensional framework included joinpoint regression, age-period-cohort (APC) modelling, Das Gupta decomposition, disease spectrum ranking and Bayesian-APC projection. In 2023, APMP caused 2.955 million deaths in BRICS (59% of the global total). Age-standardised mortality and DALY rates remained higher than global averages and increased since 1990, contrasting with sustained declines in the G7. Substantial heterogeneity existed: India's burden was heaviest and growing, China's remained high but stabilised, while Brazil and Russia achieved marked reductions. APC modelling revealed pronounced mortality increases in older ages (especially 95+ years in China and India). Decomposition identified population ageing as the key driver in BRICS, especially China; population growth and deteriorating epidemiological conditions under high exposure drove increases in India and South Africa. Leading APMP-attributable burdens in BRICS were ischaemic heart disease, chronic obstructive pulmonary disease and intracerebral haemorrhage, unlike in the G7 where Alzheimer's disease and other dementias ranked first. Projections indicate the BRICS burden will remain above the global average by 2050, with China and India continuing to bear severe burdens. BRICS is the epicentre of global APMP-attributable burden. The widening gap with the G7 underscores divergent environmental health governance paradigms. Findings call for differentiated strategies within BRICS and enhanced transnational collaboration to curb APMP burden rises and bridge global environmental health equity gaps.
Emerging infectious diseases (EIDs) cause significant health and economic burdens in the USA and globally. Existing methods and analyses fall short of what is required to prioritise diseases for health technology research and development (R&D), including for medical countermeasure (MCM) development within rapid response frameworks by the Center for Biomedical Advanced Research and Development Authority, part of the Administration for Strategic Preparedness and Response within the U.S. Department of Health and Human Services. We developed a method for quantifying and ranking health and economic disease burdens ('full burdens') and applied it to 15 high-priority EIDs for 223 countries and territories, including the USA and US territories, historically from 2000 to 2022 and prospectively from 2025 to 2034. Health burdens consisted of disability-adjusted life-year losses, converted into monetary values using the value of a statistical life-year. Economic burdens consisted of direct and indirect costs during the acute stage of illness for hospitalised cases. We computed unweighted and weighted burden measures, the latter controlling for global disparities in ability-to-pay to avoid EID burdens. We projected future disease burdens using Monte Carlo simulation. Pandemics caused the largest historical and projected unweighted and weighted full burdens in the USA and globally. Among non-pandemics, across unweighted and weighted burdens, dengue and cholera imposed the largest historical and projected full burdens globally; West Nile Virus imposed the largest historical and projected full burdens in the USA, and dengue imposed the largest historical full burdens in the US territories. Weighted full burdens exceeded five times the unweighted ones. Regionally, the Americas and Africa faced the largest per capita weighted burdens while the Western Pacific region faced the smallest. R&D priority-setting, including MCM development, depends on multiple criteria, including disease burdens. Our full burden quantification methods and results, along with other such criteria, can inform optimal priority-setting.
Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, structured tools to support healthcare professionals (HCPs) in systematically exploring these barriers in routine care remain limited. To address this gap, a clinically oriented questionnaire was developed by a multidisciplinary panel of diabetes experts. This paper describes the development of the questionnaire and its preliminary evaluation in terms of clarity, comprehensibility, usability, relevance, and perceived acceptability. A panel of 12 diabetes experts from 11 countries across Europe, the Middle East, and Africa (EMEA) reviewed the literature on barriers to diabetes technology use, grouped these barriers into key thematic domains, and developed a structured questionnaire that was translated into multiple languages. The questionnaire then underwent a two-round end-user evaluation involving HCPs and PWT1D to assess clarity, comprehensibility, practicality, relevance, and potential bias. Feedback from the first round informed refinement of the questionnaire before reassessment in a second round. The evaluation was descriptive and focused on end-user feedback; formal psychometric testing and hypothesis-driven validation analyses were not undertaken. The expert panel named the questionnaire LIFESTEPS, reflecting its core thematic domains. The questionnaire covers the following areas of discussion related to barriers to technology: psychological and relational aspects of diabetes, experience with technology and body image, and anticipation and adaptation to new technology. In the first evaluation round, feedback was obtained from 19 HCPs and 37 PWT1D recruited by panel members. Following revision of the questionnaire, a second round involving 5 HCPs and 7 PWT1D was conducted to reassess clarity and usability. Overall, participants reported that the final version of the questionnaire was understandable, perceived as easy to complete, and potentially useful for supporting discussion of barriers to diabetes technology use in clinical practice. LIFESTEPS is a newly developed, multilingual clinical support tool designed to facilitate structured discussion of psychosocial and lifestyle-related barriers to diabetes technology use. The findings provide preliminary support for its clarity, acceptability, and perceived clinical usefulness. Further psychometric and prospective clinical evaluation is needed before broader analytical or predictive applications can be considered. Accordingly, LIFESTEPS should be interpreted as a preliminary conversation-support tool rather than as a validated measurement instrument.
Medical Ethics integrates scientific approaches from ethics, philosophy, religious studies, history, and sociology into all relevant fields and subdisciplines of medicine, biomedicine, and healthcare. However, there is a lack of detailed analysis of research activity and networking of peer-reviewed research in Medical Ethics. Consequently, this study employs established bibliometric methods to examine the chronological, geographical, and thematic patterns of global research, as well as network structures, by analyzing metadata retrieved from the Web of Science. The analysis identified a total of 11,663 articles published in journals in the field of Medical Ethics. The number of articles peaked slightly in 2015 but remained more or less constant otherwise. From a global perspective, the USA was the dominant country in absolute numbers, followed by China and Japan. By contrast, the European countries Sweden, Austria, and Norway were positioned first when the research activity was related to the population size. Large parts of Africa, South Asia, and South America/Caribbean are virtually not present in the global landscape of Medical Ethics research, although these areas offer many open questions. Although a far-reaching, global network has been established, networking primarily takes place among English-speaking countries such as the USA, the UK, Canada, and Australia, while developing countries in particular are underrepresented. The growth in publication numbers is not as steep as in other fields and is imbalanced from a global viewpoint. Therefore, countries with weaker economies should be systematically encouraged to participate in international research collaborations.
Objective To synthesize population-based studies of epilepsy prevalence published between 1980 and 2025, estimate pooled global prevalence, characterize regional differences, quantify temporal trends, and examine the influence of study characteristics and development indicators (Human Development Index [HDI] and Socio-demographic Index [SDI]). Methods We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for observational studies published from January 1, 1980 to December 31, 2025. Random-effects meta-analysis was used to pool prevalence estimates. Pre-specified subgroup analyses were conducted by geographical region, survey period, study design, data source, sample size, and HDI/SDI strata. Methodological subgroup analyses and sensitivity analyses were further performed to assess the robustness of the pooled estimates. Temporal patterns were assessed using regression-based β trend analysis across study survey years and estimated annual percentage change (EAPC) derived from the Global Burden of Disease (GBD) database. Results We included 216 studies comprising 278,651,975 participants and 2,114,157 epilepsy cases. The pooled global prevalence was 7.57 per 1,000 population (95% confidence interval [CI], 6.78-8.45). Literature-based trend analysis suggested an increase in reported prevalence estimates from 1980 to 2025 (β = 0.206 per 1,000 population per year; P < 0.01). GBD-based analyses also showed an overall increase from 1990 to 2021 (EAPC = 0.102% per year), with significant increases during 1990-2009 but no significant change during 2010-2021. Prevalence differed significantly across geographical regions (P < 0.001), highest in Africa (10.67 per 1,000) and lowest in Asia (5.20 per 1,000). Prevalence was higher in low-HDI settings than in very high-HDI settings, but meta-regression did not support significant linear associations between prevalence and HDI or SDI (both P > 0.05). No significant sex difference was observed (P = 0.76). Sensitivity analyses supported the robustness of the main pooled estimate, and methodological subgroup analyses showed no major variation across prevalence definitions, case ascertainment methods, or diagnostic confirmation approaches. Conclusions Epilepsy prevalence remains high worldwide, with an overall increase in reported prevalence over the past four decades but a slower recent rise. Marked geographical disparities were observed, with higher reported prevalence in low-resource settings. Strengthening standardized epidemiological surveillance and improving access to diagnosis and treatment remain priorities, particularly in resource-limited regions.
The genus Meriones Illiger, 1811 is widely distributed in the Middle East, Northern Africa, and Central Asia. In spite of many studies evaluating the gerbil phylogeny, the systematics of this genus is controversial because studies analyzing a single gene region yield inconsistent results. The presented research provides the first complete mitogenomes of four gerbil species (Meriones crassus, Meriones persicus, Meriones tristrami, and Meriones vinogradovi) distributed in Türkiye and novel and strong results to clarify the phylogenetic relationships of these gerbils. Next Generation Sequencing (NGS) was performed using the specimens from Türkiye. Other gerbil species (M. tamariscinus, M. meridianus (M. dahli), M. unguiculatus, M. libycus, Rhombomys opimus, Psammomys obesus, Brachiones przewalskii, and Gerbilliscus leucogaster) were also included in the phylogenetic analyses. In addition to determining the mitogenome characteristics, mean genetic distance values, haplotype and nucleotide diversity values, numbers of mutations and polymorphic sites were calculated, and a Bayesian Inference and Maximum Likelihood trees were constructed along with the divergence times. Most of the 37 gene regions were encoded on the H-strand; the GC% ratio varied between 36.9 and 38.1% among the four species that show their genomes were AT-rich. Bayesian Inference and Maximum Likelihood trees gave well-supported genetic relationships: P. obesus and G. leucogaster were located as the most distant species, and M. tamariscinus and R. opimus were found to be closer. M. meridianus, M. unguiculatus, and M. persicus and M. tristrami, M. crassus, M. libycus, and M. vinogradovi formed two differentiated lineages. In the latter lineage, M. tristrami and M. crassus were clustered. Also, B. przewalskii was linked to the former two lineages. In addition, mean genetic distance values between Meriones species were determined to be 7.04-16.59%, in accordance with the results of the phylogenetic approach. It was also calculated that the species mentioned above diverged 11.04 MYA (95% HPD: 7.94-14.68), corresponding to the Late Miocene Epoch. In contrast to previous studies, this study supports the paraphyly of subgenus Pallasiomys regarding the M. persicus' position with high reliability results. Besides, the paraphyletic status of the genus Meriones was proved with the phylogenetic relationship of B. przewalskii and Meriones species. It was also emphasized that mitogenome analyses are notably effective in order to study problematic systematics of rodent groups like Meriones.
This study examines global and regional trends in maternal mortality (1990-2023) and explores shifts in cause-specific and age-specific patterns using the latest Global Burden of Disease (GBD) 2023 data. We analyzed maternal deaths and age-standardized mortality rates (ASMR) globally and across Sociodemographic Index (SDI) and GBD regions. Temporal trends were assessed using estimated annual percentage changes (EAPC). Cause-specific and age-specific mortality patterns were examined. Globally, maternal deaths declined by 43.27% from 422 924 in 1990 to 239 929 in 2023, with ASMR falling from 7.46 to 3.00 per 100 000 population. All age-specific rates declined but with uneven pace. The age distribution shifted toward older women, particularly in high SDI regions where the modal age shifted from 20-24 to 30-34 years. The proportion of hemorrhage decreased, while hypertensive disorders and ectopic pregnancy increased, despite stable or falling absolute rates. ASMR rose in high-income North America and Southern Sub-Saharan Africa but fell sharply in East and South Asia. Low SDI regions retained a younger age distribution and high absolute burden despite substantial rate reductions. Despite global progress, maternal mortality shows uneven epidemiological transition and widening inequities across age, cause, and region. Future strategies must be tailored to local contexts with strengthening emergency obstetric care and early pregnancy diagnostic capacity in low-resource settings, while integrating multidisciplinary management of complex and indirect causes in higher SDI regions, with a sustained focus on age-specific and equity-oriented interventions.