Africa is facing a rising prevalence of non-communicable diseases (NCDs), driven by shifts in lifestyle and dietary habits. Children with delays in motor coordination are less likely to participate in physical activity, active play, and sports, placing them at increased risk for obesity, reduced physical fitness, and cardiovascular diseases. Existing motor performance tests for school-aged children were not designed for African populations and lack culturally valid normative data. As part of an African-led initiative, the PERFormance and FITness test battery (PERF-FIT) was developed to assess motor performance and motor skill-related physical fitness in children aged 6-12 years. The PERF-FIT test battery is open-source, contextually relevant, and tailored for low-resource settings. This study involved the collection of motor performance data from a large sample of African children to establish age- and sex-specific normative values. This study generates normative data for motor skills in African children aged 6-12 years (n = 2604), stratified by age and sex. These norms complement the previously validated psychometric properties of the PERF-FIT, confirming its reliability and applicability across diverse African contexts. The PERF-FIT test battery provides a culturally appropriate and psychometrically sound tool for assessing motor performance in African children. It serves as a valuable resource for clinicians, educators, and policymakers to monitor motor skill related physical fitness and detect motor delays in children aged 6-12 years in African countries. This study aimed to make a motor performance test that is suitable for African children aged 6 to 12 years. Many existing tests were developed in other regions and do not reflect the abilities or context of African children. Researchers of an African-led initiative developed the PERFormance and FITness test battery (PERF-FIT), which is free to use and designed for schools, clinics and healthcare workers in low-resource settings. The study describes how data were collected from 2604 children to create age- and sex-specific norms. These results help professionals understand what typical motor skills look like in African children. This tool can support early identification of children at risk for motor delays and health problems based on low motor fitness.
The coronavirus disease of 2019 (COVID-19) pandemic left lasting effects in all sectors globally. Particularly among women of reproductive age, it has instilled difficulty of accessing healthcare, which has been linked to fear of being exposed to the virus at health facilities. However, most studies especially in East Africa have narrowed COVID-19 related research to qualitative reviews and descriptive analyses due to inadequacy of COVID-19 data. The purpose of this study was to determine the relationship between health facility visiting and healthcare access difficulty due to fear of COVID-19 at health facilities, while exploring both individual and contextual determinants. The current study applied a multilevel logistic mixed-effects regression model to account for both individual and contextual dimensions in the study. Overall, 30.0% of the women reported difficulty in accessing healthcare. Women who had visited a health facility in the past 4 weeks of the survey and had health insurance were associated with less healthcare access difficulty; (AOR= 0.73; 95% CI, 0.57-0.95) and (AOR= 0.74; 95% CI, 0.59-0.94) respectively. On the contrary, women who watched television, in households that had partially and completely lost household income due to the virus were associated with more difficulty; (AOR= 1.38; 95% CI, 1.10-1.74), (AOR= 2.09, 95% CI, 1.51-2.88) and (AOR= 2.40, 95% CI, 1.65-3.47) respectively. About 72% of the total variance in healthcare access difficulty was attributable to differences in enumeration areas (ICC= 0.72; 95% CI, 0.66-0.76), with less significant individual level contribution. Interventions that influence routine health facility visits can boost healthcare access among women. Enumeration area-specific interventions may be more effective.
Access to safe sanitation is a human right, yet millions in Africa practice open defecation, risking disease and environmental harm. Despite global efforts, rural-urban disparities remain, especially in low-income countries. This study examines these disparities to inform policies for equitable sanitation access. To assess rural-urban disparities in open defecation across 47 African countries using WHO and HEAT data, identifying patterns for equitable sanitation policies and SDG 6 progress. This study assessed disparities using WHO and HEAT data, focusing on open defecation prevalence, defined as the population without sanitation facilities. The main inequality measure was the absolute prevalence difference between rural and urban populations. In 2022, South Africa, Mauritius, and Rwanda had near-universal access, with prevalence below 3%. Eritrea, Chad, and South Sudan exceeded 40%, some over 60%. Disparities were pronounced, with rural rates higher. Largest differences were in Niger (66.7 percentage points), Chad (62.2), and South Sudan (65.2). Some countries had minimal disparities, nearly eliminating open defecation in both areas. The study highlights significant sanitation inequalities, with rural areas most affected. It calls for targeted rural interventions, continued urban progress, and equity-focused policies to achieve SDG 6 and improve public health across Africa.
Health impacts of global warming in sub-Saharan African countries that received President's Emergency Plan for AIDS Relief (PEPFAR)-funded HIV support are not known. Assuming the narrative of the Shared Socioeconomic Pathway 2, we estimated excess deaths, life expectancy losses at birth, and economic welfare losses in terms of full income. We relied on the MAGICC climate model for temperature predictions from 2025-2100 and net all-cause mortality risks estimated by others. Surface temperature increases could reduce life expectancy at birth by 0.057 years in 2025 (95% CI: 0.024-0.095). By 2050, the reduction could increase by 30.7%, to 0.075 years (95% CI: 0.0311-0.1247). By 2100, it could further increase by 44.5%, to 0.083 years (95% CI: 0.034-0.138). Corresponding full income losses are US$11.44 billion in 2025 (95% CI: $4.77-$19.07 billion), which increases by 4-fold in 2050 to US$44.62 billion (95% CI: $18.65-$74.36 billion). By 2100, a 30-fold increase is possible, to US$353.56 billion (95% CI: $148.84-$588.32 billion). On a per capita basis, the highest full income losses consistently accrue to Lesotho between 2025 and 2100 (US$20.51, or 0.70% of per capita GDP, to US$355.39, or 0.80%). Adjusted investment is needed to address climate impacts, especially in countries such as Lesotho that may bear damage due to other regional emitters.
High-risk fertility behavior is a leading contributor to adverse maternal and child health outcomes. This study assessed the prevalence and determinants of high-risk fertility behavior among reproductive-age women in sub-Saharan Africa. We conducted a secondary analysis of Demography and Health Survey data from eight sub-Saharan African countries with extremely high or very high maternal mortality. A weighted sample of 78,353 reproductive-age women who had given birth in the five years preceding the survey was included. A multilevel mixed-effects binary logistic regression model was used to identify individual- and community-level factors associated with high-risk fertility behavior, accounting for the hierarchical nature of the data. Statistical significance was determined using AOR with a 95% CI and a p-value ≤ 0.05. The overall prevalence of high-risk fertility behavior was 71.46% (95% CI: 71.14%, 71.77%)), with the highest prevalence observed in Chad (87.75%) and the lowest in Lesotho (40.49%). Key individual-level determinants included women's and husbands' education, religion, wealth status, child sex, marital status, mobile phone and internet use, antenatal care attendance, history of pregnancy termination, and contraceptive use. At the community level, low poverty was associated with a reduced likelihood of high-risk fertility behavior. The prevalence of high-risk fertility behavior remains high in countries with extremely high and very high maternal mortality countries, highlighting a need to address it through urgent and concerted interventions. Policymakers and planners should prioritize interventions targeting the key determinants high-risk fertility behavior to curb its occurrence and improve maternal and child health outcomes. High-risk fertility behavior (HRFB) is defined as having children at very young or older ages, having many births, or spacing pregnancies too closely, which can lead to serious health problems for mothers and children. This study aimed to determine the magnitude of high-risk fertility behaviors and the factors that affect the behavior among women in eight sub-Saharan African countries with very high maternal mortalities. Using data from over 78,000 women, we analyzed both individual and community-level characteristics linked to HRFB. This study found that about 71% of women had HRFB. The highest rates were in Chad, and the lowest were in Lesotho. Factors such as low education, poverty, limited use of antenatal care, lack of contraception, and reduced access to mobile phones or the internet increased the likelihood of HRFB. Communities with lower poverty showed lower rates. These findings underscore the need for targeted policies and programs to reduce HRFB and improve maternal and child health.
Goats are an integral part of the livelihoods of South Africans, particularly in the rural communities, yet reproductive inefficiencies (low libido, poor semen quality, uterine infections, postpartum disorders, parasitism, and nutrition gaps) limit their productivity. Most resource challenged farmers resort to the use of ethnoveterinary plants for reproductive health of their goats due to their safety and ease of access; however, there is still a lack of standardization on their safety, dosing and efficacy. This study aimed to review and document the South African traditional medicinal plants used to enhance reproductive performance in goats. The study carried out a narrative review of ethnoveterinary surveys and pharmaco-ethnobotanical literature focused on South Africa, complemented by relevant goat reproduction studies. Our search used various keywords, including "medicinal plants," "goat breeding," "ethnoveterinary," and "medicinal plants" to identify relevant literature in several databases, including Scopus, Web of Science, Access to Global Online Research in Agriculture, and ScienceDirect. Additional searches were conducted using citations found in articles in these databases. The focus was on peer reviewed journals published between the year 2000 and 2025 on South African medicinal plants used to enhance goat reproduction, whether directly or indirectly. During the literature review, it was found that among other plants Securidaca longepedunculata Fresen. (violet tree), Moringa oleifera Lam (moringa), Elephantorrhiza elephantina (Burch.) Skeels (elephant root), Kigelia africana (Lam.) Benth. (sausage tree), Aloe ferox Mill., were frequently mentioned. Strong evidence was noted from ethnobotanical use to in vitro/in vivo validation, though limited but growing, especially for anthelmintic and antioxidant actions. Based on the literature, it can be concluded that South Africa's ethnobotanical resources hold credible value for improving goat reproduction by acting as antioxidants, regulating hormones, fighting infections, and controlling parasites that affect body condition. However, well-designed goat studies with proper dosing and safety testing are limited.
Background: Posttraumatic stress disorder (PTSD) during pregnancy is directly related to negative maternal health and birth outcomes. However, prenatal screening for PTSD is not conducted regularly. In addition, PTSD and maternal morbidity disproportionally affect Black women, making it critical to improve detection and treatment of PTSD for Black women in pregnancy. Obstetrics clinics in urban safety net hospitals are uniquely positioned to implement systemic changes in how pregnant women are screened for comorbidities and retained in perinatal care, which could result in decreased maternal morbidities and improved mental health outcomes.Methods: Using a multicenter, randomized, parallel-group design, we outline a clinical trial that will compare the effectiveness of two active PTSD screening approaches for Black pregnant women receiving care in urban obstetrics clinics. Participants are randomly assigned to one of two intervention arms: a brief screening for PTSD or a culturally responsive screening, brief intervention and referral to treatment for obstetrics (SBIRT for OB) intervention.Discussion: This is the first study to directly examine the effects of these PTSD screening approaches on mental and physical health outcomes and care management for pregnant women. Improving how PTSD is identified and addressed during pregnancy could help reduce racial disparities in maternal health outcomes and ensure that Black mothers receive the care and support they deserve.Trial registration: The study has been registered with clinicaltrials.gov (NCT#06522022). This study will compare two screening interventions for PTSD to determine which intervention is more effective at reducing PTSD symptoms and promoting maternal perinatal care utilization for Black pregnant women.We will train peer providers to administer a culturally adapted screening, brief intervention, and referral to treatment protocol for PTSD screening in the context of an obstetrics prenatal care visit in an urban safety net hospital.Study findings could ultimately help reduce racial disparities in maternal health outcomes.
Polygenic risk scores (PRSs) improve prediction of the development of type 2 diabetes over the use of clinical risk factors alone; however, they perform poorly in populations of non-European ancestry, limiting their global clinical utility. We aimed to deliver comprehensive and rigorously tested multi-ancestry PRSs for prediction in type 2 diabetes. We conducted meta-analyses using data from type 2 diabetes genome-wide association studies (GWAS) across cohorts from five major global ancestries: European, African or African American, Admixed American, South Asian, and East Asian. We used summary statistics from the GWAS to construct single-ancestry PRSs (using the continuous-shrinkage PRS-CS method) and multi-ancestry PRSs (using the PRS-CSx method), and constructed ancestry-specific linkage disequilibrium panels to model pairwise correlations between single-nucleotide polymorphisms in GWAS during PRS construction. Models were validated for association with type 2 diabetes in at least four independent cohorts per ancestry. The effect sizes of PRSs were estimated as the odds ratio (OR) per SD of the PRS, and ORs for individuals at the 90th, 95th, and 97·5th PRS percentiles were compared with the IQR as a reference. We also tested our PRS models for prediction of diabetes incidence with or without additional clinical factors, as well as microvascular complications and comorbidities. Our analysis used data from 409 959 individuals with type 2 diabetes and 1 983 345 controls: respectively, 359 819 and 1 825 729 indivduals were included in the GWAS dataset, with 10 992 and 31 792 individuals in the training dataset and 39 148 and 125 824 individuals in the validation dataset. The best predictive performance for the single-ancestry PRSs was in European (incremental AUC 0·07-0·14) and East Asian (0·02-0·16) ancestries, whereas prediction was poorer for African or African American (0·02-0·03), Admixed American (0·02-0·04), and South Asian (0·02-0·04) ancestries, correlating with sample sizes in the GWAS. Compared with single-ancestry PRSs, our multi-ancestry PRSs showed higher effect sizes and smaller 95% CIs across all ancestries: OR per SD 1·73 (95% CI 1·67-1·80) in African or African American, 2·82 (2·67-2·97) in Admixed American, 2·45 (2·36-2·54) in East Asian, 2·36 (2·32-2·41) in European, and 2·23 (2·05-2·42) in South Asian ancestries. Individuals in the 97·5th PRS percentile had a 3-7 times increased risk of type 2 diabetes compared with those in the IQR (OR 3·43 [95% CI 2·80-4·21] in African or African American, 7·47 [5·64-9·89] in Admixed American, 6·62 [5·58-7·85] in East Asian, 6·25 [5·72-6·82] in European, and 4·50 [2·70-7·53] in South Asian ancestries). These PRSs were also associated with earlier onset of type 2 diabetes, higher risk of developing microvascular complications, and provide additional predictive value beyond clinical factors. In individuals with type 2 diabetes, the association between multi-ancestry PRSs and risk of microvascular complications and comorbidity was studied in populations of African, Admixed American, and European ancestries and was significant in all three ancestry groups for diabetic retinopathy (ORs per SD 1·28-1·57), diabetic nephropathy (1·25-1·58), proliferative diabetic retinopathy (1·39-2·08), and end-stage diabetic nephropathy (1·44-1·87); PRS was associated with coronary artery disease in the Admixed American ancestry group only (1·16 [95% CI 1·08-1·25]). These validated, publicly available PRSs can improve risk stratification for type 2 diabetes onset and complications across diverse ancestries, supporting their further evaluation in clinical settings. The National Human Genome Research Institute of the US National Institutes of Health.
When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals' interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.
The genetic architecture of cardiovascular traits is poorly characterised in non-European populations, limiting our understanding of disease aetiology and contributing to health disparities. Here, we analyse the genetic architecture of four cardiovascular traits (systolic and diastolic blood pressure, pulse rate, and maximum heart rate) using multi-trait analysis of genome-wide association studies and local genetic correlation analysis in 459,327 European (EUR) and 6654 African (AFR) ancestry individuals from the UK Biobank. Our analysis identifies 957 and 45 novel variants in the EUR and AFR cohorts, respectively, but reveals a profound divergence in the pleiotropic architecture of blood pressure. We identify 181 genomic loci with significant local genetic correlation between systolic and diastolic blood pressure (SBP-DBP) in the European sample, whereas such signals are completely absent in the African ancestry cohort. This marked disparity in local genetic correlation structure highlights that pleiotropic mechanisms can be highly ancestry-specific, underscoring the limitations of transferring genetic risk models across populations and the critical need for inclusive genomic research.
Chronic kidney disease (CKD) and chronic inflammation are highly prevalent in African populations, yet their relationship remains understudied. We examined the association between acute-phase reactants (C-reactive protein and ferritin) as markers of acute and chronic inflammation and the incidence of CKD 6 years later in a prospective Ghanaian population-based cohort. Data from the prospective Research on Obesity and Diabetes among African Migrants (RODAM-Pros) cohort were analysed and included participants living in rural and urban Ghana and Ghanaian migrants in the Netherlands. Acute-phase reactants were assessed between 2012 and 2015, while CKD incidence was assessed between 2019 and 2021 by using the race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Robust Poisson regression models adjusted for potential confounders were used to assess associations. We explored interactions with age, sex, education, and geographical location, and stratified C-reactive protein (CRP) analyses by using established clinical cutoffs. The role of ferritin as an iron-storage marker was also evaluated. Among 1435 participants, the baseline CRP was not associated with CKD incidence at follow-up [adjusted incidence rate ratio (aIRR) 1.02; 95% confidence interval (CI): 0.84-1.15]. Higher ferritin levels were associated with increased CKD risk (aIRR 3.53; 95% CI: 2.42-5.01) and albuminuria (aIRR 4.22; 95% CI: 2.87-6.10), but not with reduced estimated glomerular filtration rate (aIRR 0.99; 95% CI: 0.92-1.05). No effect modification was observed by age, sex, education, or geographical location. We found no evidence that iron overload or deficiency contributed to the ferritin-CKD relationship. Elevated ferritin levels, but not CRP levels, were associated with future CKD risk in Ghanaians. Multi-population prospective studies with repeated ferritin measurements are needed to better understand the links between ferritin, iron status, and CKD in African populations.
This study aimed to evaluate growth performance, amino acid and fatty acid composition of fillets, and blood biochemistry of hybrid catfish (Heteroclarias) cultured on Black Soldier Fly (BSF), Hermetia illucens larval-based diets. The experiment was conducted in a recirculating system, circular poly tanks (350 L), in a completely randomized design. Four isonitrogenous (400 g kg-1 crude protein) and isolipidic (140 g kg-1 crude fat) diets were formulated in which fishmeal (400 g kg-1) was replaced at 0%, 25%, 50%, and 75% with defatted BSF larval meal and fish oil was completely replaced with corn oil in the test diets. 180 hybrid African catfish (12 weeks post-hatching) with an initial body weight of 200 ± 25 g were randomly distributed in the 12 experimental tanks (15 fish per tank, 45 fish per treatment) and were hand-fed at 3% body weight for 8 weeks. The findings showed that replacing 50% of fishmeal with BSF meal resulted in the highest growth performance (final weight, weight gain, specific growth rate [SGR], thermal growth coefficient [TGC]). However, at 75% level, growth performance and nutrient utilization (FCR, PER) significantly decline (p  < 0.05). The dietary modification had no significant impact (p  > 0.05) on organosomatic indices, proximate composition, amino acid profile, deposition, or retention of arachidonic acid (ARA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and sum n-3 polyunsaturated fatty acids (PUFA) in fish fillets. There were no significant differences in the hematological parameters (p  > 0.05) across all treatments. Except for a reduction in globulin and cholesterol levels, all the plasma metabolites, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, remained stable (p  > 0.05). Overall, the findings of this study suggest that BSF larval meal may partially replace dietary fishmeal up to 50% (200 g kg-1), and corn oil may completely replace fish oil in a practical diet for hybrid African catfish without exerting adverse impacts on growth, feed conversion efficiency, fillet quality, health status, and physiological well-being.
Schools play a crucial role in supporting adolescent mental health, especially in low- and middle-income countries (LMICs), where young people face structural and societal challenges. This study explores the feasibility and acceptability of the Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a multilevel intervention for at-risk adolescents aged 13-14 in South Africa. HASHTAG includes two components: thriving environment in schools (TES), a whole-school approach, and thriving together (TT), a classroom-based programme. Using a mixed-methods design, we assessed feasibility in two Khayelitsha schools through implementation measures (attendance, fidelity and acceptability), focus groups (n = 46), and pre-post surveys (n = 231). Despite COVID-19 disruptions, the intervention was implemented with high fidelity and met all progression criteria. Students and staff found HASHTAG relevant and engaging, particularly appreciating the TT sessions delivered by external facilitators. The TES teacher module also created space for reflection and self-care. Some teachers suggested improved sensitisation could strengthen the programme's impact. Although no significant changes were observed in quantitative outcomes, no harms were reported. These findings support the feasibility and acceptability of HASHTAG and highlight the need for a full-scale trial to evaluate its potential impact on adolescent mental health in LMIC settings.
Childhood adversity is widespread globally and is one of the strongest predictors of later psychopathology. However, the differential effects of type and timing of childhood adversities on childhood psychopathology remain unclear, highlighting the need to explore which life-course hypotheses (sensitive periods, accumulation of exposure, and/or recency of exposure) best explain these associations. Of particular importance, there is a lack of research in low- and middle-income countries (LMIC), where children experience higher rates of adversity relative to children in high-income countries (HIC). Participants included 787 children and their mothers from a South African birth cohort, the Drakenstein Child Health Study. Mothers reported child exposure to adversity from birth to 8 years of age across six adversity categories. We used the two-stage Structured Life-Course Modeling Approach (SLCMA) to examine life-course associations between childhood adversity exposures and internalizing/externalizing symptoms measured using the Child Behavior Checklist at age 8 years. Maternal psychopathology, maternal adverse events, child food insecurity, and child exposure to community/domestic violence had the strongest associations with child psychopathology symptoms, with varying life-course models selected. The accumulation hypothesis best explained associations of maternal adverse events (partial R2 = 2.3%) and child exposure to community/domestic violence (partial R2 = 1.6%) with internalizing symptoms. The combined middle childhood sensitive period (age > 5-8) and recency hypotheses model best explained associations between maternal psychopathology and internalizing (partial R2 = 7.0%) or externalizing (partial R2 = 5.1%) symptoms. We identified that different types and timing of childhood adversity confer differential risk for childhood psychopathology symptoms in this LMIC sample. Our work has implications for strategically-timed intervention and prevention strategies to improve mental health, which may need to be specifically designed for children in LMIC.
Metabolic syndrome (MS) is an atherogenic risk factor influenced by both modifiable and non-modifiable risk factors, including race, hypertension, obesity, and age. This study evaluated the association between MS and arterial stiffness (AS) in individuals of African ancestry. Using WHO criteria, MS was assessed in 668 participants aged 18-70 years. Obesity was evaluated through body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Blood pressure (BP) measurements included office BP, 24-hour ambulatory BP monitoring (ABPM), and daytime/nighttime BP. Arterial stiffness was assessed via pulse wave velocity (PWV). Blood samples were analyzed for triglycerides (TG), high-density lipoprotein (HDL), and fasting blood glucose. Statistical analysis was performed using SPSS and STATA. The prevalence of metabolic syndrome increased with age and was significantly higher in females. Participants with MS had a higher prevalence of hypertension and obesity. PWV was significantly associated with BP parameters and obesity indices (BMI, WC, WHR). Moreover, PWV was higher in individuals with MS compared to those without. Obesity and hypertension, key diagnostic components of MS, are independently associated with arterial stiffness. This underscores their role in driving target organ damage among individuals with MS in this African ancestry cohort.
Despite the electrocardiogram (ECG) being a critical bedside diagnostic tool, evidence suggests suboptimal ECG interpretation competence among doctors worldwide. Limited research exists evaluating the ECG interpretation skills of South African junior doctors. This study addresses an important knowledge gap in the literature which assesses the knowledge of "must-know" ECG conditions of junior South African doctors, previously identified through a Delphi study. This cross-sectional survey assessed ECG interpretation competence among 117 junior doctors across four public hospitals in Gauteng Province, South Africa. Data were collected over the period December 2024 to November 2025. Respondents completed a 20-question assessment based on consensus-derived "must-know" ECG diagnoses for medical students adapted from Viljoen's Delphi study, which identified ECG teaching priorities for medical schools using expert consensus performance was analysed according to professional category, training background, and emergency medicine exposure. Overall mean score was 10.3/20 (51.5%), with only 34.2% achieving the predefined pass standard of 75%. Community service doctors outperformed interns (57.1% vs 49.1-49.3%) though not significantly (p = 0.194). Formal ECG training significantly improved performance: 62.1% versus 52.9% self-taught and 39.4% untrained (p < 0.001). Critical diagnostic deficiencies included polymorphic ventricular tachycardia; monomorphic ventricular tachycardia; second and third-degree heart blocks. The lowest-scoring ECGs were right ventricular hypertrophy, pericarditis, sinus arrhythmia, and first-degree AV block. Emergency medicine exposure showed dose-response trend (53.7% vs 42.1% vs 36.3%) without statistical significance (p = 0.109) due to sample imbalance (n = 106, 7, 4). Junior doctors in Gauteng demonstrated ECG interpretation deficiencies for life-threatening conditions such as poly and monomorphic ventricular tachycardia, and second and third-degree heart blocks. The lowest-scoring ECGs were those with pericarditis and right ventricular hypertrophy. Despite these findings, this study suggests that formal ECG training improves ECG diagnostic performance which has significant implications for curriculum development.
Antenatal care (ANC) is a cornerstone of maternal and neonatal health, yet its utilization remains suboptimal in Somalia, contributing to high maternal and perinatal morbidity and mortality. Understanding the predictors of ANC utilization is essential for designing effective interventions. This systematic review aimed to identify predictors of antenatal care service utilization among women of reproductive age in Somalia. A systematic search of PubMed, Google Scholar, Medline, CINAHL, EMBASE, and African Journals Online was conducted for studies published between 2010 and 2025. Quantitative studies reporting predictors of ANC utilization using multivariable analysis were included. Study selection and reporting followed PRISMA guidelines. Methodological quality was assessed using standardized appraisal tools. The review protocol was registered in PROSPERO (registration number: CRD420251244002). Nine studies met the inclusion criteria. ANC utilization in Somalia was influenced by a combination of sociodemographic, obstetric, knowledge-related, and health system factors. Consistently reported predictors included maternal education, place of residence, household wealth index, marital status, pregnancy intention, maternal age, and exposure to mass media. Early gestational age at first visit, gravida status, knowledge of ANC, distance to health facilities, accessibility of services, and perceived health worker attitudes were also significant predictors. Antenatal care utilization in Somalia is shaped by complex and interrelated individual, socioeconomic, and health system factors. Targeted interventions focusing on female education, community awareness, early ANC initiation, and improved access to quality maternal health services are critical to increasing ANC utilization and improving maternal and neonatal outcomes. https://www.york.ac.uk/inst/crd, PROSPERO registration number, CRD420251244002.
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Thyroid diseases vary geographically, with iodine deficiency being a major cause in Africa. These conditions range from congenital anomalies to acquired neoplastic and non-neoplastic lesions. To establish baseline data on the frequency and patterns of thyroid lesions diagnosed in a teaching hospital's histopathology department over an 11-year period (2012-2022). A retrospective descriptive study was conducted using slides and paraffin-embedded blocks of thyroidectomy specimens from January 2012 to December 2022. Clinical data including age, sex, and histological diagnosis were retrieved and analyzed using SPSS version 23.0. A total of 111 thyroid lesions (2.4% of all cases) were reviewed, with a female-to-male ratio of 5.5:1 and a mean age of 42.5 years (SD = 12.94). Hyperplastic lesions predominated (76.6%), comprising nodular hyperplasia (45.0%) and diffuse goitre (31.5%). Neoplasms accounted for 18.9%, including papillary carcinoma (7.2%) and follicular carcinoma (4.5%). Congenital and inflammatory lesions were least frequent. Neoplasms peaked in the fourth decade, with significant associations between age, gender, and lesion type (p < 0.001). Thyroid lesions showed strong female predominance. Non-neoplastic conditions were most common, with peak incidence between the fourth and sixth decades.