We provide a novel quantitative geospatial analysis of school attacks perpetrated by Boko Haram in Nigeria. Such attacks are used by Boko Haram to kidnap boys (for potential use as child soldiers and suicide bombers) and girls (for potential use as domestic servants, as sex slaves, and suicide bombers). We first build a novel geospatially tagged data set spanning almost 15 years (July 2009 to April 2023) of data not only on Boko Haram attacks on schools (our dependent variable) but also a set of 15 independent variables (or features) about other attacks by Boko Haram, locations of security installations, as well as socioeconomic and geospatial characteristics of the regions around these schools. Second, we develop a univariate statistical analysis of this data, showing strong links between three broad factors affecting attacks on schools: Security presence in and around a school, the Boko Haram Activity in the area around a school, and the Socioeconomic characteristics of the region around a school. Third, we train several predictive machine learning models and assess their predictive efficacy. The results show that some of these models can accurately quantify the likelihood that a school will be at risk of a Boko Haram attack. In addition, they cast light on the features that are most important in making such predictions. We then analyze learned decision trees to identify some conditions on the independent variables that help predict Boko Haram attacks on school. Fourth, we use these decision trees to formulate multivariate hypotheses that we investigate further from a statistical perspective. We find that Security presence near schools, Activity of Boko Haram in regions, and the Socioeconomic factors characterizing the region a school is in are all significant predictors of attacks. We conclude with a policy recommendation.
Children are a particularly vulnerable group and, in northeast Nigeria, they are severely affected by Boko Haram terrorism. Although previous studies have looked at the effects of terrorism on children's mental health, there is a lack of peer-reviewed studies on the effects of terrorism on adolescents' psychosocial adjustment. This study addresses this gap with data on the consequences of Boko Haram terrorism in the northeast of Nigeria. A cross-sectional research design was adopted through systematic sampling. In total, 391 children who were directly affected by Boko Haram terrorism were surveyed. A majority of the sample was male (60.4%). Respondent age ranged from 11 to 23 years (M = 18.00, SD = 2.83). Analyses revealed that 291 (74.42%) of the respondents reported severe traumatic exposure-a markedly increased percentage compared with prevalence rates in countries without conflict. The majority of respondents (70.4%) reported clinically significant symptoms of post-traumatic stress disorder (PTSD). PTSD regularly co-occurred with other mental health and behavioral symptoms: depression, anxiety, and aggression. Terrorism-induced distress had an adverse effect on psychosocial adjustment (R2 = .364, F(6, 385) p < .01). For example, it was found that children were restricted in their social life. Boko Haram terrorism has a devastating impact on adolescents' mental health; most victims presented clinically relevant symptoms of PTSD. The victimized respondents were affected in their psychosocial adjustment to daily life and their educational development. Their vulnerability increases the risk of becoming potential recruits for terrorists. Supporting the victims would thus not only reduce their suffering but also decrease the likelihood of an ongoing cycle of violence.
The 'Boko Haram insurgency' is one of the most devastating armed conflicts that the Nigerian State has experienced in the post-civil war era. The quantum of destruction in terms of lives and property is beyond rational comprehension as it left in its trail both physical and psychological traumata. Post-traumatic stress disorder (PTSD) is one of the psychological sequelae of violent conflicts globally, with prevalence rates of up to 72% in sub-Saharan Africa. The main objectives of this study were to assess the prevalence rate of PTSD as well as to examine its psychosocial correlates among the residents of Maiduguri, which is the epicentre of the armed insurrection. This was a multi-staged, cross-sectional, community-based random study conducted among the residents of Maiduguri. A total of 378 residents of Maiduguri Metropolitan Council were interviewed in 2017, eight years after the onset of the insurgency. Predesigned Sociodemographic Proforma, Modified version of the Communal Traumatic Events Inventory (CTEI), PTSD checklist civilian version (PCL-CV), PTSD Module of the Composite International Diagnostic Interview (CIDI), Rosenberg Self-Esteem scale (RSES), and the Connor-Davidson Resilience Scale (CD-RISC) were administered. Bivariate analyses were used to explore the associations between the psychosocial variables and PTSD diagnosis, while Binary logistic regression was conducted to determine the independent predictors of PTSD. The prevalence of PTSD among the residents of Maiduguri was 54.49% using the PTSD Module of CIDI. The study also found that 57.2% (CI 53.4 - 60.1) of the study participants had experienced between 5 to 10 traumatic events. PTSD was significantly associated with; gender, exposure to multiple traumatic events (P <0.001), history of Abuse (p = 0.032), lower self-esteem (p <0.001), and lower levels of resilience (p <0.001). Sub-syndromic PTSD was experienced by over two-thirds of the study participants, while over 50% of them had CIDI-diagnosable and clinically matched PTSD based on the ICD-10 criteria. This study, therefore, recommends the need for the incorporation of mental health and psychosocial support and the prioritization of the mental health of populations exposed to any form of armed insurrection. L'insurrection de Boko Haram est l'un des conflits armés les plus dévastateurs que l'État nigérian ait connus depuis la guerre civile. L'ampleur des destructions en termes de vies humaines et de biens dépasse l'entendement rationnel, laissant derrière elle des traumatismes physiques et psychologiques. Le trouble de stress post-traumatique (TSPT) est l'une des séquelles psychologiques des conflits violents à l'échelle mondiale, avec des taux de prévalence pouvant atteindre 72 % en Afrique subsaharienne. Les principaux objectifs de cette étude étaient d'évaluer le taux de prévalence du TSPT ainsi que d'examiner ses corrélats psychosociaux parmi les résidents de Maiduguri, qui est l'épicentre de l'insurrection armée. Il s'agit d'une étude aléatoire communautaire, transversale et multi-étapes menée auprès des résidents de Maiduguri. Un total de 378 habitants du Maiduguri Metropolitan Council ont été interrogés en 2017, huit ans après le début de l'insurrection. Les outils utilisés comprenaient un formulaire sociodémographique préétabli, une version modifiée de l'Inventaire des événements traumatiques communautaires (CTEI), la liste de contrôle du TSPT version civile (PCL-CV), le module TSPT de l'Entretien diagnostique international composite (CIDI), l'échelle d'estime de soi de Rosenberg (RSES) et l'échelle de résilience de Connor-Davidson (CD-RISC). Des analyses bivariées ont été utilisées pour explorer les associations entre les variables psychosociales et le diagnostic de TSPT, tandis qu'une régression logistique binaire a été réalisée pour déterminer les prédicteurs indépendants du TSPT. La prévalence du TSPT parmi les résidents de Maiduguri était de 54,49 % selon le module TSPT du CIDI. L'étude a également révélé que 57,2 % (IC 53,4 - 60,1) des participants avaient vécu entre 5 et 10 événements traumatiques. Le TSPT était significativement associé au sexe, à l'exposition à plusieurs événements traumatiques (p < 0,001), aux antécédents de maltraitance (p = 0,032), à une faible estime de soi (p < 0,001) et à de faibles niveaux de résilience (p < 0,001). Un TSPT sous-syndromique a été observé chez plus des deux tiers des participants à l'étude, tandis que plus de 50 % d'entre eux présentaient un TSPT diagnostiquable selon le CIDI et cliniquement conforme aux critères de l'ICD-10. Cette étude recommande donc l'intégration du soutien psychosocial et de la santé mentale ainsi que la priorisation de la santé mentale des populations exposées à toute forme d'insurrection armée. Insurrection de Boko Haram, Prévalence, Corrélats psychosociaux, Trouble de stress post-traumatique.
Approximately one in four adolescents in Sub-Saharan Africa experiences significantly elevated symptoms of anxiety and depression. Those living in resource-constrained communities face heightened risks due to acute distress, trauma, and less responsive health care services. Boikoetliso Ba Boko (meaning 'exercising the mind') is an intervention prototype designed for adolescents and young people experiencing common mental health conditions. The prototype aims to implement a youth-centred community mental health intervention, through collaboration with existing public health systems and community resources. It seeks to enhance access to mental health support for adolescents and young people in Soweto, South Africa, by creating a dynamic and engaging therapeutic environment for those dealing with anxiety, depression, and suicidal ideation. This protocol outlines how we will evaluate the feasibility, acceptability, and implementation process of the prototype mental health intervention. We will enrol 200 at-risk adolescents and young people, aged 14-24 years, who will serve as their own controls, into the intervention and collect assessment and process evaluation data using mixed methods. This study aims to provide a comprehensive understanding of how the Boikoetliso Ba Boko adolescent mental health prototype can be effectively evaluated and scaled up in resource-constrained communities. The findings will inform the development of a Phase II randomized controlled trial protocol to assess the prototype's efficacy. Ethical approval was granted by the Human Ethics Research Committee of the University of the Witwatersrand (M231045 MED23-09-040). Boikoetliso Ba Boko is registered with the Pan African Clinical Trial Registry (PACTR202409702283764).
The bulk of research exploring the impacts of Boko Haram-induced crisis in Nigeria's Northeast region focuses on the country's social, economic, and political conditions while the understanding on the welfare of vulnerable populations - children living in the conflict-ridden communities is sparse. This study addresses the sparsity by investigating the plights of children who became orphans in the wake of horrific Boko Haram attacks in the region in the mid-2010s. Using a qualitative method, we draw insights from Damaturu, Yobe State, where three hundred and eight (orphaned) children were recruited and interviewed. Based on our analysis of the interview data, we argue that they suffered life-threatening situations - parental fatalities by insurgents, alms begging, hard labour for sustenance, degrading living conditions, sexual exploitation, and recruitment into armed groups for violence. The cumulative effects of the attacks made them unsafe and vulnerable to unconventional coping strategies and delinquency amidst the precarity of decent living in the communities. We provide key research and policy-relevant evidence in advancing the understanding of the predicaments of children in wars and socio-politically precarious environments. Also, we underscore the need for holistic and targeted interventions that include vulnerable children in post-insurgency humanitarian efforts to mitigate their discomfort and improve their living conditions.
Missile injury is a global public health problem, which occurs in both military and civilian settings. Boko Haram insurgency in North-Eastern Nigeria is one of the major violence the country experienced that resulted in many civilian casualties. This study was aimed at exploring the various patterns of the missile injuries to the maxillofacial region during Boko Haram insurgency. In this retrospective cross-sectional study, relevant information was retrieved from patient records including sociodemographic, causes of missile injuries, site of injuries, pattern of presentation, treatment, and the complications, and analysed using SPSS version 23. A total of 526 patients with various maxillofacial injuries were seen during this 12-year study period, with age ranging from 4 to 65 years, the peak incidence in the age group 31-40 years, 89.5% were males, 92.9% of the injuries were allegedly inflicted by insurgents and comprised of 61.0% gunshot injuries, 24.5% bomb blast, and machete cuts 7.4%. Most of the injuries occurred in the lower third of the face, 39.8%, and mandible was the commonest fractured facial bone. Facial injuries commonly are associated with devastating consequences to survivors and, hence, may require long time monitoring and psychosocial rehabilitations.
This study examined the roles of rank and its interaction with armed service characteristics, including combat exposure, frequency of deployments, and length of service on psychological distress among non-commissioned military officers (NCOs). A cross-sectional sample of 256 NCOs (Meanage = 34.10 ± 7.33) of the Nigerian Army deployed to fight Boko Haram in North-East, Nigeria, participated in the study. Data were collected using self-report instruments and analyzed using multiple linear regression. The ranks of corporal and lance corporal/private (LCP) were associated with greater psychological distress than the sergeants. However, corporals had higher psychological distress than sergeants and LCPs. Rank accounted for almost twice the variances in psychological distress more than other service characteristics. LCPs had adverse mental health at increased service length than sergeants and corporals. Also, LCPs were more vulnerable to stress at higher combat experience than the corporals. Other factors may be inherent in rank effect on psychological distress beyond combat experience, deployments, and service length. Nevertheless, these service characteristics are important in the rank effect on psychological distress. Identifying relevant combat-related structural problems may additionally explain the association of rank with psychological distress beyond combat experience, deployments, and service length among NCOs.
Violent armed conflict befell Nigeria in 2009 in form of Boko Haram terrorism and insurgency, and has been extended and sustained in all nooks and crannies of the country by banditry, kidnapping for ransom, herder-farmer clash and unknown gunmen attack or ethnic militia. On the other hand, between 2009 and 2024, Nigeria has suffered two economic recessions. This study interrogated the association between the sustained violent armed conflict with the attendant environmental shock and insecurity with the related deaths and economic health in Nigeria (2004-2020), covering the pre-Boko Haram years (2004-2007) and the Boko Haram operation years (2009-2019). The longitudinal study regressed the secondary data on violent armed conflict related deaths in Nigeria against % value added to gross domestic product by agriculture for 2004-2020 and against the prevalence of undernourishment for 2004-2019. Results showed that increase in battle related deaths led to statistically significant decrease in value added to national productivity by agriculture, forestry, and fishing. Prevalence of undernourishment increased significantly with increase in battle-related deaths. The study concluded that violent armed conflicts had significant negative impacts on environmental security in Nigeria and recommended that policymaking and direction be guided as such in order to stem the tide.
Introduction: The COVID-19 pandemic disrupted immunization services in Togo, resulting in 69,672 "zero-dose" and 24,846 "under-vaccinated" children by the end of 2023. This study assessed the effectiveness, acceptability, and feasibility of a social marketing approach deployed during the 2025 Big Catch-Up initiative in Togo. Methods: A convergent mixed-methods study was conducted in 17 priority health districts. The quantitative component compared vaccination coverage before and after the intervention using administrative data. Chi-squared test for linear trend compared district-level coverages, and statistical significance was set at p < 0.05 for all tests. The qualitative component used in-depth interviews with key informants to collect data, followed by thematic content analysis. The intervention was grounded on the social marketing framework with 4 pillars (4Ps): Product, Price, Place, and Promotion. Results: Coverage increased dramatically: Penta1 from 1% to 64%, Penta3 from 1% to 45%, MR1 from 4% to 50%, and MR2 from 6% to 49% (all p < 0.001). Togo ranked 3rd out of 24 African countries for Penta1 progress. The approach demonstrated high community acceptability, with Vaccination Monitoring Committees praised as being culturally appropriate. Key concerns included sustainability and resource constraints. Conclusions: Social marketing was associated with increased community adherence and immunization coverage improvement. However, long-term sustainability requires the institutionalization of community structures with domestic funding and continued health system strengthening.
To develop a machine learning model capable of predicting the bony risk of non-contact anterior cruciate ligament injury, thereby enabling the identification of factors that contribute to such injuries. Data were collected from 400 cases of non-contact ACL-injured and 200 ACL-intact control subjects using Computed Tomography between March 2022 and June 2025. Thirteen features, encompassing demographic, clinical, and radiomic data, as well as six different algorithms, were utilised to develop predictive machine learning models. Shapley Additive Explanations (SHAP) analysis was subsequently performed on the optimal model. The Maximum 2D Diameter Column values for the non-contact ACL injury group and the intact ACL group were 31.12 ± 2.92 mm (95% confidence interval [CI]: 30.83-31.40, p < 0.05) and 32.37 ± 3.07 mm (95% CI: 31.94-32.80, p < 0.05). The Extreme Gradient Boosting classifier was identified as the optimal predictive model, achieving an area under the precision-recall curve of 0.94, the highest among all models evaluated. SHAP analysis revealed that the most predictive feature was the Maximum 2D Diameter Column of the notch, defined as the largest pairwise Euclidean distance between tumour surface mesh vertices in the row-slice plane, followed by the lateral and medial posterior tibial slope. The machine learning model developed in this study demonstrated excellent predictive performance for non-contact ACL injuries. The Maximum 2D Diameter Column was the most important predictor, followed by the lateral and medial posterior tibial slope. Level III.
The 2022 global mpox outbreak highlighted the critical importance of public health emergency preparedness. Although mpox is not a new disease, its sudden emergence and rapid spread in many countries, including Cameroon, raised numerous concerns about the ability of health systems to respond effectively. This study aimed to assess the level of preparedness of health districts in the Littoral Region of Cameroon in the event of a potential mpox outbreak, to identify strengths, weaknesses, and priority areas for intervention. We conducted a descriptive cross-sectional study in the health districts of the Littoral Region of Cameroon from August to September 2024. A grid for evaluating preparedness for a potential mpox outbreak was developed and administered to the district health management teams. This tool was based on the Integrated Disease Surveillance and Response (IDSR) technical guidelines. Data collected were analyzed using Microsoft Excel 2016. A total of 17 health districts were surveyed. Regarding their level of preparedness, 5 districts (29%) showed insufficient preparedness (Nkondjock, Loum, Manoka, Ndom, Pouma); 3 districts (17%) had limited preparedness (Boko, Manjo, Dibombari); 7 districts (41%) had an average level of preparedness (Bangue, Edea, Logbaba, Ngambe, Yabassi, Njombe Penja, Nkongsamba); and only 2 districts (11%) demonstrated good preparedness (Newbell, Mbanga). No district in the region reached the optimal level of preparedness. Significant disparities were observed among the districts, with preparedness scores ranging from 0.16 (Nkondjock) to 3.21 (Newbell). Epidemiological surveillance and laboratory capacity had the highest preparedness level (average preparedness score of 3.01), in contrast to case management (insufficient preparedness score of 1.07). The main barriers to preparedness included the absence of a specific mpox response plan, inadequate allocation of financial and material resources, insufficient diagnostic and laboratory confirmation capacity, lack of clinical management protocols, limited training of health personnel on case management, and absence of a risk communication plan. The health districts in the Littoral Region of Cameroon generally exhibited a limited level of preparedness. Several obstacles to preparedness were identified. To prevent a potential mpox outbreak, it is essential to strengthen district-level preparedness, particularly in coordination and response management, case management, risk communication and community engagement, and prevention and control measures, while adopting a differentiated approach that accounts for disparities between districts. L’épidémie de mpox qui s’est propagée à l’échelle mondiale en 2022 a mis en lumière l’importance cruciale de la préparation aux urgences de santé publique. Bien que le mpox ne soit pas une nouvelle maladie, son apparition soudaine et son expansion rapide dans de nombreux pays tels que le Cameroun a soulevé de nombreuses questions sur la capacité des systèmes de santé à y faire face. Cette étude avait pour objectif d´évaluer le niveau de préparation des districts de santé de la région du Littoral au Cameroun face à une éventuelle épidémie de mpox, afin d’identifier les forces, les faiblesses et les domaines prioritaires d’intervention. Il a été mené une étude descriptive transversale sur une période allant d´aout à septembre 2024, dans les districts de santé de la région du Littoral au Cameroun. Une grille d’évaluation de la préparation face à une éventuelle épidémie de mpox a été élaborée et administrée auprès des responsables des équipes cadres des districts, basée sur le guide technique de Surveillance Intégrée des Maladies et Riposte (SIMR). Les données collectées ont été analysées avec le logiciel Excel 2016. Au total 17 districts ont été enquêtés. En rapport avec le niveau de préparation, il ressort que 5 districts (29%) avaient un niveau de préparation insuffisant (Nkondjock, Loum, Manoka, Ndom, Pouma); 3 districts (17%) avaient une préparation limitée (Boko, Manjo, Dibombari); 7 districts (41%) avaient un niveau de préparation moyen (Bangue, Edea, Logbaba, Ngambe, Yabassi, Njombe Penja, Nkongsamba) et seuls 2 districts (11%) avaient un bon niveau de préparation (Newbell, Mbanga). Aucun district de la région n´avait le niveau de préparation optimal. Aussi, il a été observé de grandes disparités entre les districts avec des scores variants de 0,16 (Nkondjock) à 3,21 (Newbell). La surveillance épidémiologique et laboratoire était la plus significative dans la région avec le meilleur niveau de préparation (préparation Moyenne) (3,01) à l´opposé de la prise en charge des cas (préparation insuffisante) (1,07). Les principaux obstacles à la préparation étaient l´absence d’un plan de préparation de riposte au mpox, l´allocation insuffisante de ressources financières et matérielles, les capacités insuffisantes de diagnostic et de confirmation en laboratoire, l´indisponibilité de protocole de prise en charge clinique, le déficit de formation du personnel de santé sur la prise en charge et l´absence d’un plan de communication des risques. Les districts de santé de la région du Littoral avaient de façon générale un niveau de préparation limité. Plusieurs obstacles pouvant entraver la préparation à la riposte ont été identifiés. Afin de prévenir une éventuelle épidémie de mpox dans les districts de santé de la région du Littoral, il est essentiel de renforcer la préparation des districts sur la coordination et gestion de la réponse, la prise en charge des cas, la communication des risques et engagement communautaire, les mesures de prévention et de contrôle en intégrant une approche différenciée tenant compte des disparités entre districts.
Guidelines recommend structured self-reported functional capacity assessment for preoperative cardiac risk stratification, including the Duke Activity Status Index (DASI). However, evidence supporting its incremental prognostic value beyond established risk factors remains limited. We evaluated the prognostic performance of the DASI using pooled data from two prospective cohorts. We conducted a pooled cohort analysis of adults undergoing elective major non-cardiac surgery enrolled in the Measurement of Exercise Tolerance before Surgery (METS) and Functional Improvement Trajectories After Surgery (FIT After Surgery) studies, including data collected between March 2013 and April 2023. Before surgery, participants completed the Duke Activity Status Index (DASI), a structured 12-item questionnaire based on daily physical activities, and underwent routine preoperative biomarker measurement. The primary outcome was 30-day major cardiac complications (myocardial infarction or non-fatal cardiac arrest) or death. The secondary outcome was all-cause major complications. Hierarchical logistic regression assessed the incremental prognostic value of the DASI beyond age, Revised Cardiac Risk Index (RCRI), and natriuretic peptide concentration. Prognostic performance was evaluated using the likelihood ratio test (LRT), fraction of new predictive information, net reclassification improvement, c-index, calibration plots, and decision curve analysis. Among 3485 patients, 3.6% (n = 126) experienced the primary outcome and 19% (n = 647) experienced the secondary outcome. The DASI provided prognostic information beyond age, RCRI, and natriuretic peptide concentration for the primary outcome (LRT p = 0.009), and beyond age, sex, and surgery type for the secondary outcome (LRT p < 0.001). Inclusion of the DASI improved prognostic performance across multiple metrics, but overall discrimination of the final models remained modest (c-index 0.70-0.71), with limited net clinical benefit. Predicted risk associated with a given DASI score varied substantially by age, RCRI, and natriuretic peptide concentration, supporting interpretation of the DASI as a continuous prognostic marker rather than a dichotomous screening test. The DASI provides incremental prognostic information for preoperative cardiac risk assessment beyond guideline-recommended predictors. Its prognostic implications are modest, context-dependent, and best interpreted as a continuous prognostic marker alongside established risk factors, rather than as a stand-alone threshold-based tool. Canadian Institutes of Health Research; PSI Foundation; and the Elizabeth A. and Richard J. Currie, O.C. Chair in Translational Anesthesia Research at St. Michael's Hospital and the University of Toronto; The Ottawa Hospital Academic Medical Organization Innovation Fund; Heart and Stroke Foundation of Canada; Ontario Ministry of Health and Long-Term Care; Ontario Ministry of Research, Innovation and Science; UK National Institute of Academic Anaesthesia; UK Clinical Research Collaboration; Australian and New Zealand College of Anaesthetists; Monash University.
Bovine tuberculosis (bTB), caused by Mycobacterium bovis, is a chronic zoonotic disease of major global importance, particularly in low- and middle-income countries where surveillance and control remain inadequate. This systematic review and meta-analysis aimed to estimate the global prevalence of bTB, identify key risk factors, and evaluate diagnostic approaches to support evidence-based control strategies within a One Health framework. A systematic search following PRISMA 2020 guidelines was conducted across eight electronic databases (PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar, CAB Abstracts, SpringerLink, and AJOL) for studies published between 1990 and October 2025. A total of 7,775 records were identified, of which 98 studies met the inclusion criteria and were included in the quantitative synthesis. The pooled global prevalence of bTB was estimated at 3.98% (95% CI, 3.94-4.03) and an overall herd's estimate was 18.48% (95% CI, 17.47-19.49). Meta-analysis revealed a significantly lower odds of infection at the animal level compared to herd level (OR = 0.23; 95% CI: 0.15-0.37; p < 0.00001; I2 = 94%), indicating higher cumulative detection in herds. Subgroup analysis showed that Africa contributed the largest proportion of reported cases (61.22%), followed by Asia (30.61%), while other continents had marginal contributions. At regional level, Eastern Africa accounted for 41.84% of included studies, with Ethiopia representing the highest country-specific contribution (34.69%). Age-stratified analysis indicated higher prevalence in older cattle (≥5 years: 21.80%; 95% CI: 14.19-30.71) compared to younger animals (<5 years: 12.90%; 95% CI: 6.55-19.98), with borderline statistical significance (OR = 0.81; 95% CI: 0.66-1.00; p = 0.05). Among diagnostic methods, tuberculin-based skin tests were most frequently used (42.86%), followed by molecular techniques (23.47%). Sample type analysis showed the highest detection rates in skin samples (41.84%), followed by blood (28.57%) and milk (14.29%). Breed-specific analysis revealed higher prevalence in Holstein cattle (30.08%) compared to indigenous zebus (9.08%), suggesting increased susceptibility in improved breeds. Despite generally symmetrical funnel plots indicating low publication bias, substantial heterogeneity was observed across analyses (I2 > 75%), reflecting methodological and regional variability. Bovine tuberculosis remains a persistent and unevenly distributed zoonotic disease, with a disproportionate burden in Africa and Asia. The higher detection at herd level, significant influence of age and breed, and variability in diagnostic methods underscore the need for harmonized surveillance systems, improved diagnostic standardization, and targeted control strategies.
Adolescent reproductive health activities and programmes have been made available to adolescents at schools, non-governmental organisations, and youth-friendly services. However, boys feel neglected as services are mostly catered for girls. This study reflects the neglected voices of a boy-child in Adolescent Sexual and Reproductive Health in Vhembe District in Limpopo province of South Africa. The study was conducted using a cooperative inquiry design. The data were collected using the Lekgotla discussion method. Data were analysed using NVIVO software version 14 and five steps of thematic analysis were followed during the data analysis. The main themes were as follows: We are on our own, Distorted information on Boko (masturbation); boys don't get pregnant"; Discussion about sex with elders is taboo; Programmes are centred around a girl-child. The findings revealed that boys felt isolated as they had to rely on friends to teach them methods of preventing pregnancy that can be used by boys, such as masturbation and pulling out. They also felt that discussing sex education with parents and teachers is taboo. It is, therefore, recommended that there is a need for the Department of Health Services to consider having boy-friendly services to assist boys in managing their sexuality. Des activités et des programmes de santé reproductive pour adolescents ont été mis à la disposition des adolescents dans les écoles, les organisations non gouvernementales et les services adaptés aux jeunes. Cependant, les garçons se sentent négligés dans la mesure où les services sont principalement destinés aux filles. Cette étude reflète les voix négligées d'un garçon-enfant dans le cadre de la santé sexuelle et reproductive des adolescents dans le district de Vhembe, dans la province du Limpopo en Afrique du Sud. L'étude a été menée selon un modèle d'enquête coopérative. Les données ont été collectées en utilisant la méthode de discussion Lekgotla. Les données ont été analysées à l'aide du logiciel NVIVO version 14 et cinq étapes d'analyse thématique ont été suivies lors de l'analyse des données. Les thèmes principaux étaient les suivants : Nous sommes seuls, Informations déformées sur Boko (masturbation) ; les garçons ne tombent pas enceintes » ; Les discussions sur les relations sexuelles avec les aînés sont taboues ; Les programmes sont centrés sur une petite fille. Les résultats ont révélé que les garçons se sentaient isolés car ils devaient compter sur des amis pour leur enseigner des méthodes de prévention de la grossesse qui peuvent être utilisées par les garçons, comme la masturbation et le retrait. Ils estiment également que discuter de l’éducation sexuelle avec les parents et les enseignants est tabou. Il est donc recommandé que le ministère des Services de santé envisage de mettre en place des services adaptés aux garçons pour les aider à gérer leur sexualité.
Pyrethroid resistance in Anopheles gambiae sensu lato threatens the efficacy of long-lasting insecticidal nets (LLINs) in Benin. District-level resistance data and evaluations of next-generation insecticides are needed to inform insecticide resistance management (IRM). We assessed insecticide susceptibility in An. gambiae s.l. populations from three southern Beninese districts (Porto-Novo, Akpro-Missérété, Lokossa) via WHO tube bioassays with pyrethroids (deltamethrin, permethrin, alpha-cypermethrin), pirimiphos-methyl, clothianidin, and chlorfenapyr. Molecular species identification and genotyping of the kdr L995F and Ace-1R G119S mutations were performed via allele-specific PCR. Confirmed pyrethroid resistance was recorded at all sites, with permethrin mortality as low as 17.1% (95% CI 10.6-26.2%) in Porto-Novo. The kdr L995F allele was detected at near-fixation frequencies ranging from 82 to 93% across both An. coluzzii and An. gambiae s.s. Ace-1R G119S remained rare (3-7%), which is consistent with its retained susceptibility to pirimiphos-methyl. The species composition ranged from exclusive to An. coluzzii in Porto-Novo to near-equal distribution in Lokossa. Clothianidin was associated with ≥ 99% cumulative mortality by day 7, and chlorfenapyr was associated with ≥ 98.8% cumulative mortality within 24-48 h across all populations. Pyrethroid resistance is entrenched in southern Benin, driven by the near-fixation of kdr L995F along an urbanization gradient. The fully preserved efficacy of clothianidin and chlorfenapyr against these resistant populations supports the urgent scale-up of next-generation LLINs as a core IRM strategy in this high-burden region.
Poor cardiopulmonary fitness is an important risk factor for postoperative complications, yet a feasible, objective and prognostically accurate method to assess preoperative fitness has not been established. The 6 min walk test (6MWT) is a simple, inexpensive and widely applicable measure that shows promise for predicting postoperative risk. However, robust data are lacking on whether the 6MWT accurately predicts complications, provides incremental prognostic value beyond routinely collected clinical factors or outperforms simpler alternatives such as questionnaires, cardiac biomarkers or grip strength testing. The Functional Assessment for Surgery by a Timed Walk (FAST Walk) study is designed to address these knowledge gaps by evaluating whether the 6MWT improves prediction of key postoperative outcomes compared with clinical factors and simpler measures of fitness. The FAST Walk study is an international multicentre prospective cohort study of 1672 adults (≥40 years) undergoing major elective non-cardiac surgery at centres in Canada, Hong Kong, Australia, Spain and the Netherlands. Participants complete a preoperative 6MWT and baseline assessments of comorbidities, self-reported cardiopulmonary fitness (MET: Re-evaluation for Perioperative Cardiac Risk questionnaire), biomarkers (N-terminal pro-B-type natriuretic peptide) and grip strength. The primary outcome is 30-day death or major postoperative complication, defined as Clavien-Dindo grade II or higher. Secondary outcomes are (1) death or new significant disability at 90 days after surgery and (2) days alive and out of hospital at 30 days after surgery. Disability is measured using the short-form WHO Disability Assessment Schedule 2.0 instrument. Multivariable regression models and complementary metrics of prediction performance will be used to determine whether 6MWT distance adds prognostic value beyond routinely collected clinical factors and simpler measures of fitness. The FAST Walk study has received research ethics board approval at all participating sites. Recruitment commenced in June 2024, with completion of participant follow-up expected in 2026. Findings will be disseminated through peer-reviewed publications and conference presentations, with the primary results anticipated in 2027. NCT06412367.
Person-centered maternity care (PCMC) is an essential aspect of quality maternal healthcare. However, limited research has been conducted on PCMC in Northeast Nigeria, where the Boko Haram insurgency has impacted healthcare delivery. We sought to assess the status of PCMC as well as women and providers' perceptions of security drawing on cross-sectional data collected through 167 postpartum patient exit surveys and 32 surveys with maternity care providers in public health facilities in Yobe State, Nigeria. Results were analyzed using descriptive statistics to describe the environment of care, and PCMC was calculated, using a validated 13-item scale. We calculated an overall PCMC score as well as scores for each of the three PCMC sub-domains. We additionally assessed bivariable associations between PCMC and factors like facility type, women's characteristics, and provider training in respectful care. The average PCMC score was 27 out of 39 (or 70% of the maximum score), indicating important gaps in the quality of person-centered maternity care. While respectful care and dignity (78%) and supportive care (78%) were rated relatively high, effective communication and autonomy scored notably lower (57%). Women reported challenges, including limited ability to ask questions (33%), lack of autonomy in choosing birthing positions (12%), and inadequate explanations of prescribed medications (12%). Women reporting household internal displacement, those with less education and those who delivered in higher level facilities tended to report worse PCMC scores. However, both providers and women generally reported feeling safe within healthcare facilities. Poor communication between provider and patient and lack of support for women's autonomy were important contributors to suboptimal PCMC. Our findings highlight the vulnerability of internally displaced women and those with less education to poor care, underscoring key areas for targeted improvement and intervention.
Bartolomei, S, Mammadova, G, Manno, R, Haff, GG, Hoffman, JR, and Merni, F. Echoes of the modern training periodization concepts in Russia before the October 1917 revolution. J Strength Cond Res XX(X): 000-000, 2025-The debate on the origins of the discipline of training periodization is still ongoing. The text "Olympic Sport," published by B. A. Kotov in 1916, was one of the first known books to focus on training methods and strategies for performance development. The book is also considered the first to deal with training organization and periodization. In addition, Kotov was the only author to cover these topics in Russia before the Soviet Bolshevik Revolution of October 1917. Recently, our research group had the opportunity to work on the original text published in 1916 in Russian, and on the article published with the pseudonym of "Boko" in 1913 for the journal "Russky Sport." The analysis of Kotov's articles offers an insight into periodization and training at the beginning of the 20th century. The knowledge of the historical events and of the evolution of sport allow this article to be contextualized and to understand the author's attempt to promote a different approach to athletic training. Relevant breakthroughs were included in this article, such as the use of training programs to organize long training periods, the prescription of submaximal training loads based on perceived effort and the use of specific preparation phases. In addition, the text contains one of the first notations of the concept of overtraining. Considering its novelty, "Olympic Sport" represents a revolutionary book and the author can be considered as a fundamental contributor to the development of the discipline of the training theory and a starting point of modern periodization.
The advancement of small ruminant farming in Benin has encountered challenges associated with health issues and agricultural practices. This study aimed to provide the initial documentation of the prevalence of enzootic ovine abortion and evaluate the health status of animals concerning various recurring diseases on traditional small ruminant farms in Benin. In 2023, a semi-structured survey of 450 farms was carried out in two agricultural development centers in Benin. Additionally, 385 sera samples (200 sheep and 185 goats) from 77 farms, selected from the 450 surveyed farms, where animals exhibited signs of reproductive loss, underwent testing using the indirect Elisa method for Chlamydia abortus species. Among the 385 sera samples tested, 30 (7.79%) from pole 1 and 25 (6.49%) from pole 2 were positive for Chlamydia abortus. The survey results unveiled that small ruminants were primarily raised for savings and, to a lesser extent, for meat production and socio-cultural reasons, predominantly in Pole 1. During the rainy season, the common practice among farmers is to let their animals run free, although some opt to tie them to a fixed stake or keep them in loose confinement, the latter being more common in pole 2. The primary animal diseases reported by farmers included peste des petits ruminants, scabies, verminous digestive diseases, pasteurellosis, Rift Valley fever, sheep pox, agalactia, and trypanosomosis. The incidence of these diseases varied between the poles. Enzootic Ovine Abortion emerges as a substantial threat to both animal well-being and public health. This research sheds light on the overlooked nature of this perilous disease, aiming to contribute to the enhancement of small ruminant livestock.
System-wide trauma registries have played a key role in reducing preventable death among combat casualties of high-resource militaries. Although several efforts exist to introduce trauma registries in low- and lower-middle-income countries, no standardized data collection exists for casualties in low-resource conflict settings (LRCS) encompassing prehospital to operative management. We developed a casualty data form (CDF) for LRCS based on a previous analysis of casualty care in Burkina Faso. An initial paper CDF was iteratively refined during data collection and then evaluated against existing tools (e.g., World Health Organization [WHO] and the U.S. Department of Defense Trauma Registry [DoDTR]) to ensure harmonization of variables. The final version of the CDF was then translated into electronic formats (Excel and KoboToolbox) to maximize usability in a range of contexts. The final toolkit includes (i) a Microsoft Word-based CDF for paper data collection, (ii) an Excel sheet with a coding guide for offline electronic data capture, and (iii) a KoboToolbox form for online or offline data collection. The CDF consists of 29 parent variables that capture patient demographics, prehospital care, injury characteristics, resource utilization, surgical interventions, and early outcomes. We present an open-access toolkit designed for casualty care data collection in LRCS. By providing standardized data collection instruments in multiple formats compatible with limited connectivity and minimal existing data infrastructure, this toolkit holds the potential to facilitate casualty care documentation in LRCS. An improved evidence base may help data-driven approaches to reducing preventable death and disability among local casualties.