Cryptosporidium (C.) is one of the most important causes of gastrointestinal disorders in various animal species, leading to significant economic losses in the dairy sector. The parasite has also significant zoonotic relevance, with well-documented cross-transmission between animals and humans. However, data on the status of cryptosporidiosis in scattered nomadic populations is scarce. Therefore, this study was conducted to determine the prevalence and associated risk factors of cryptosporidiosis in cattle raised by socioeconomically deprived nomadic communities in an important agro-ecological zone (Multan) of South Punjab, Pakistan. Fecal samples (n = 184) were collected from cattle belonging to nomadic communities of study area. Samples were analyzed for the detection of C. parvum copro-antigen using commercially available species-specific ELISA kits (IDEXX, USA; sensitivity 98%, specificity 94%). Data on potential risk factors were collected using a pre-designed questionnaire and analyzed using bivariate and multivariable logistic regression analyses. Data showed that overall prevalence of cryptosporidiosis in target cattle population was 13.59% (n = 25/184; 95% CI: 9.03%-19.21%). Bivariate analysis revealed significant association (p < 0.05) of cryptosporidiosis with age, health status, history of gastrointestinal problems, physiological status of females, herd size, drinking water source, history of deworming and routine vaccination, and contact with other susceptible animals. Multivariable logistic regression analysis identified age ≤ 1 year (OR = 7.53), contact with susceptible animals (OR = 7.79), small herd size (1-5 heads; OR = 0.21), and history of routine vaccination (OR = 0.17) as significant predictors of cryptosporidiosis. Findings of this study concluded that C. parvum is prevalent in cattle raised by nomadic communities in the study area. Targeted animal health action plans should be developed to control infectious zoonotic diseases, including cryptosporidiosis, by considering nomadic populations as an integral segment of society. The frequent movement of nomads and their animals may facilitate disease transmission across regions. Awareness campaigns are recommended to prevent and control diseases of veterinary public health importance.
This study explores the psychosocial consequences of recurrent environmental displacement among river-nomadic (Bede) communities in Bangladesh, emphasizing how cyclical mobility, ecological degradation, and social marginalization shape mental health and resilience. A qualitative phenomenological approach was adopted, analyzing twelve in-depth interviews and one focus group discussion from three Jamuna River settlements (2025 monsoon season) via NVivo 14. We identified six themes: income-driven relocation, environmental hazards as triggers, cumulative physical and emotional tolls, negotiation/reputation as safety mechanisms, culturally rooted coping, and aspirations for stability. Participants described chronic uncertainty alongside strong communal solidarity and faith-based coping. Findings highlight that displacement among river nomads is a continuous, multifaceted psychosocial exposure rather than an isolated event. Sustainable interventions should integrate mobile, community-based mental health and psychosocial support (MHPSS) services with environmentally informed livelihood programs and inclusive governance. This research contributes empirical evidence to the discourse on climate-related migration, emphasizing the need for culturally grounded, mobility-sensitive approaches for marginalized riverine populations.
The Eurasian Steppe in the first millennium BCE saw the rise of the Scytho-Siberian archaeological horizon, which would come to stretch from the Altai Mountains in the east to the Black Sea in the west. We examined the genetic profiles of Iron Age Scythians to explore how social status shaped biological relatedness and ancestry patterns. We present genome-wide data from 85 individuals (38 elite and 47 non-elite), including 45 newly sequenced individuals and the first genome-wide data for the Scythian "Golden Man." We identify consanguineous unions, a reduced effective population size, and identity-by-descent links among the elites. Dynastic rule is supported by elite grandparent-grandchild relationships across cemeteries. While ancestries are heterogeneous, elite Iron Age Scythians show lower variation and no detectable patrilocal or matrilocal signal. These findings highlight hereditary status transmission and the emergence of social stratification in ancient nomadic societies.
We have recently demonstrated that muscle sympathetic nerve activity and normetanephrine levels are transiently increased for several days immediately after acute type B aortic dissection. We now report other markers of sympathetic activation, natriuresis and inflammation over the same time frame. In 13 patients with known acute type B aortic dissection (median age, 71 years; 95% confidence interval, 29-89 years), we undertook serial measurements of catecholamine metabolites including normetanephrine, metanephrine, and their second messenger cyclic adenosine monophosphate; renin and aldosterone; N terminal-pro-brain natriuretic peptide (NT-proBNP), and its second messenger cyclic, guanosine monophosphate; C-type natriuretic peptide; the inflammatory growth differentiation factor 15; the stress hormone copeptin; mid-regional-proadrenomedullin; and the marker of cardiac muscle damage Troponin T. Venous sampling times were on admission, then 12 hours, 24 hours, 1 week, and 6 weeks later. Serial measurements were also undertaken in 12 controls (median age, 61 years; 95% confidence interval, 25-86 years) who presented with chest pain. During the first week after dissection, normetanephrine levels were increased: 617 to 792 vs 425 to 489 pmol/L in controls (analysis of variance [ANOVA] P = .01). There was also a simultaneous increase in NT-proBNP levels: 49 to 93 vs 14-21 pmol/L (ANOVA P = .07), and growth differentiation factor 15 levels: 1507 to 2873 vs 1146 to 1448 pg/mL (ANOVA P = .01) over the same period. The increase in normetanephrine levels during the week after type B dissection confirms sympathetic nerve activity as a likely mechanism for hypertension in these patients. This surge of sympathetic activity may be partially antagonized by a simultaneous increase in NT-proBNP, which is possibly triggered by acute inflammation and oxidative stress caused by the dissection. This pilot study focused on assessing the timeline of neuroendocrine hormone release in acute type B aortic dissection. Our results demonstrated an increase in normetanephrine levels suggesting the involvement of the sympathetic nerve activity in driving hypertension in the acute setting of type B aortic dissection. There was also a concurrent increase in N-terminal pro-brain natriuretic peptide and growth differentiation factor 15 levels seen, suggesting an underlying inflammatory process and vascular stress. These can be the focus of future research in the development of pharmaceutical targets or the use of natriuretic drugs and anti-inflammatory agents in the mainstay treatment of type B aortic dissection.
Food insecurity remains a critical public health and development challenge in Somalia, particularly among rural and nomadic households, who are vulnerable to climate shocks, poor infrastructure, and socioeconomic constraints. Evidence on its scale and determinants is needed to guide targeted interventions. To estimate the prevalence of food insecurity and associated multidimensional determinants among rural and nomadic households in Somalia. This study analyzed 9,399 rural and nomadic households from the 2018/2019 Somalia Health and Demographic Survey (SHDS) using the Food Insecurity Experience Scale (FIES). Multilevel ordinal logistic regression was applied to examine associated factors. Overall, 58.86% of households were food secure or mildly food insecure, 9.13% experienced moderate food insecurity, and 32.01% experienced severe food insecurity. Larger household size was associated with higher odds of severe food insecurity (4-6 members: AOR = 1.22, 95% CI: 1.10-1.37, p < 0.01; ≥7 members: AOR = 1.47, 95% CI: 1.29-1.68, p < 0.01). Higher education was protective (AOR = 0.65, 95% CI: 0.54-0.78, p < 0.01). Lack of livestock (AOR = 1.37, 95% CI: 1.21-1.56, p < 0.01) and lack of electricity (AOR = 1.50, 95% CI: 1.20-1.86, p < 0.01) were associated with increased risk. Wealth showed a strong protective gradient, with progressively lower odds across higher quintiles (highest: AOR = 0.39, 95% CI: 0.28-0.53, p < 0.01). Nomadic households had lower odds of severe food insecurity than rural households (AOR = 0.78, 95% CI: 0.70-0.87, p < 0.01). Significant regional disparities were observed, with higher odds in Central (AOR = 2.45, p < 0.01) and Southern (AOR = 4.80, p < 0.01) regions compared to the North. Food insecurity in Somalia is shaped by socioeconomic, livelihood, and geographic factors. Targeted social protection, livelihood strengthening, and improved access to basic services are essential to reduce inequalities.
In Mongolia, no national data are currently available on the status of antimicrobial-resistant (AMR) bacteria in livestock and companion animals. Given the need for international coordination in tackling antimicrobial resistance, clarifying the prevalence of AMR bacteria in animals is an urgent priority. In this study, we isolated Escherichia coli, as an indicator bacterium, from eight animal species, including livestock and companion animals, and examined their antimicrobial resistance to evaluate the current burden of AMR bacteria in animals in Mongolia. The prevalence of AMR E. coli was very low in livestock raised under nomadic systems (camels, goats, and sheep). AMR E. coli prevalence in cattle remained low, possibly due to a mix of nomadic and intensive husbandry practices. In contrast, AMR E. coli was highly prevalent in pigs and chickens raised by intensive husbandry. In chickens, 93.9% of E. coli isolates were AMR, and 67.4% exhibited multidrug resistance. In pigs, 70.3% of E. coli isolates were AMR, and 37.8% were multidrug-resistant. Rates of horses and dogs carrying AMR E. coli were also very high. In particular, animals in frequent contact with humans exhibited higher AMR E. coli carrying rates. Moreover, carbapenemase-producing E. coli and fluoroquinolone- and/or cephalosporin-resistant E. coli clonal groups ST131 and ST1193, which pose significant global public health threats, were identified only in owned dogs. To the best of our knowledge, this is the first report on the prevalence of AMR E. coli in livestock and companion animals in Mongolia. These findings highlight the urgent need for coordinated One Health interventions to reduce transmission risk between humans and companion animals.
Somalia reports low overall immunization rates; the 2020 Somalia Demographic and Health Survey (SDHS) indicated that overall BCG vaccination coverage for children under five years of age was only 37.0%. However, coverage specifically for newborns and early infants remains underexplored. This study assessed the determinants of BCG vaccination among infants aged 0-2 months. Secondary data from the 2020 SDHS were analyzed for 457 mother - infant pairs. Descriptive statistics and multivariable logistic regression were used to identify factors associated with BCG uptake. BCG coverage was 79.7% (95% CI: 75.8%-83.2%). Infants in nomadic communities (OR = 0.18, p < .01) were significantly less likely to be vaccinated than urban infants. Mothers with primary education (OR = 2.62, p < .05) and the lack of maternal healthcare utilization - specifically antenatal care and health-facility delivery in the past 12 months (OR = 0.41, p < .01) - were key determinants of vaccination status. While early infant BCG coverage is significantly higher than the national average for all children under five, severe inequities still exist in nomadic and rural populations. Improving maternal education and increasing contact with healthcare facilities are essential steps to closing the immunization gap.
Maternal mortality remains a major public health challenge in fragile and conflict-affected settings, where insecurity can disrupt referral pathways, skilled birth attendance, and timely emergency obstetric care. This case report describes a maternal death in transit from a remote nomadic community in Mahas District, Hirshabelle State, Somalia, and uses the Three Delays Model to frame the health-system failures contributing to the outcome. A 22-year-old primigravida woman developed prolonged labour at home under the care of a traditional birth attendant. The nearest district health facility had reportedly been non-functional for approximately six months because of insecurity and armed conflict, leaving no nearby access to skilled obstetric assessment or emergency obstetric care. As her condition deteriorated, the family attempted referral to Baladweyne Regional Hospital, but she died during transport before reaching the facility. Based on the reported history and clinical course, the death was most consistent with obstructed labour complicated by delayed access to emergency obstetric care. This case illustrates how conflict-related facility closure, weak referral systems, transport barriers, and lack of antenatal and skilled delivery care can combine to create a fatal second delay. It highlights the need for context-specific strategies to maintain essential maternity services in insecure districts, strengthen referral transport and communication, improve community recognition of obstetric danger signs, and protect emergency obstetric care for remote and nomadic populations.
Healthcare systems face increasing complexity alongside persistent nursing shortages. Shared Governance, operationalized through Unit Practice Councils, is a professional practice model designed to strengthen nurse engagement, accountability and evidence‑informed decision-making at the point of care. While Shared Governance has been associated with positive nurse outcomes, evidence on the impact of Unit Practice Councils in European academic settings remains limited. To evaluate the impact of introducing Unit Practice Councils on nurse engagement, the nurse practice environment and evidence-based practice (EBP) implementation, and to assess the extent to which Unit Practice Councils are embedded into routine practice inpatient units. Longitudinal observational study. Study was conducted across four inpatient units in a Dutch academic hospital. Data were collected at baseline (T0) and at 12-month follow-up (T1) using the Autonomy to Engagement Scan (A tot Z scan), the Practice Environment Scale of Nursing Work Index (PES-NWI) and Evidence Based Practice Implementation Scale (EBP-I). Generalized Estimating Equations were used to analyze changes over time, accounting for interactions between time, council membership, and measurement (paired vs. unpaired). At T1, the Normalization Measure Development (NoMAD) questionnaire was administered to assess the normalization of Unit Practice Councils into routine nursing practice. Differences between council members and non-members were analyzed using the Mann-Whitney U test. Not registered. A total of 59 nursing staff participated at T0 and 63 at T1, with 36 completing both measurements. Nurse engagement and the nurse practice environment showed small but significant improvements over time (p = 0.006, β=+0.050 and p = 0.048, β=+0.026) with significant interaction effects for council membership (p = 0.016, β=+0.190 and p = 0.008, β=+0.307), indicating increasing scores among council members. EBP implementation remained unchanged in the full sample (p = 0.957). However, council members participating at both time points demonstrated a large and clinically meaningful increase in EBP-I scores (three-way interaction: p < 0.001; β=+21.98). NoMAD results indicated high normalization levels (median=4.26, IPR=3.86-4.62), with significantly higher scores among council members (p = 0.002, r = 0.39), indicating that Unit Practice Councils were becoming embedded in routine nursing practice. Introducing Unit Practice Councils, particularly alongside structured EBP training, resulted in clinically meaningful improvements in EBP among council members with continuing membership. Council members also showed early positive trends in nurse engagement and the nurse practice environment, while outcomes in the broader nursing workforce remained stable over the 12‑month period. High normalization scores indicate successful embedding of Unit Practice Councils within routine practice in an academic hospital.
This study evaluates the equivalency (noninferiority) of two approaches to training clinicians in the delivery of an evidence-based dementia caregiving program in PACE (Programs of All-Inclusive Care of the Elderly) settings. Considered are clinician outcomes following each training method and PACE participant-caregiver outcomes following COPE receipt after 4 months. 11 PACE settings were randomized to have clinicians trained in-person (n = 7) or online (n = 4) to deliver COPE to caregivers of patients with dementia. PACE provides long-term care services and support to dually eligible older adults (PACE participants), most of whom have dementia diagnoses, to age in place at home. The study included occupational therapists (n = 14) and registered nurses (n = 8) employed at participating PACE sites. Caregivers (n = 17) and PACE participants (n = 17) with dementia were enrolled as dyads to receive COPE. Primary outcomes included changes in clinician knowledge and training satisfaction via the Knowledge and Skills Survey and implementation competence via the Normalization Process Theory (NoMad) survey. For dyad outcomes, caregivers identified priority areas using validated assessments, selected up to four "target behaviors" and rated confidence in managing each. No significant differences were found between training groups in clinician or dyad characteristics. Training modalities showed similar impacts on clinician knowledge and skills, with no statistically significant differences between groups in change scores across NoMad domains (all p >0.3). After COPE, all caregivers reported significant improvement in the Perceived Change Index (p = 0.0034) and increased confidence in managing target behaviors. Online training in COPE was noninferior to in-person training for clinician competence and PACE participant-caregiver outcomes. These findings support online training as a scalable approach for disseminating evidence-based dementia care programs without compromising effectiveness.
Extreme weather events, like drought and heat stress, make it harder to meet water needs in water-insecure settings, particularly vulnerable groups. This study examines how short-term (heat stress) and long-term (drought) water stress affects hydration status across reproductive states (pregnant, lactating, compared to non-pregnant/non-lactating) for Daasanach semi-nomadic pastoralist women in northern Kenya. Drawing on unbalanced panel data, we analyzed 565 observations from 303 women (aged ≥ 16 years) in 2019-2024. Hydration was assessed via urine specific gravity (USG) with dehydration classified as USG > 1.020. Environmental heat stress was measured by ambient temperature and humidity, with sensitivity analyses using wet bulb globe temperature. Mixed effect logistic regression models indicated ambient temperature and humidity were significantly associated with greater odds of dehydration across all women. Holding heat stress constant, lactating but not pregnant women had higher odds of dehydration than non-pregnant/non-lactating women. A significant interaction between heat stress and reproductive status indicated that the probability of dehydration increased fastest for pregnant women as temperatures rose. Holding heat constant, dehydration probability increased during drought years compared to pre- and post-drought and was most pronounced among lactating women. Ambient heat stress increases dehydration risk among Daasanach women with effects compounded in pregnancy, though overall lactation was the period of greatest vulnerability to dehydration. Dehydration probability peaked during the drought illustrating how long-term periods of water scarcity also challenge water needs. Heat stress and droughts exacerbate maternal and infant health risks; thus, targeted hydration and cooling interventions are needed.
Pastoral cattle breeding sustains nomadic communities by conserving local and non-commercial but valuable genetic resources. The aim of this study was to understand the genetic structure and diversity of newly registered pastoral Belahi cattle using genome-wide SNP data (Illumina BovineSNP50 v3.0 Array). After quality control, nearly 47% of SNPs were removed due to low minor allele frequency (< 0.05), yet the retained markers indicated well-distributed genetic variation across the genome, demonstrating substantial genetic diversity. Observed and expected heterozygosity were relatively high and nearly equal, suggesting adequate genetic variation and genomic inbreeding estimates indicated low inbreeding in Belahi cattle, although FROH analysis of longer runs of homozygosity revealed signs of recent inbreeding. The recent effective population size suggested a moderate risk of losing genetic diversity, which warrants attention for conservation management. The pattern of linkage disequilibrium decay showed relatively strong genetic linkage over short genomic distances, gradually decreasing over longer distances, indicating moderate recombination. Genetic diversity in Belahi cattle has been preserved, likely due to weaker artificial selection and higher historical effective population sizes. This study revealed that Belahi cattle had no evidence of recent admixture with taurine breeds. The breed exhibits a distinct genetic identity, clustering closely with other indigenous zebu breeds yet standing apart as a unique population. The findings suggest that historical management under low selection intensity and maintenance of sizable effective population size have helped preserve genetic variation in Belahi cattle.
Non-invasive ventilation (NIV) is the only intervention that significantly improves survival and quality of life in motor neuron disease, extending life by 8-13 months. However, at least half of patients are unable to reach the recommended ≥ 4 h daily NIV use, and current NHS services provide insufficient follow-up for intensive optimisation. Delivering Effective Non-Invasive ventilation in Motor neuron disease using intensive remote support (DENIM) is a stepped-wedge cluster randomised trial. This protocol describes a process evaluation embedded within DENIM aiming to understand how and why the implementation strategy works (or does not work) across different contexts. The process evaluation employs a convergent mixed-methods multiple-case study design across twelve NHS ventilation services. We developed a programme theory informed by Normalization Process Theory (NPT), the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change, which states how the DENIM implementation strategy is expected to achieve normalisation of evidence-based NIV practice. Data collection across twelve sites include: ethnographic observations of patient-staff interactions; semi-structured interviews with staff (n = 24-48) and patients/carers (n = 24) exploring implementation experiences; the NoMAD questionnaire measuring normalisation perceptions from healthcare professionals within the services and NIV adherence data from participants' ventilators. Barriers and facilitators to research participation for underserved populations including ethnic minorities, those with low digital literacy, and women over 80 with bulbar onset disease will also be identified. Qualitative data will be analysed using NPT-informed thematic analysis. Integration occurs at three levels (design, methods, interpretation) with joint display tables presenting quantitative and qualitative findings alongside meta-inferences. This process evaluation will generate explanatory insights into how implementation strategies can address the evidence-to-practice gap in complex, technology-supported care for progressive diseases, with implications for health equity and wider NHS digital transformation. ISRCTN10105285. 16/04/2025.
Increasingly, the conservation of large and wide-ranging animals is challenged by environmental variability, static boundaries of protected areas, and the expansion of human activities. The Critically Endangered Onager (Equus hemionus onager) exemplifies these issues in Qatrouiyeh National Park (QNP) and the surrounding Bahram-e-Goor Protected Area (BPA) in Iran. Using GPS telemetry data from 9 adult females tracked over 2 years, we examined seasonal patterns in movement and incursions into cultivated lands in 2017 and 2018. Net squared displacement analyses indicated that most individuals exhibited range-resident behavior with occasional nomadic movements, with no evidence for migration (i.e., predictable movements to and from distinct seasonal ranges). Both monthly home range size and monthly movement rate varied seasonally, peaking in late spring and early summer (May-July). Individual home ranges were between 257 and 1,928 km2, while the extrapolated population-level home range (718 km2; 95% confidence interval = 276-1368) extended well outside QNP, covering large portions of the BPA. Occurrence distributions also expanded beyond the protected area into adjacent cultivated lands, highlighting the use of human-occupied areas by onagers. We recorded 2,285 (out of 72,168) GPS locations within cultivated lands and their surrounding 50 m buffer, with 60% of these incursions occurring immediately adjacent to QNP. Most incursions occurred at night and were strongly associated with both season and cumulative rainfall over the preceding 9 months. These findings emphasize how rainfall-driven variability in resource dynamics shapes the spatial distribution and behavior of onagers, thus elevating the risk of conflict with humans. The scale and seasonality of Onager movements highlight the need for flexible, landscape-level conservation strategies that extend beyond fixed park boundaries to encompass critical habitats and to mitigate conflict across the broader region.
Maternal health utilization in fragile states is hindered by complex social and structural barriers. This study examined socio-digital stratification and explored the threshold effects of digital inclusion on antenatal care (ANC) utilization in Somalia. Using data from the 2020 Somalia Demographic and Health Survey (N = 8,940), we constructed a Digital Inclusion Index (0-3) and employed survey-adjusted logistic regression models to estimate the odds of achieving four or more ANC visits (ANC 4+). Only 8.4% of the women achieved the ANC 4+ threshold, with pronounced disparities between urban (14.0%) and rural/nomadic (5.5%) residents. Evidence consistent with a threshold effect was observed, whereby the initial transition from digital exclusion to basic connectivity (score = 1) was associated with the largest marginal gain in health seeking probability (OR = 1.55, p = 0.013). While mobile money penetration is high (85.2%), internet access remains deeply stratified by wealth (22.0% among the rich versus 1.0% among the poor). Interaction analysis suggests that digital inclusion complements but does not substitute for physical health infrastructure, partially mitigating distance-related barriers without eliminating the need for physical proximity to healthcare facilities. Digital inclusion is a critical entry point for improving maternal health access in Somalia. Policies should prioritize universal basic connectivity and SMS-based interventions, while simultaneously addressing persistent physical and socioeconomic inequities. Main findings: This study identifies a significant threshold effect where the initial transition to basic mobile connectivity provides the largest marginal gain in maternal health service utilization.Added knowledge: While mobile financial services have achieved broad penetration, a deep data divide persists, and digital tools function as complements to, rather than substitutes for, physical health infrastructure.Global health impact for policy and action: Public health interventions in fragile states should prioritize universal basic connectivity and text-based communication over data-intensive applications to avoid widening health inequalities.
The digital world affects people, especially children, who are exposed to it from an early age. This consumption, excessive at times, and its effects on children's development are of growing concern to pediatric authorities and the public sector. However, few studies on digital use among children aged 3 to 11 have been conducted in priority education networks in France. The aim of this study is to investigate screen exposure by elementary school children and its evolution with age in a disadvantaged socioeconomic context. Data on family structure and socio-professional category were collected from parents on paper. Quantitative data were collected from 366 children (divided into 3 cycles: aged 3-6, 6-9, and 9-12), in a school group located in a priority education network. Among the 366 children interviewed, 85.2 % reported using screens daily, particularly after school in the evening. This proportion was quite stable across school cycles, ranging from 81 % to 88 %. Close to 50 % of children in Cycles 1 and 2 have their own screen, a proportion that rises to 79.1 % in Cycle 3 (p < .0001). Among significant developments across cycles, we observed an increase in smartphone ownership (from 6.6 % to 57.1 %, p < .0001). Watching television during meals was already high in Cycle 1 (77.9 %) and did not significantly change across cycles, but appeared significantly more in single-parent than in two-parent families (p = .006). We observed that the new uses in Cycle 2 is linked to children's autonomy, whereas it is linked to the ownership of a digital device in Cycle 3. The type of digital device children own at each cycle reflected both the intrinsically nomadic nature of screens and their fun dimension. Exposure to screens at an early age is steadily increasing, exceeding official recommendations, particularly in priority education networks.
The electronic Community Health Information System (eCHIS) is a mobile health technology that was scaled nationally to community health workers (CHWs) in Kenya beginning in 2023. Since the rapid scale up, reports on eCHIS uptake show varying adoption rates. The overall purpose of this study was to assess the relationships between implementation process and acceptability of eCHIS by CHWs in Kenya. A cross-sectional study was conducted in 5 counties in Kenya with 310 CHWs (40 community health assistants and 270 community health promoters) selected through convenience stratified sampling. A structured questionnaire, developed by integrating the Technology Acceptance Model questionnaire and the Normalization MeAsure Development (NoMAD) tool, was administered by trained research assistants using Kobo Collect. The data was analyzed using descriptive statistics and structural equation modelling in STATA version 18. Implementation process mechanisms were found to have positive and significant relationships with the acceptability of eCHIS. Specifically, cognitive participation had a significant and positive relationship with perceived usefulness of eCHIS (β = .2783, p < .05). Additionally, coherence (β = .3911, p < .001) and reflexive monitoring (β = .3272, p < .05) had significant and positive relationships with perceived ease of use. The study also revealed inadequate training, financial resources, and technical and management support as the key implementation barriers. Implementation process significantly influences the acceptability of eCHIS. It is therefore important for governments and other implementing partners to strengthen the eCHIS training programs, allocate sufficient financial and technical resources, and provide management support to the CHWs to enhance eCHIS adoption.
Infection with human papillomavirus (HPV), the primary cause of cervical cancer, disproportionately affects women in low- and middle-income countries (LMICs). While school-based vaccination of adolescent girls against HPV is highly effective, this strategy systematically excludes out-of-school (OOS) girls. Using the RE-AIM framework, we explored strategies to reach OOS girls with HPV vaccination across six African and Asian LMICs. We conducted semi-structured key informant interviews with 32 vaccination program stakeholders from Cambodia, Cameroon, Kenya, Malawi, Mozambique, and Uganda between May and September 2024. Interviews explored countries' implementation successes, challenges, and strategies to reach OOS girls with HPV vaccination and sustainability considerations. Data were analyzed using a hybrid team-based thematic analysis approach guided by the RE-AIM framework. Community outreach-based strategies, typically integrated into routine immunization outreach, were identified as the most effective approach to reach OOS girls with HPV vaccination. Targeted strategies, such as locating outreach clinics in community venues frequented by OOS girls (e.g., churches, markets) enhanced implementation. Perceived effectiveness of these strategies varied across participants, and formal assessment of effectiveness was constrained by the absence of disaggregated vaccination coverage data by school enrollment status. Some subpopulations of OOS girls (i.e., girls in nomadic or migrant communities, urban OOS girls) were not readily reached through standard outreach approaches, prompting implementation of adapted and tailored strategies for these subpopulations. Costs associated with conducting outreach in harder-to-reach areas were major barriers to reaching OOS girls, presenting challenges to the sustainability and cost-effectiveness of these approaches. Routine community outreach platforms were widely perceived as most effective for reaching OOS girls. Strengthening disaggregated monitoring systems, adapting outreach for harder-to-reach subpopulations of OOS girls, and financing delivery models for tailored outreach strategies will be critical to improving equitable HPV vaccine coverage among OOS girls.
A wide variety of spectroscopic methods are used for the diagnostics of laser-produced plasma. One particularly powerful diagnostic is high-resolution emission line spectroscopy, in conjunction with atomic calculations and radiation hydrodynamic simulations. In this work, we present line-resolved spectra of L-shell molybdenum (Z=42) plasma produced by high-energy laser pulses of ∼200-400 J at a wavelength of 351 nm, with durations of 1-3 ns. The experiments were conducted at the National Laser Facility, Soreq, Israel. Time-integrated spectra were recorded in the range of 2 to 4.1 keV with a high-resolution crystal spectrometer (E/ΔE>400). Lines of Al-like Mo^{+29} to F-like Mo^{+33} were identified, although the spectrum is dominated by the intense Ne-like Mo^{+32} lines. Collisional-radiative calculations using the HULLAC and nomad codes are in good agreement with the experimental results, providing estimates of an electron density of n_{e}=0.6-3×10^{21}cm^{-3} and an electron temperature of kT_{e}=1.1-1.3keV originating from the coronal region of the plasma.
Background Mobile populations in malaria-endemic regions are at increased risk of Plasmodium falciparum infection and may contribute to the spread of antimalarial drug resistance across borders. However, evidence on infection prevalence, molecular resistance markers, and associated risk factors in these populations remains limited. This systematic review and meta-analysis synthesized available evidence to inform mobility-responsive malaria surveillance and control strategies. Methods A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Studies published between January 2000 and October 2025 reporting P. falciparum infection and resistance-associated mutations in PfK13, PfCRT, PfMDR1, PfDHFR, and PfDHPS among mobile populations were included. PubMed, EMBASE, Global Health, and Scopus were searched. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Pooled prevalence estimates were generated using random-effects models in Stata 17, with subgroup analyses by WHO region and population type. Heterogeneity was assessed using I² statistics. Results Twenty-six studies involving 7,217 participants from 10 countries were included. Populations studied comprised refugees, migrant workers, travellers, forest-goers, gold miners, and nomadic groups. The pooled prevalence of P. falciparum infection was 18% (95% CI: 15-21%), with higher prevalence in Africa (36%) and lower prevalence in South-East Asia (6%). Refugees had the highest pooled prevalence (38%), whereas short-term travellers had lower prevalence (8%). Resistance markers were widely reported, although prevalence varied across settings and time periods. PfK13 mutations were generally infrequent but heterogeneous; validated mutations such as C580Y were repeatedly detected in Myanmar and neighbouring areas of Cambodia and Vietnam, indicating artemisinin resistance hotspots. PfCRT K76T remained common in older studies. PfMDR1 mutations, especially N86Y and Y184F, were frequently reported and reached up to 68% in African refugee populations, although declining trends were noted in recent African studies. PfDHFR and PfDHPS mutations were widely distributed. Infection risk was associated with mobility patterns, occupational exposure, and parasite origin. Substantial heterogeneity was observed (I² = 97.8%). Conclusion Mobile populations bear a substantial burden of P. falciparum infection and frequently harbor antimalarial drug-resistance markers. Integrating these populations into genomic and cross-border surveillance systems may improve early detection of resistance and strengthen malaria elimination efforts.