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Serogroup X has emerged as an important cause of invasive meningococcal disease across Sub-Saharan Africa. Recent advances in serogroup X vaccines were reviewed. Early vaccine development efforts focused on outer membrane vesicle-based approaches. The growing epidemiological importance of serogroup X accelerated the development of serogroup X conjugate vaccines. Building on the success of MenAfriVac, PATH and the Serum Institute of India Pvt. Ltd. developed NmCV-5 (MenFive), the first pentavalent meningococcal conjugate vaccine targeting serogroup X. NmCV-5 achieved World Health Organization (WHO) pre-qualification in 2023, enabling deployment across Sub-Saharan Africa. A second pentavalent vaccine, EuNmCV-5, developed by Eubiologics is advancing through clinical development, while an additional candidate from Sinovac Biotech is entering early phase evaluation. These advances representative a major milestone in meningococcal disease prevention. Within the last fifteen years significant vaccine developments have been made to combat serogroup X. With NmCV-5 attaining WHO pre-qualification, strategies for its implementation within Sub-Saharan Africa are being devised. Only one vaccine is currently available in Sub- Saharan Africa, but trials of a second pentavalent ACWYX conjugate vaccine are ongoing. Carriage studies and disease surveillance are crucial to monitor serogroup X vaccine effectiveness.

Non-thyroidal illness syndrome (NTIS) frequently occurs in critically ill patients and reflects alterations in thyroid hormone metabolism without intrinsic thyroid disease. It has been increasingly recognized as a potential marker of disease severity and poor outcomes in intensive care settings, yet data from Sub-Saharan Africa remain limited. To determine the prevalence of NTIS and identify determinants of mortality among patients admitted to a medical intensive care unit (ICU) in northern Tanzania. We conducted a prospective cohort study among 120 adult patients admitted to the medical ICU at a tertiary referral hospital between October 2024 and March 2025. Thyroid function tests (T3, T4, and TSH) were measured within 24 hours of admission. NTIS was defined based on characteristic biochemical patterns in the absence of known thyroid disease. Clinical, laboratory, and outcome data were collected prospectively. Associations were assessed using Chi-square tests and modified Poisson regression to estimate adjusted risk ratios (aRR) with 95% confidence intervals. The prevalence of NTIS was 23.3%. Overall mortality was 42.5%, with significantly higher mortality among patients with NTIS (67.9%) compared with those without NTIS (34.8%). NTIS remained independently associated with mortality after adjustment (aRR 8.05; 95% CI: 2.27-28.56; p=0.001). Patients with NTIS were also more likely to experience prolonged hospital stays. Although several clinical variables showed associations in bivariate analysis, most did not remain significant after adjustment. Illness severity, as reflected by clinical scoring systems, remained an important contributor to outcomes. NTIS is common among critically ill patients and is strongly associated with increased mortality. It may serve as a practical prognostic marker in ICU settings, particularly in resource-limited environments. Further multicenter studies are needed to validate its prognostic utility and integration into routine clinical practice. When people become critically ill, their thyroid hormone levels may change even though they do not have a thyroid disease. This condition is called non-thyroidal illness syndrome (NTIS) or euthyroid sick syndrome. These changes are common in intensive care units and may indicate that a patient is more severely ill. However, little is known about NTIS in sub-Saharan Africa. We studied 120 adults admitted to the medical intensive care unit at a tertiary hospital in northeastern Tanzania. Thyroid hormone levels were measured within 24 hours of admission, and patients were followed to determine whether NTIS was associated with a higher risk of death. Almost one in four patients (23.3%) had NTIS. Patients with NTIS were much more likely to die during their hospital stay than those without NTIS. More than two-thirds of patients with NTIS died, compared with about one-third of patients without the condition. Even after considering other clinical factors, NTIS remained one of the strongest predictors of death. Our findings suggest that NTIS is an important indicator of severe illness in critically ill patients. Identifying NTIS early may help healthcare professionals recognize patients who need closer monitoring and more intensive supportive care, especially in hospitals with limited resources. However, our findings do not support routine treatment with thyroid hormones. Instead, the priority should remain early recognition of NTIS and appropriate treatment of the underlying critical illness. Larger studies are needed to confirm these findings and determine how thyroid hormone testing can best support the care of critically ill patients.

Migration is a well-established risk factor for psychosis, yet limited research has examined long-term clinical trajectories following first-episode psychosis (FEP) in migrant populations within Southern European settings. This study investigates how country of origin and time since migration influence psychiatric outcomes in a naturalistic FEP cohort. A 5-year longitudinal study was conducted on 184 patients with FEP attending the Early Intervention Service from Hospital Universitari de Mataró. Patients were grouped by geographic origin (Spanish, Latin American, Maghrebi, Sub-Saharan) and migration recency (≤5 years vs. >5 years). Primary outcomes included treatment adherence, use of long-acting injectable (LAI) antipsychotics, relapse, and service disengagement. Logistic regression and survival analyses were used to identify associations. Maghrebi origin was associated with lower treatment adherence (OR = 0.32, 95% CI [0.12-0.89], p = 0.030). In time-to-event analyses, Maghrebi patients showed a higher hazard of service disengagement compared with Spanish-born patients (HR = 2.42, 95% CI [1.10-5.34], p = 0. 028). Recent migrants (≤5 years in Spain) also had a significantly increased hazard of disengagement (HR = 2.89, 95% CI [1.30-6.40], p = 0.009). Sub-Saharan origin was strongly associated with earlier initiation of long-acting injectable antipsychotics (HR = 3.40, 95% CI [1.58-7.32], p = 0.002), alongside higher overall odds of LAI use. No significant differences were observed in relapse rates across groups. Both migrant origin and recent arrival were associated with differences in psychiatric care trajectories following FEP. These findings highlight the need to consider adaptation of treatment approaches for migrant populations according to their origin and migration context in order to improve long-term outcomes.

Despite a 60% decline in new HIV infections since 1995, significant challenges persist. In 2023, 1.3 million new HIV infections occurred, with 645,500 in sub-Saharan Africa, where cisgender adolescent girls and women represent over two-thirds of new cases. Approximately one-quarter of vertical HIV transmissions are linked to infections during pregnancy and lactation, yet data on PrEP use in these populations remains generally limited due to their exclusion from clinical trials, despite a recent movement toward inclusion, such as in the PURPOSE 1 trials evaluating the efficacy and safety of lenacapavir. This data gap is concerning given that women face an elevated risk of HIV acquisition during pregnancy. Despite this heightened risk, access to PrEP remains restricted among these groups. This article, based on insights from a multi-regional and multi-sectoral working group convened by the Forum for Collaborative Research between January 2024 and February 2025, addresses this critical issue. The working group, comprising stakeholders from regulatory agencies, research, industry, and communities, held meetings and a scientific symposium to inform evidence-based strategies for improving the inclusion of pregnant and lactating women in PrEP trials. The working group identified key barriers, including ethical concerns, limited safety data, minimal community engagement, regulatory gaps, weak incentives, and limited surveillance capacity. They recommend reframing pregnant and lactating women as needing protection through research, alongside standardized data systems, stronger incentives, global collaboration, and digital innovation to ensure equitable inclusion in HIV prevention efforts.

The Bantu language family of sub-Saharan Africa is among the largest in the world by the number of languages, by geographical extent, and by the number of speakers. The expansion of the Bantu languages is an important example of large-scale language-family expansions in the history of humankind. To learn the early prehistory of the Bantu language family, one needs to disentangle the signal of the original splits and diversification from that of the subsequent language contact, known to be strong in the Bantu languages. We introduce a coalescent-theoretic model to computationally study the prehistory of the Bantu family. Our model treats language contact as a norm rather than a rare exception, in contrast to earlier computational work. Applying Approximate Bayesian Computation, we show the rates of both language change and language contact to have been so high within the Bantu family that the signal of the original diversification has been largely erased in the currently available Bantu lexical data.

Pre-eclampsia (PE) is a major hypertensive disorder during pregnancy, contributing significantly to maternal and perinatal mortality, especially in low- and middle-income countries. While primary studies on PE have been conducted in Ghana and meta-analyses exist for sub-Saharan Africa broadly, no review has synthesized Ghana-specific evidence to produce a pooled prevalence estimate. This study aimed to provide a comprehensive summary of the prevalence, risk factors, and outcomes associated with PE among pregnant women in Ghana. Following the PRISMA guidelines, we searched four databases. Studies published between January 2015 and July 2025 were eligible for inclusion. Fourteen studies were included in the final meta-analysis. Pooled prevalence was calculated using random-effects meta-analysis in R Studio, with heterogeneity evaluated via the I 2 statistic and publication bias assessed through funnel plots and Egger's regression test. The pooled prevalence of PE was 14.52% (95% CI: 7.88-22.74). Regional prevalence was highest in the Greater Accra (18.32%, 95% CI: 4.10-39.39), followed by Ashanti (17.41%, 95% CI: 6.38-32.32) and Northern (16.43%, 95% CI: 0.65-46.48) regions. Commonly reported risk factors included advanced maternal age, primigravidity, previous cesarean section, placental malaria, and vitamin D deficiency. Notable outcomes were lower Apgar scores, cesarean deliveries, stillbirths, and postpartum depression. PE affects a significant proportion of pregnant women in Ghana, with a pooled prevalence of 14.52%, which varies across regions and clinical settings. This estimate is derived from highly heterogeneous studies and should be interpreted as an approximate indicator of burden rather than a precise national figure. The identified risk factors and outcomes highlight the urgent need for enhanced prenatal screening and tailored interventions to reduce the burden of PE in Ghana.

In the context of the extension of HIV pre-exposure prophylaxis (PrEP) prescription to all physicians in France, we conducted an exploratory study investigating care access and PrEP knowledge in women engaging in sex work (WSW) in Lille, Northern France. A cross-sectional quantitative study was conducted from May to September 2024 through a questionnaire administered to all WSW who attended the meetings of "Le Mouvement du Nid," a nonprofit association supporting WSW. Sociodemographic characteristics, healthcare uptake, sexual practices, PrEP knowledge, and use were assessed according to self-reported data via a structured questionnaire. Forty-five WSW were included: 42 cisgender WSW, 3 transgender WSW. The median age was 36 years. All WSW but 2 were migrants, mainly from sub-Saharan Africa (87%). Vulnerability factors were frequent, especially difficulties with access to social rights (58%) or housing (67%). WSW were often victims of violence (67%). The majority of WSW (76%) reported having a family doctor, and 42% consulting 1 within a year. Only 22% had disclosed engaging in sex work to their family doctor. Screening for sexually transmitted infections has been done by 64% of WSW in the last year, rarely with their family doctor (18%). Four (9%) WSW reported a history of postexposure prophylaxis, all were cisgender WSW. Four (9%) WSW knew about PrEP, including 1 cisgender WSW. No WSW was using PrEP. After receiving education about PrEP, 51% of WSW were interested with PrEP. Knowledge of HIV prevention tools was poor among WSW. Enhancement of sexual healthcare of WSW among family doctors may help PrEP implementation.

The widespread use of antibiotics in poultry production raises concerns about drug residues in chicken tissues and associated public health risks. Chicken tissue samples (n = 180; 60 each from breast, thigh, and liver) were purchased from various poultry shops in Egypt and analyzed using high-performance liquid chromatography (HPLC). Residues of enrofloxacin, oxytetracycline, and sulfadimidine were detected in 51.67% (93/180), 71.67% (129/180), and 16.67% (30/180) of chicken samples, respectively. Interestingly, 54.84% (51/93) of enrofloxacin-positive samples, 55.81% (72/129) of oxytetracycline-positive samples, and 70% (21/30) of sulfadimidine-positive samples exceeded the maximum residue limits (MRLs). Among the 180 samples of each of chicken breast, thigh, and liver samples, 5% of each tissue type contained the three antibiotics tested, while 40% of chicken breasts and 50% of both thighs and liver samples contained two of the three antibiotics. HPLC analysis revealed mean concentrations of 90.4, 317.7, and 573.3 µg/kg for enrofloxacin, oxytetracycline, and sulfadimidine, respectively, in chicken breasts; 161.5, 964.1, and 47, respectively, in chicken thighs; and 1707.3, 10,625, and 3848.1, respectively, in livers. The estimated daily intake (EDI) for antibiotics analyzed in chicken tissue among consumers was between 0.012 and 0.590 µg/kg body weight/day. The Hazard quotient (HQ) values of enrofloxacin, oxytetracycline, and sulfadimidine ranged between 0.0006 and 0.050 for schoolchildren, 0.0003 and 0.022 for women, and 0.0002 and 0.021 for men, respectively. Among the different age groups of the Egyptian consumers, schoolchildren had the highest daily intake and hazard quotient values of antibiotic residues from chicken tissue. The HQ values for tested antibiotics indicated no significant health risk for either adults or children, although children showed relatively higher values. Overall, the findings highlight the need for strict antibiotic monitoring, with consideration of their withdrawal periods in the veterinary field, to ensure food safety and to protect public health.

The global adoption of English-medium instruction (EMI) in higher education has introduced complex implementation challenges, the severity of which often depends on the resources available within specific educational contexts. Evidence remains limited in public medical schools in under-resourced, non-Anglophone countries, which serve a socioeconomically and educationally diverse student population. In such settings, the direct transfer of existing EMI integration models presents significant practical challenges. This exploratory, observational, monocentric study aimed to investigate medical students' perceptions and attitudes toward EMI implementation at the Faculty of Medicine and Pharmacy of Rabat (FMPR) in Morocco and to evaluate their readiness for EMI adoption. A cross-sectional survey was administered to 102 second-cycle medical students at FMPR. The 23-item questionnaire included Likert-type scales and multiple-choice questions across 4 domains: demographic data, self-reported English language proficiency, language perceptions and attitudes, and EMI needs. Bivariate, univariate, and multivariate logistic regression analyses were conducted to determine the effects of the explanatory variables on EMI choice. The sample comprised 65 female and 37 male participants. Most reported using English speaking and listening skills "often" on a daily basis, while writing skills were reported as being used "rarely." Participants rated their general English proficiency and their academic listening and reading skills as "good." Overall, 82.4% (84/102) of students were strongly in favor of implementing EMI at FMPR. Bivariate analysis showed significant positive associations between EMI choice and age (P=.04), course year (P<.001), interest in learning English (P=.006), and the belief that English should be the language of higher education (P=.02). Preference for EMI increased alongside course year, peaking at 96.4% (27/28) among students in the third and fourth years. Multivariate logistic regression confirmed that being in the fourth vs third course year (adjusted odds ratio 22.12, 95% CI 2.56-190.84; P=.005) and having an interest in learning English (adjusted odds ratio 5.12, 95% CI 1.05-25.03; P=.04) were significant positive predictors of EMI choice. Medical students at FMPR exhibit highly positive perceptions and attitudes toward the potential implementation of EMI, despite variations in their self-reported English readiness. These findings provide actionable insights for the successful integration of EMI that extend beyond the Moroccan context, offering a valuable framework for medical institutions in other under-resourced, low- and middle-income, non-Anglophone settings across the Global South.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in infants in low- and middle-income countries, and Egypt faces a clinical and economic burden associated with it. This study aimed to estimate the 5 y budget impact of maternal RSV Prefusion F (RSVpreF) vaccination, compared with no vaccination, from the public healthcare payer perspective in Egypt. A deterministic cohort model simulated weekly birth cohorts for five years, assuming a 10% maternal uptake of RSVpreF administered year-round at 24-36&#x2009;weeks' gestation. Outcomes included RSV-LRTI cases, healthcare use (hospitalizations, emergency department, and outpatient), and RSV-related deaths among infants, with costs reported both in aggregate and as per-member-per-year (PMPY). Deterministic sensitivity analysis (DSA) varied clinical and economic inputs by &#xb1;30%. Without vaccination, 425,421 RSV-LRTI events, 1,173 RSV-related deaths, and EGP 1,652.3 million in medical costs were projected over five years among 9,877,775 live births. With 10% maternal vaccination, 16,784 RSV-LRTI events and 69 deaths were averted, yielding medical cost offsets of EGP 95.0 million. Vaccination costs of EGP 8,578.1 million produced an incremental PMPY of EGP 15.92 (USD 0.3) under list-price assumptions. In DSA (&#xb1;30%), results were most sensitive to vaccine acquisition price, with other parameters exerting smaller effects, and the conclusions remained unchanged. Conclusively, maternal RSVpreF vaccination can reduce RSV burden in Egypt's public sector, and at list price, the program results in a net incremental budget of EGP 15.92 (USD 0.3) PMPY; lower public procurement prices would proportionally reduce the net impact while preserving clinical gains.

While existing AI-based microplastic monitoring studies predominantly rely on task-specific fine-tuned models, this study evaluates whether general-purpose multimodal foundation models with no spectroscopic instrumentation, minimal fine-tuning, and minimal computational resources can serve as accessible, low-cost tools for polymer classification under ecologically realistic field conditions with samples of plastic debris collected from coastal Sousse, Tunisia, a Mediterranean region experiencing anthropogenic pollution pressures. A curated dataset of 1080 high-resolution images was developed, representing six polymer groups (HDPE, LDPE, PA, PET, PP, PS, and mixed plastics). Fragments were imaged under standardized lighting conditions against natural sand backgrounds to preserve environmental realism. Each image was manually annotated using polygon-based boundaries to generate pixel-level segmentation masks and associated class labels, providing expert-validated ground truth for quantitative evaluation. Multimodal LLMs were evaluated using a composite scoring framework. Spatial accuracy was assessed using mean Intersection-over-Union (mIoU) against expert annotations, while polymer classification performance was measured using macro-averaged F1 scores across all categories. Model reliability was further evaluated through prompt stability testing and robustness analyses under controlled environmental perturbations designed to assess consistency across varying coastal imaging conditions. Results indicate that multimodal foundation models can distinguish plastic fragments from sand backgrounds, although performance varied across polymer classes and environmental perturbations. The weighted composite framework provides a structured approach for comparing model performance according to ecological monitoring objectives rather than computational metrics. These findings contribute to understanding the potential utility and current limitations of AI-based approaches for marine microplastic analysis and provide insights into coastal pollution patterns and ecosystem health within a One Health monitoring context.

Herpes simplex virus (HSV) is an endemic pathogen, infecting over half of all adults world-wide. HSV infection can cause a wide spectrum of disease outcomes, ranging from asymptomatic infection or mild lesions to rare cases of infectious keratitis, encephalitis, and death. HSV genome sequences differ between individuals and within individuals. To date, the vast majority of publicly available HSV genomic data has come from Europe and North America. Populations in South America, Africa, and Asia are under-sampled, as are non-industrial (e.g., agricultural, pastoral) populations, for which the natural environment plays a large role in health and disease dynamics. We used Whatman FTA card stabilization of DNA to develop a procedure for capturing oral and genital swabs from a geographically isolated pastoralist population in a desert region of northern Namibia. This is the first study to document HSV genome sequences from this type of remote setting and these are the first HSV genomes from Namibia. The resulting HSV sequences, collected in 2015 and 2016 from remote settlements in Namibia, fit within the scope of viral genetic diversity previously defined by African strains. The methodological approaches developed in this study can be expanded to broaden viral detection, improve diagnostics, and raise public health awareness about the burden of pathogens in under-served populations.

Survival rates for pediatric acute lymphoblastic leukemia (ALL) have markedly improved; however, survivors remain at risk of long-term hepatic complications, including progressive fibrosis related to chemotherapy and prior viral infections. The objective of this study is to evaluate hepatic fibrosis in pediatric ALL survivors using a sequential non-invasive algorithm combining transient elastography (TE) and enhanced liver fibrosis (ELF) score. This comparative cross-sectional study included 159 pediatric ALL survivors who had completed therapy at least 2&#xa0;years earlier and 99 age- and sex-matched healthy controls from two Egyptian oncology centers. Liver fibrosis was assessed using TE and serum biomarkers for calculation of the ELF score. The mean age at diagnosis was 6.9&#x2009;&#xb1;&#x2009;2.7&#xa0;years, and at assessment, 11.1&#x2009;&#xb1;&#x2009;2.7&#xa0;years. Hepatitis C virus (HCV) prevalence declined significantly from 75% during treatment to 5% at enrollment following antiviral therapy (p&#x2009;<&#x2009;0.001). Fibrosis was detected in 75% of survivors by TE, predominantly moderate (F2) fibrosis. Combined TE/ELF assessment identified advanced fibrosis (&#x2265;&#x2009;F3) in 6% of patients, while most survivors had mild-to-moderate fibrosis. Mean ELF score was significantly higher in survivors than controls (9.3&#x2009;&#xb1;&#x2009;1.2 vs. 4.5&#x2009;&#xb1;&#x2009;1.03, p&#x2009;<&#x2009;0.0001). Agreement between TE and ELF was fair (Cohen's &#x3ba;&#x2009;=&#x2009;0.34-0.39). HCV-positive survivors had significantly higher ELF scores than HCV-negative peers.Conclusion: Persistent hepatic fibrosis in pediatric ALL survivors was observed predominantly among patients with current or previous HCV exposure. A combined TE/ELF approach represents an effective non-invasive strategy for early detection and monitoring.

Gut colonization with multidrug-resistant (MDR) Klebsiella pneumoniae is commonly associated with an increased risk of extraintestinal infections among hospitalized patients. Extensive antibiotic exposure during the COVID-19 pandemic, is a critical contributing factor for the emergence of resistant strains. This investigation sought to elucidate the phenotypic and molecular resistance traits of carbapenem-resistant K. pneumoniae (CRKP) and extended-spectrum &#x3b2;-lactamase-producing K. pneumoniae (ESBL-KP) colonizing the gut of pediatric patients with confirmed COVID-19. A cross-sectional study was conducted from October 2020 to March 2022 at a tertiary pediatric hospital in Fayoum, Egypt. Fecal samples were collected from hospitalized pediatric COVID-19 patients. K. pneumoniae isolates were identified using standard microbiological methods. Antimicrobial susceptibility testing was carried out in accordance with the CLSI guidelines. ESBL and carbapenemase production were assessed phenotypically, while resistance genes were detected by multiplex and uniplex PCR. Microtiter plate method was used to assess biofilm formation. K. pneumoniae was detected in 36 of 71 patients (50.7%) using antibiotic-supplemented selective culture. The isolated strains were exclusively resistant, including 22 CRKP and 14 ESBL-KP. Colistin susceptibility was maintained in all isolates. CRKP strains showed significantly increased rate of resistance to fluoroquinolones and amikacin compared with ESBL-KP. BlaNDM gene (54.5%) and blaKPC (45.5%) were detected among CRKP isolates. ESBL-associated genes blaCTX-M, blaTEM, and blaSHV were prevalent in both groups. Biofilm formation was common and comparable between CRKP and ESBL-KP isolates. A high prevalence of fecal carriage of MDR K. pneumoniae, driven by carbapenemase-producing strains, was observed among hospitalized pediatric COVID-19 patients. These outcomes highlight the necessity for routine colonization surveillance, optimized antimicrobial stewardship, and strengthened infection control strategies in pediatric settings.

Background/Objectives: Granulomatous inflammation in tissue biopsies presents a diagnostic challenge, particularly in differentiating between Mycobacterium tuberculosis complex (MTB) and non-tuberculous mycobacteria (NTM) in high-HIV-prevalence areas. This study evaluates the prevalence and species distribution of mycobacteria in formalin-fixed, paraffin-embedded (FFPE) tissues from patients with granulomatous inflammation and correlates these findings with demographic and clinical data. Methods: Conducted at the NHLS-Dr George Mukhari Tertiary Laboratory, the retrospective descriptive study analysed 37 FFPE samples (January 2019-December 2020) after obtaining ethical approval and collecting clinicopathological data. Histopathological assessments using H&E and Ziehl-Neelsen (ZN) stains were carried out, and mycobacterial species were identified utilising multiplex PCR with reverse hybridisation (GenoType MTBC/CM/AS assays). Results: The cohort had an average age of 38.59 years, with a predominance of females (59.5%) and a high HIV positivity rate (62.2%). The most common biopsy site was lymph nodes (32.4%). All samples exhibited necrotising granulomas, but only 8.1% displayed acid-fast bacilli (AFB) on ZN staining. Molecular testing revealed mycobacterial DNA in 75.7% of samples, identifying NTM alone in 50.0%, MTB alone in 10.7%, and both in 28.6%. M. fortuitum was the most frequently recognised species. Importantly, there was no significant association between mycobacterial detection and HIV status (p > 0.05). Conclusions: The findings demonstrate that molecular methods substantially improve mycobacterial detection rates and speciation. This underscores the diagnostic limitations of ZN staining and highlights the importance of molecular diagnostics for accurately identifying bacterial aetiology, crucial for appropriate antimicrobial therapy in immunocompromised patients.

Climate change poses growing challenges to Egyptian agriculture, yet farmers' adaptive responses remain uneven. This study examines perceptions of climate change, its impacts, and adaptation pathways among 2953 farmers across seven major agricultural governorates in Egypt. Utilizing composite indices, this study captures the multidimensionality of climate awareness, perceived impacts, adaptation practices, barriers, and institutional support. The findings reveal a clear mismatch between high levels of climate awareness and the limited uptake of technical adaptation measures. Farmers' responses are largely concentrated on low-cost, incremental practices, while capital-intensive technologies, such as modern irrigation systems and digital tools, are rarely adopted. Traditional irrigation methods continue to dominate, despite widespread reports of climate-related impacts on agriculture, including severe productivity declines in key crops. Statistical analyses show a strong positive association between adaptation practices and reported changes in productivity, whereas the perceived severity of climate impacts is not significantly associated with adaptation levels. These results indicate that farmers' adaptation decisions are primarily reactive-shaped by tangible production outcomes and structural constraints rather than by awareness alone. These findings underscore the importance of complementing awareness-focused interventions with targeted financial, market, and extension support to enable effective, transformative climate adaptation in Egyptian agriculture.

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