Breast cancer represents a major public health burden in Sudan, where most patients are diagnosed at advanced stages and access to comprehensive diagnostic and molecular services remains limited. Current treatment strategies are largely extrapolated from non-African populations, despite the substantial genetic diversity across African populations that may significantly influence drug response, efficacy, and toxicity. Pharmacogenomics offers a promising approach to optimize breast cancer therapy through genetically informed treatment decisions; however, its clinical application in Sudan and across Africa remains limited. This narrative review synthesizes published evidence on pharmacogenetic determinants influencing breast cancer treatment, with a particular focus on African and Sudanese populations. Relevant studies published between 2005 and 2026 were identified through searches of PubMed, Google Scholar, and PharmGKB. A qualitative synthesis was conducted to summarize key pharmacogenes, population-specific genetic variability, and their potential clinical and therapeutic implications. Considerable interethnic variability has been reported in pharmacogenes involved in drug metabolism and transport, including CYP2D6, CYP3A4, CYP2B6, DPYD, and ATP-binding cassette transporter genes. African populations exhibit distinct allele frequency patterns that may substantially affect drug disposition, therapeutic efficacy, and toxicity, particularly for endocrine therapies and commonly used chemotherapeutic agents. These differences limit the direct applicability of pharmacogenomic data derived from European and Asian populations and underscore the need for population-specific evidence. Integrating pharmacogenomics into breast cancer management has the potential to improve treatment effectiveness and safety in Sudan. Achieving this goal requires the generation of locally relevant pharmacogenomic data, strengthened diagnostic and laboratory infrastructure, and a stepwise, context-appropriate incorporation of pharmacogenomic principles into clinical practice. Such an approach is important to support equitable and effective precision oncology for Sudanese and African populations.
Strong and resilient health systems are those equipped to withstand shocks and continue providing quality services as response measures are implemented. We conducted a qualitative evidence synthesis of stakeholders' understanding of health system resilience in Africa, focusing on definitions and attributes. We searched for peer-reviewed articles and grey literature, filtered for Africa, from 1980 to November 2025, using the SPIDER framework. The search was conducted in four databases: PubMed, the Bielefeld Academic Search Engine, the Cumulative Index to Nursing and Allied Health Literature, and Scopus; we also reviewed the websites of the World Health Organization (WHO), Africa Centers for Disease Control and Prevention (Africa CDC), and Ministries of Health of African countries. Articles were selected based on predefined inclusion and exclusion criteria. Qualitative articles were appraised using the Critical Appraisal Skills Programme, and mixed-methods articles using the Mixed Methods Appraisal Tool. We mapped the distribution of included articles by the country studied, the infectious disease responsible for the shock, and the health system building block described. For each article, we identified the definition of health system resilience and its attributes. The search yielded 5,448 relevant articles, eighty-three of which were included in the synthesis. Articles were from 48 of the 54 African countries. Up to 74.5% of the articles focused on COVID-19; others were on Ebola Virus Disease, cholera, and meningitis. Service delivery, leadership and governance and health workforce were the most frequently cited health system building blocks. Adaptive capacity of health systems resilience was most frequently cited, followed by absorptive capacity, preparedness, and recovery. Identified attributes of a resilient health system were community engagement and involvement; leadership and governance; collaborations and partnerships; human resources for health; health education and promotion; health information systems; health service delivery; decentralization and local governance; health infrastructure and logistics; preparedness; learning and adaptation; and innovation and financing.
Cancer care capacity in sub-Saharan Africa (SSA) is constrained by late diagnosis and limited treatment access. Few funding mechanisms support innovative, locally led programs to address these challenges. A collaborative initiative was developed to strengthen oncology care through quality improvement (QI) projects. The program was developed by Global Bridges Oncology (GBO) at Mayo Clinic, Pfizer Global Medical Grants, and the African Organisation for Research and Training in Cancer. A committee composed primarily of African oncology experts guided the process. An RFP was disseminated across SSA in English, French, and Portuguese, inviting applications to improve diagnostic and therapeutic cancer care. Applications underwent a structured, two-stage review, with GBO providing technical support, expert guidance, and training resources. The RFP generated 218 applications reflecting strong demand for oncology QI funding in SSA. After review, 17 projects representing 10 African countries were selected and awarded $1.1 million USD. Funded initiatives reflected four themes: oncology training and clinical practice improvements, early detection and accurate diagnostics, pediatric cancer care, and oncology nursing and palliative medicine. As of March 2026, 11 (65%) of 17 projects are complete, with 4,565 health care professionals engaged through direct training, conference dissemination, system adoption, and sensitization activities, and program-supported services were delivered to more than 47,300 patients. This initiative demonstrates the feasibility of a competitive, regionally guided grant program to strengthen cancer care capacity. Early implementation outcomes, including measurable improvements in diagnostic delay, treatment adherence, and care network expansion, confirm that locally led QI initiatives can generate meaningful results across diverse institutional settings. By centering African leadership and supporting diverse QI projects, it advances equitable access to funding, capacity building, and sustainability planning.
Using vital historical data, we modelled tuberculosis (TB) incidence and mortality rates across different scenarios of United States government's (US) development assistance for health (DAH), domestic general government health spending (GHES) and non-US donor funding to determine how changes in these funding would affect TB incidence and mortality in Africa. A serial cross-sectional ecological analysis was conducted using a panel dataset covering the period from 1990 to 2022 for all 54 African countries. The dataset included age-standardised TB incidence and mortality rates, source-specific DAH and other socioeconomic variables. Mixed-effects tests were performed to assess associations among US DAH, other healthcare funding and TB outcomes. Total annual TB-specific DAH in Africa increased from US$4.4 million in 1990 to US$168.7 million in 2022. The US government contributed more than a quarter of the total funds (US$713 million; 27.4%). Compared with scenarios in which US DAH was low but other funds were high, a combination of high US DAH, high funding from other donors and high GHES (one unit above their means) was associated with a 6.5% (95% Confidence Interval (CI) -73.6% to 49.6%) and a 14.6% (-86% to 60.8%) reduction in TB incidence and mortality, respectively. The corresponding decreases in incidence and mortality rates were 16.8 (-172.17 to 138.57) and 5.88 (-34.85 to 23.16) per 100 000. Although higher US DAH, Other DAH and GHES were associated with declines in TB incidence and mortality rates, the estimated differences in TB outcomes between high-funding and low-US-DAH scenarios were small and not statistically significant.
Ticks are known vectors of pathogens affecting animals and humans globally. However, there are gaps in knowledge regarding the diversity of ticks and tick-borne pathogens (TBPs) affecting wildlife in South Africa. This study aimed to determine the occurrence, diversity, and distribution of ticks and TBPs in cheetahs and lions from different localities in South Africa using morphological and molecular techniques. Thirty-three blood samples and 94 ticks were opportunistically collected from 30 cheetahs and four lions in 12 conservation facilities. DNA was extracted from 88 ticks and 33 blood samples. Six tick specimens were submitted to the Gertrud Theiler Tick Museum as reference vouchers. The CO1 and 16S rRNA genes were targeted for tick identification, while the 18S rRNA gene was targeted for the identification and characterisation of Apicomplexan parasites (Babesia, Theileria, Hepatozoon spp.). Nine species belonging to the genera Amblyomma, Haemaphysalis, Hyalomma, and Rhipicephalus were identified, with Haemaphysalis elliptica (59/94; 62.8%) identified as the most abundant species. Sequencing results for the CO1 and 16S rRNA genes were consistent with the morphological identification, except the CO1 sequence of FEL 09dT, which was morphologically identified as R. afranicus, but clustered between the reference sequences of R. linnaei and R. turanicus. Analysis of the 18S rRNA sequences from host blood and ticks revealed 98-100% similarity with published sequences of Babesia lengau, Hepatozoon felis, Hepatozoon ingwe, Hepatozoon luiperdjie, and uncharacterized Babesia and Hepatozoon species. This study demonstrates that wild carnivores in South Africa harbour diverse tick species and TBPs, most of which have unknown host range, transmission, and pathogenicity. Therefore, further studies are crucial to unravel the risk they may pose to the ecosystem.
Metal contamination in estuarine environments poses environmental and public health concerns, particularly where surface waters support domestic and subsistence uses. This study assessed the seasonal distribution, controlling mechanisms, and non-carcinogenic health risks of selected metals (Mg, Al, Ba, Fe, Mn, and Zn) in the Buffalo River Estuary, Eastern Cape, South Africa. Water samples were collected from 11 stations during wet and dry seasons and analyzed using standard methods. Descriptive statistics, Pearson's correlation analysis, and principal component analysis (PCA) were applied to evaluate metal distribution, inter-element relationships, and dominant controlling processes. Marked seasonal variability was observed, with higher concentrations of Al (97-1708 μg/L), Ba (7.4-29 μg/L), Fe (54-1751 μg/L), Mn (4-116 μg/L), and Zn (4-23 μg/L) during the wet season, while Mg concentrations were elevated in the dry season (10686-851 382 μg/L) relative to the wet season (1056-1313 μg/L). PCA indicated that wet-season metal dynamics were governed by lithogenic and hydrological processes linked to runoff and suspended sediments, whereas dry-season variability reflected sedimentary geochemical controls, redox processes, conservative mixing, and secondary anthropogenic inputs. Non-carcinogenic health risk assessment for Al, Ba, Fe, Mn, and Zn showed Mn as the largest contributor to risk, although cumulative hazard indices for adults (2.19 × 10-2-1.39 × 10-1) and children (8.10 × 10-2-5.01 × 10-1) remained below unity, indicating low health risk. These findings highlight the dominance of seasonal geochemical processes, providing essential baseline data for water-quality management, and underscore the need for continued monitoring to support effective water-resource management.
Primary health care (PHC) is recognized as pivotal for achieving universal health coverage and reducing mortality rates among children younger than 5 years. To estimate the association of effective PHC coverage with child mortality in 3 diverse sub-Saharan countries over the past 2 decades and to estimate the number of child deaths that could occur by 2035 if PHC services are dismantled due to the current decrease in development assistance for health funding. This cohort study assessed children younger than 5 years from January 1, 2007, to December 31, 2022, in Mozambique, Gabon, and Ethiopia. The study drew on 5 national and subregional representative US Agency for International Development Demographic and Health surveys with longitudinal information from the 3 countries. Statistical analysis was performed from October 2024 to May 2026. An effective PHC coverage index (PHC index) was developed for this study, integrating core dimensions of child PHC service provision and access and structured into progressively ordered coverage categories. The outcome was child mortality, assessed with 2-way fixed-effects multivariable Poisson regression models with child-clustered standard errors, adjusted for relevant confounding factors at the individual, regional, and national levels. This evaluation was also integrated into validated microsimulation forecasting analysis. Of the 118 911 child-year observations of 37 583 children (mean [SD] age, 1.4 [1.3] years; 60 252 boys [50.7%]), Gabon had the greatest coverage of service provision, followed by Mozambique and Ethiopia, though Mozambique showed a marginally higher proportion in the highest category (Gabon, 796 of 33 269 [2.4%]); Mozambique, 554 of 20 728 [2.7%]; and Ethiopia, 317 of 64 914 [0.5%]); the inverse pattern was observed for the lowest coverage categories (Gabon, 2143 of 33 269 [6.4%]; Mozambique, 1976 of 20 728 [9.5%]; and Ethiopia, 32 189 of 64 914 [49.6%]). Across all child-year observations, there were 2166 deaths (1.8%). Ethiopia accounted for 2.1% of deaths (1338 of 64 914 child-years), Mozambique for 1.8% (364 of 20 728), and Gabon for 1.4% (464 of 33 269). Increasing PHC coverage was associated with decreases in child mortality in a dose-response manner, reaching a 58% reduction (rate ratio, 0.42 [95% CI, 0.19-0.91]) for consolidated high coverage. The dismantling of PHC coverage, triggered by the defunding of development assistance for health , may lead to an increase in preventable child deaths, amounting to an estimated 373 108 deaths (95% uncertainty interval, 313 152-444 244 deaths) across the 2025 to 2035 period. This cohort study found evidence indicating that PHC was associated with substantially reduced mortality rates among children younger than 5 years in sub-Saharan Africa over the past 2 decades. These findings suggest that PHC should be expanded rather than dismantled, particularly amid the ongoing defunding of development assistance for health.
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Experimental huts are the gold standard for the semi-field evaluation of insecticide-treated nets (ITNs) but the design of the huts used varies markedly between sites. Structural differences may influence mosquito behaviour - and, consequently, the measured efficacy of ITNs. This raises concerns about the comparability, validity, and policy relevance of trial outcomes. We assessed the influence of four commonly used hut designs on entomological endpoints central to ITN evaluations. A 126-night comparative trial was conducted in Tanzania, using 18 experimental huts in two contiguous 9 × 9 Latin squares. Four hut types-East African, West African, Ifakara, and Rapley-were tested with PRONet Duo, Interceptor® G2, MAGNet®, and untreated nets. Sleepers and treatments were rotated throughout the trial. The primary outcome was 72-h mortality (M72); secondary outcomes were mosquito density, blood-feeding success, and exiting. Endpoint estimates for each hut type were compared using East African huts as the reference. Non-inferiority analysis of PRONet Duo in each hut type were compared with findings from a sister trial conducted exclusively in West African huts in West Africa. A total of 22611 Anopheles gambiae s.l. (99.9% An. arabiensis) were collected. Rapley and Ifakara huts captured over six times more mosquitoes than East African huts (rate ratio [RR] = 6.50 and 6.22, respectively; both p < 0.0001), whereas West African huts caught 88% fewer mosquitoes (RR = 0.12, p < 0.0001). West African huts recorded the highest mortality (70%) and blood feeding (15%) whilst the other hut types recorded 40-46% mortality and 3-8% blood feeding. All hut designs and the West African sister trial detected the same direction of effect between PRONet Duo and Interceptor® G2 and predicted non-inferiority of PRONet Duo, although smaller sample sizes limited statistical certainty in East African and West African huts in Tanzania. Experimental hut design substantially affected key entomological outcomes, influencing both the magnitude of measured efficacy of ITNs and the statistical power of trials. Whilst relative product performance was broadly consistent across designs, absolute values varied widely, underscoring the need for greater standardisation of hut architecture in ITN evaluations. Harmonising experimental hut designs and reporting standards would strengthen cross-site comparability, improving the reliability of vector control product assessments, and enhancing the evidence base for global malaria control policy.
Quiet quitting, whereby employees limit their effort to the minimum requirements of their job descriptions, represents an emerging form of voluntary disengagement that is particularly prevalent amongst Gen Z and Millennial employees. Despite growing global attention to this phenomenon, limited research addresses its contributing factors within the South African workplace context. This study employed an interpretivist qualitative approach using purposive and snowball sampling to conduct semi-structured interviews with 12 South African Gen Z and Millennial employees across various professional sectors. Data were analysed using Braun and Clarke's reflexive thematic analysis framework. Three key themes emerged: (1) quiet-quitting behaviours and attitudes, encompassing withdrawal, minimal effort performance, career transition preparation, generational work attitudes, and digital distraction; (2) workplace value misalignment, encompassing inadequate compensation and recognition, limited growth opportunities, changing generational priorities, and toxic work environments; and (3) organisational strategies to mitigate quiet quitting, encompassing workplace culture and voice, detection and intervention, growth and development opportunities, well-being and work-life balance, and recognition and reward systems. The study contributes to theory by proposing a generational refinement of job embeddedness theory and introducing a motivational typology distinguishing protective and assertive orientations to quiet quitting. The findings suggest that, within this sample, quiet quitting amongst younger employees appears to be driven primarily by a perceived misalignment between employee values and organisational culture and practices, though the transferability of these patterns to other contexts requires further investigation. To address this, organisations could consider implementing strategies that foster inclusive cultures, provide development opportunities, and improve recognition systems. HR professionals and leaders may use these findings to implement targeted interventions to reduce disengagement and turnover risk amongst Gen Z and Millennial employees in South African workplaces.
Mycotoxin exposure is a major public health concern in Africa due to food insecurity that compromises food safety. Infants and young children are highly vulnerable due to immature immunity and higher food intake per body weight. However, data on mycotoxin exposure in Africa remain limited. This study investigated mycotoxin exposure in Nigerian infant-mother pairs and toddlers using biological samples (breast milk, infant/toddler urine) collected from three agro-ecological zones. Overall, 75.6% of all the samples tested positive for at least one mycotoxin. Zearalenone, aflatoxin M1, ochratoxin A, and citrinin were most prevalent across all sample types, with mean levels (ng/mL) of 4.1, 1.1, 1.2, and 2.0 in breast milk; 0.83, 0.78, 0.11, and 0.79 in infant urine; and 0.99, 1.0, 0.1, and 1.9 in toddler urine, respectively. No significant associations were found between mycotoxin contamination in breast milk and infant urine or between diet patterns across the regions and mycotoxin levels. Mycotoxin exposure assessment of infants/toddlers using the probable daily intake approach based on urinary biomarkers revealed high exposure to mycotoxins especially ZEN, OTA, and AFM1. The results suggest widespread exposure among the studied population and highlight the need for further research and interventions to reduce mycotoxin exposure, especially in vulnerable populations.
Cowpea (Vigna unguiculata (L.) Walp.) is the primary grain legume in sub-Saharan Africa, yet protein-energy malnutrition and micronutrient deficiencies persist widely across the region. This study evaluates the proximate and mineral composition of twelve early-maturing, high-yielding M5 mutant lines derived through multi-generational pedigree selection from 60Co gamma irradiation (452 Gy) of the Ghanaian cowpea cultivar Hansadua. Seeds harvested from a randomized complete block design (three replications) at the University of Cape Coast, Ghana, were analyzed for proximate composition (protein, fat, fiber, ash, carbohydrate, moisture) and mineral content (N, Ca, Na, K, Mg, Fe) using AOAC and wet acid digestion methods. All twelve parameters differed significantly (p < .001) among genotypes. Crude protein ranged from 18.96 ± 0.09% to 30.49 ± 0.14%, compared to 20.54 ± 0.09% in the parent; ten of twelve mutant lines exceeded Hansadua. All mutant lines surpassed the parent in calcium (44.47-105.60 mg/100 g) and potassium (745.87-1,112.03 mg/100 g). Protein was strongly correlated with nitrogen (r = 0.99, p < .001) and magnesium (r = 0.60, p < .001) but was independent of iron (r = 0.18, p > .05). Mutant lines HanM4(12)(3), HanM4(52)HY, and HanM4(33)(HY43) show promise for cowpea biofortification breeding efforts aimed at fighting protein-energy malnutrition and mineral deficiencies in West Africa.
Patient satisfaction is a key indicator of health care quality, and it guides improvement efforts. Although many local studies have examined perioperative patient satisfaction in Ethiopia, there is no comprehensive national synthesis. This gap limits the development of targeted strategies to enhance patient care. The aim of this systematic review and meta-analysis is to determine the pooled prevalence of patient satisfaction with perioperative services in Ethiopia and identify associated factors. This study included all observational research articles on patient satisfaction with perioperative services in Ethiopia. A multidatabase search strategy, incorporating PubMed/MEDLINE, HINARI, Web of Science, Cochrane Library, African Journals Online, and Scopus, was used alongside a gray literature search to identify all Ethiopian studies on perioperative satisfaction available before January 1, 2024. The Newcastle-Ottawa Scale was used to assess the quality of the studies. To assess heterogeneity, subgroup analyses were conducted, and I² statistics were calculated. This study used funnel plots, the Egger test, and a nonparametric trim-and-fill analysis to assess publication bias. A sensitivity analysis was also used to identify any influential studies. Univariate meta-regression examined the association between study-level covariates and perioperative satisfaction. This review included 21 studies comprising 6858 participants. Overall satisfaction with perioperative services was expressed by 5072 participants (73.96%, 95% CI 68.84%-79.08%; I²=96.56%). Factors significantly associated with higher satisfaction included effective postoperative pain management (adjusted odds ratio [AOR] 2.23, 95% CI 1.56-2.90), illiteracy (AOR 3.18, 95% CI 1.23-5.13), primary school education (AOR 6.55, 95% CI 3.61-9.49), local anesthesia use (AOR 2.80, 95% CI 2.03-3.57), and history of prior surgery or anesthesia (AOR 2.76, 95% CI 1.51-4.01). This study found that the pooled prevalence of patient satisfaction with perioperative services in Ethiopia was 73.96% (5072/6858 participants). Postoperative pain management, illiteracy, primary school, local anesthesia, and a history of surgery or anesthesia were significantly associated with patient satisfaction with perioperative services. Health care facilities should focus on providing effective postoperative pain management, clear information about perioperative services, and training for surgical and anesthesia teams to boost patient satisfaction with perioperative services in Ethiopia.
Variegate Porphyria (VP) is the predominant porphyria in South Africa, historically linked to Dutch colonization, and is considered the second most common AHP. Data from Brazil remain scarce. This study aimed to describe the genetic findings in a case series of Brazilian VP patients. We conducted a cross-sectional study including patients with VP from three different Brazilian tertiary centers. Medical records and previous genetic testing reports from commercial kits were reviewed and presented including literature review. A total of 35 patients from 19 families were identified. Twenty-three of these had experienced acute attacks, with first symptoms presenting between 17 and 62 years of age. All patients initially presented abdominal pain, and 20 developed severe attacks followed by acute flaccid paralysis. Genetic analysis revealed that fourteen (74%) families carried the same missense variant in exon 6 of PPOX gene (p.Arg168His). We describe the first case series of Brazilian VP patients with a recurrent variant p.Arg168His that may suggest a regional founder effect or uncharacterized ancestral links, which warrant further genetic and epidemiological studies.
Climate change poses significant threats to biodiversity, altering species survival and interactions within diverse ecological networks. In this systematic review, we synthesized current knowledge on climate change impacts on arboreal mammals and identified gaps, biases, and future opportunities in research. Following PRISMA guidelines, we identified 142 studies spanning 33 countries. We identified significant phylogenetic and geographic gaps in knowledge, revealing that large proportions of taxa remain unstudied or under-represented. Australia and South America were the most frequently studied countries; however, considering the high diversity of arboreal mammals in these regions, this research focus remains inadequate. The koala and greater glider were major focal animals of climate change studies. The order Diprotodontia was the most studied (46%), followed by Primates (23%). Conversely, studies focusing on the orders Chiroptera, Pilosa, and Microbiotheria, as well as research conducted in Africa and Europe, were noticeably underrepresented. Extreme temperature was found to be the main driver behind many negative impacts on arboreal mammals. Meta-analysis revealed that several arboreal mammal families are projected to experience significant future range contractions, particularly Pseudocheiridae, Cercopithecidae, and Tarsiidae. Conservation practitioners should target areas that ensure both climatic and ecological suitability for species survival in future climate scenarios, prioritising highly vulnerable species. Current research highlights the critical need for habitat protection, restoration, and management, identification of climate and thermal refugia, and conducting more species-specific research. Future research should focus on expanding to underrepresented taxa and regions, conducting more longitudinal studies in well-studied taxa and regions, investigating multiple climate drivers, and considering multiple species where appropriate, to enhance our understanding of climate change impacts on arboreal mammals.
Mountain regions support rich biodiversity,1 yet they are increasingly threatened by climate change and human activities.2,3 Although protected areas (PAs) are important for mountain biodiversity conservation,4,5 their effectiveness has been evaluated primarily through spatial coverage,6,7,8 with limited attention to how conservation outcomes vary along elevational gradient. Here, we assessed the effectiveness of mountain PAs for biodiversity conservation worldwide using species distribution data for 7,739 mountain species and 2,710 threatened mountain species. Applying propensity score matching, we compared species richness inside and outside PAs while controlling for environmental differences. We found that mountain biodiversity was concentrated primarily in South America and Asia, whereas effective PAs occupied a smaller area than ineffective PAs in South America for mountain species. PA effectiveness also showed pronounced elevational variation. The percentage of effective PAs was generally low at lower elevations and increased with elevation across Africa, Asia, and Europe for mountain species, but declined above 4,000 m in South America for both mountain and threatened mountain species. These findings reveal that conservation outcomes within mountain PAs are highly uneven across elevational zones. As global biodiversity conservation targets increasingly emphasize expanding PAs, our results demonstrate that an area-based approach alone does not guarantee the effectiveness of biodiversity conservation and highlight the need to prioritize management effectiveness across elevational gradient, particularly in low-elevation areas and biodiversity hotspots of South America.
Malaria distribution in sub-Saharan Africa is becoming increasingly spatially heterogeneous. Pre-elimination areas, high-transmission settings and urban areas with increasing transmission may all coexist within the same country. Effective intervention planning requires identifying high-risk areas and their drivers-an area in which geospatial models can provide valuable insights. Yet these models often assume stationary risk factors across transmission levels and frequently rely on prevalence survey data, which are unreliable in low-transmission settings. This study uses routine public-sector health facility data (ie, DHIS2) to model malaria incidence in Senegal from 2017 to 2021, accounting for transmission levels, and introduces novel fine-scale estimates of reported malaria incidence derived from dasymetric disaggregation. Health facility catchment populations were estimated using a probabilistic approach, allowing individuals to attend multiple facilities based on relative travel time. Malaria incidence per catchment was modelled using high-resolution environmental and socioeconomic covariates within a Bayesian hierarchical modelling framework. Separate models were fitted by season and endemicity-urbanisation level to assess the heterogeneity of risk factors. We adapted dasymetric disaggregation methods from population mapping to redistribute facility-level cases to 1 km pixels. Estimated malaria incidence increased from 60 cases per 1000 people in 2017 to 71 cases in 2021. Key risk factors varied across endemicity-urbanisation levels; some factors were uniquely associated with low (eg, distance to roads), moderate (eg, cropland) and high-transmission settings (eg, flooded vegetation). Fine-scale maps represent malaria cases that the public-sector health system routinely reports, rather than the total malaria burden, and revealed potential underdiagnosis in remote areas. Our findings emphasise the importance of considering endemicity levels when evaluating malaria risk factors in heterogeneous transmission contexts. As health system data quality continues to improve, this approach offers a scalable alternative for mapping reported malaria incidence, supporting better targeted interventions and the identification of underdiagnosed areas.
Maternal anaemia affects 35.5% of pregnant women globally and represents a persistent public health challenge with significant maternal and neonatal health consequences. Despite substantial research investment, progress towards anaemia reduction remains limited, suggesting potential misalignment between research priorities and translation to guidance and/or implementation of recommended interventions. Understanding the knowledge structure and thematic evolution of maternal anaemia research is essential for identifying gaps and informing future research strategies and guideline development. This study aimed to map the knowledge structure and evolution of research on anaemia in pregnant and postpartum women from 2000 to 2024, analyse global collaboration networks and geographic distribution, and identify emerging themes and research gaps using bibliometric analysis and topic modelling. A comprehensive bibliometric analysis was conducted using Web of Science Core Collection database, encompassing 1,007 articles published between 2000 and 2024. Standard bibliometric indicators were calculated using VOSviewer and CiteSpace software. Latent Dirichlet Allocation topic modelling identified thematic clusters. Linear regression analysis examined temporal trends and geographic patterns. Publication output demonstrated exponential growth (R2 = 0.9054), increasing from 12 articles in 2000 to 110 in 2024. Research output was concentrated amongst authors from high-income countries, with 68.5% of publications having first or corresponding authors based in high-income countries. Geographic disparities revealed substantial regional research gaps, particularly in Sub-Saharan Africa and South Asia. Topic modelling revealed nine clusters dominated by health outcomes research (77.4%), with less attention to management (21.6%), prevention (20.8%) and diagnosis (6.3%). This bibliometric analysis reveals substantial growth in maternal anaemia research over 25 years, with publications increasing nearly ten-fold. However, the research landscape shows thematic imbalances. Sustained attention is needed on prevention and diagnosis as well as the integrated delivery of anaemia interventions within multisectoral approaches to generate evidence and address remaining knowledge gaps.
Nurses face disproportionate occupational risk for hepatitis B virus (HBV) infection, yet global data on their seroprevalence remain fragmented. We aimed to provide the first comprehensive global estimate of HBsAg seroprevalence specifically among hospital-based nurses. In this systematic review and meta-analysis, we searched PubMed, Scopus, EMBASE, and Web of Science from inception to Dec 31, 2025. We included studies reporting laboratory-confirmed HBsAg seroprevalence in hospital nurses. A random-effects model with Freeman-Tukey double arcsine transformation was used to estimate pooled prevalence. Heterogeneity was explored through subgroup analyses and meta-regression. Forty-six studies from 28 countries, comprising 11,524 nurses, were included. The global pooled HBsAg prevalence was 3.2% (95% CI 2.3-4.4; I2 = 88.7%). Burden was highest in Africa (5.6%, 95% CI 4.1-7.3) and lowest in Europe (1.5%, 95% CI 0.4-3.0). Prevalence was significantly higher in low- and middle-income countries compared to high-income countries (3.6% vs 0.8%; p = 0.003). Meta-regression identified an inverse correlation between full vaccination coverage and HBsAg positivity (coefficient - 0.0028; p < 0.001). The temporal trend of HBV prevalence among nurses remained stagnant over the study period (p = 0.190). Approximately one in thirty hospital nurses worldwide lives with chronic HBV. The decoupling of occupational prevalence from declining global trends indicates a persistent protection gap. Ensuring mandatory three-dose immunization regimens and rigorous post-exposure surveillance, particularly in LMICs, is essential to eliminate HBV as an occupational hazard for the nursing workforce.
Schistosomiasis (SCH) and Soil-transmitted helminthiasis (STH) remain major neglected tropical diseases across sub-Saharan Africa. In Akwa Ibom State, preventive chemotherapy (PC) has been implemented in endemic Local Government Areas (LGAs). This study assessed the impact of five effective rounds of PC on the prevalence and intensity of SCH and STH in 26 endemic LGAs. This study was carried out in 26 LGAs of Akwa Ibom State between September and October 2025. A school-based cross-sectional survey was employed. Schools were purposefully selected from endemic wards, and a total of 200-300 samples were collected per LGA from school children of both sexes aged 8-14 years. Samples were collected using a systematic random sampling method. Questionnaires were administered using electronic data forms. Stool samples collected were analyzed using the Kato-Katz technique, while urine samples were analyzed using the urine filtration method. Conventional microscopy alongside a novel AiDx digital microscope was used to examine prepared specimen. Data obtained were analyzed using descriptive statistics, chi-square test, bivariate and multivariate logistic regression on SPSS, and maps were generated using ArcMap. No cases of Schistosoma mansoni or Schistosoma haematobium were detected across the 26 LGAs (0.0% prevalence). The overall prevalence of STH was 27.62% (95% CI: 26.54-28.72), ranging from 4.92% to 71.65% across LGAs. Species-specific prevalence was 15.38% (95% CI: 14.52-16.28, range: 3.3% to 38.3%) for hookworm, 15.10% (95% CI: 14.24-15.99, range: 1.6% to 67.0%) for Ascaris lumbricoides, and 1.52% (95% CI: 1.25-1.85, range: 0.4% to 9.3%) for Trichuris trichiura. Mbo (71.65%) and Udong Uko (62.04%) recorded the highest prevalences, whereas Ika (4.92%) had the lowest. Prevalence was significantly higher among children aged 11-14 years (31.77%; 95% CI: 29.95-33.64) compared with those aged 8-10 years (95% CI: 23.77-26.46), and among males (29.30%; 95% CI: 27.80-30.86) compared with females (25.73%; 95% CI: 24.24-27.35) (p < 0.05). 98.66%, 99.09% and 100.0% of schoolchildren had light infections of A. lumbricoides, hookworms and T. trichiura respectively. Compared with baseline data, STH prevalence declined by 30.15%. Significant risk factors associated with STH include; males (aOR = 1.196, 95% CI: 1.072 - 1.335), age group of 11-14 years (aOR = 1.391, 95% C.I.: 1.244 - 1.554), dry pit latrine (aOR = 1.464, 95% C.I. = 1.239 - 1.731), schools where children urinate (aOR = 2.620, 95% C.I.: 2.362 - 2.929) and defecate (aOR = 1.238, 95% C.I. = 1.097 - 1.396) around school or wait to defecate after school (aOR = 1.830, 95% C.I. = 1.365 - 2.454), schoolchildren that drinks from surface water (aOR = 1.731, 95% C.I. = 1.486 - 2.017) or boreholes that uses hand pump (aOR = 1.666, 95% C.I. = 1.412 - 1.965). Schistosomiasis was not reported in 26 LGAs of Akwa Ibom. Soil-transmitted helminths had a significant reduction in prevalence, but with varying prevalence across the states. There is a need for sustained preventive chemotherapy against STH in the State. Improvement in water, sanitation, and hygiene (WASH) infrastructures to create behavioural change, and strengthen the control efforts.