Home delivery continues to be a significant factor contributing to maternal mortality in Africa, particularly among rural women with limited access to skilled birth attendants and healthcare facilities. Factors influencing home delivery operate at individual, household, and community levels. Therefore, this study aimed to examine the prevalence and risk factors of home delivery among rural women in 28 African countries. This retrospective cross-sectional study analyzed the most recent Demographic and Health Surveys (2011-2024) from 28 African countries. The weighted sample included 103,011 rural women of reproductive age. We performed descriptive analysis, chi-square tests, and binary logistic regression. Results are presented as frequencies, percentages, and odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. The overall prevalence of home delivery among rural women in Africa was 34.01% [95% CI: 23.33%-35.26%], ranging from 5.91% in Rwanda to 85.19% in Chad. Women with mistimed pregnancy [aOR = 0.79, 95% CI = 0.76-0.82] and those with unwanted pregnancy [aOR = 0.86, 95% CI = 0.81-0.92] had lower odds of home delivery. Risk factors included having four or more births [aOR = 2.04, 95% CI = 1.91-2.17], no/other religion [aOR = 2.41, 95% CI = 2.24-2.56] and those in Central Africa [aOR = 2.09, 95% CI = 1.98-2.19]. This research reveals that home delivery remains prevalent among rural women in Africa, with significant between-country disparities. Key risk factors include high parity, no/other religion, and Central African residence. Programs should prioritize multiparous women and expand maternal health services across all religious groups. Additionally, context-specific policies and targeted investments are needed in Central Africa to address regional disparities.
Access to essential medicines is a fundamental human right and a critical pillar of effective healthcare. In Africa, armed conflicts severely weaken health systems, disrupting the availability of essential medicine, leading to gaps in patients' treatment and, in turn, posing a serious risk to overall public health. Therefore, this study aimed to identify the impact of armed conflicts on the availability of essential medicines as a cornerstone of healthcare across African regions, and quantify the extent of this disruption over time and by country. In this systematic review and meta-analysis, data were retrieved from published articles accessible in PubMed, Semantic Scholar, and grey literature covering the period from 1985 to 2025 and 2001 to 2024 for system impact and medicines availability studies, respectively. The literature search was conducted from January to May 2025. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, studies were independently screened by two reviewers and included if they contained information on medicine availability or its relation to health systems in conflict zones and were published in English. The quality of studies was evaluated using the Joanna Briggs Institute criteria. Pooled estimates of medicine availability and their 95% CIs were obtained using a random-effects analysis. Heterogeneity was assessed using the I² statistic. The risk of bias and small study effects were assessed with funnel plots and Egger's test. Additionally, the leave-one-out sensitivity test and influence diagnostics test were considered to evaluate study-level impact. The review included data from 1,581 health facilities and 989 essential medicines across eight conflict-affected African countries. The pooled availability of essential medicines calculated from the data obtained from 41 studies conducted in African countries shouldering frequent armed conflict was estimated at 55% (95% CI, 47-63), with substantial heterogeneity across studies (I² = 93%, p < 0.001). Country-level analysis showed the highest availability in the Central African Republic (79%; 95% CI, 49-95) and the lowest in Nigeria (40%; 95% CI, 1-78). A temporal decline in medicine availability was observed, from 76% (2001-2010) to 46% post-2020. No significant publication bias was detected (funnel plot asymmetry p = 0.9560; Egger's test p = 0.494). Additionally, the influence diagnostic test and the leave-one-out sensitivity analysis indicated that observed heterogeneity likely reflects methodological differences and the sample size across the studies rather than bias or outliers. The systematic review revealed that armed conflicts have profoundly compromised health system functionality through the destruction of healthcare infrastructure, closure of medical facilities, displacement of the health workforce, pervasive insecurity and psychological distress among healthcare providers, and disruptions in supply chains and transportation networks, all of which have adversely affected the accessibility of essential medicines. On average, only 55% of essential medicines were available in conflict-affected regions of Africa, which was below the WHO benchmark of 80%. This finding underscores the severe threat that armed conflict poses to medicine availability and, consequently, to increased indirect morbidity and mortality. Additionally, the conflict undermines medicine availability through multiple, often interconnected mechanisms, indicating the need for a coordinated, multisectoral approach to ensure continuous access to essential medicines. Therefore, strengthening healthcare infrastructure in conflict settings is critical. Furthermore, the international community should enforce accountability mechanisms for violations affecting healthcare services, while donors and regional humanitarian assistance and emergency response mechanisms should increase investment and medicine supply in resilient medicine supply systems capable of maintaining availability during periods of armed conflict. The study protocol was registered in PROSPERO (CRD420251154811), the International Prospective Register of Systematic Reviews, maintained by the National Institute for Health and Care Research (NIHR).
Retention in HIV care remains challenging in sub-Saharan Africa. We evaluated whether training lay counsellors in Motivational Interviewing (MI) could improve outcomes among newly diagnosed people living with HIV (PLHIV) in South Africa. We conducted a cluster-randomised pilot trial in eight Johannesburg primary healthcare clinics, randomised 1:1 to Thusa-Thuso intervention (7-day MI training plus 12-month mentorship) or standard-of-care (SOC). Adults PLHIV (≥18 years) were enrolled and followed for 12 months. The primary outcome was 12-month retention. The secondary outcome was HIV viral suppression (VL <50 copies/mL). We assessed dose-response associations between counsellor MI skills and outcomes. Between March 2020 and August 2021, 548 PLHIV were enrolled (n=291 intervention; n=257 SOC). The intervention significantly increased 12-month viral suppression (39.86% vs. 28.40%; risk differences (RD): 11.12 %; p=.007). Improvements occurred for ART initiation (88.3% vs. 74.7%; RD: p=.085) and 12-month retention (51.9% vs. 40.5%; p=.067). Patient retention increased with counsellor proficiency in cultivating change talk (RR: 1.47; p=.016), showing empathy (RR: 1.30; p=.020) and partnership (RR: 1.37; p=.010). MI training and mentorship for lay counsellors improved 12-month viral suppression among newly diagnosed PLHIV. Training existing cadres in MI skills is a high-leverage strategy to achieve UNAIDS 95-95-95 targets.
Unnatural and unexplained deaths present critical challenges to the criminal justice, medico-legal, and public health systems. This study explored forensic professionals' perspectives on the integration of point-of-care (POC) diagnostics into unnatural death investigations in South Africa. A Nominal Group Technique (NGT) was conducted with eight key forensic stakeholders to identify and prioritize the potential benefits, facilitators, and barriers associated with POC implementation. Stakeholders ranked guidance for investigation and autopsy, improved turnaround times, and resource efficiency as the most significant POC diagnostic benefits. Scientific validity, quality assurance, and alignment with legal and regulatory frameworks were identified as critical facilitators, whereas technical limitations, quality management gaps, and legal uncertainties emerged as key barriers. Participants emphasized that POC diagnostics could support timely decision-making during death scene investigations and autopsies, reduce laboratory backlogs, and improve family and community outcomes through faster case resolution. However, successful integration requires standardized protocols, validation, and appropriate training to ensure scientific and legal defensibility. These findings provide foundational evidence to inform the responsible integration of POC diagnostics into forensic death investigations, with potential benefits for justice delivery and community health in South Africa.
Acute respiratory infections, including SARS-CoV-2, remain a leading cause of childhood morbidity and mortality in low- and middle-income countries (LMICs), yet the underlying immune determinants of disease severity are poorly understood. The increased susceptibility to SARS-CoV-2 could be related to a decreased antibody or altered inflammatory response. We conducted a cohort study of South African children hospitalised with acute respiratory infections, and collected mucosal and serum samples over time. Nasopharyngeal aspirates (NPAs) or swabs were tested for viral pathogens by multiplex PCR. Antibody levels, neutralising capacity, and inflammatory proteome profiles were assessed. In the cohort (median age 7.31 months, IQR 2.9-31.7), 67 children (54%) were SARS-CoV-2 positive at enrolment. Substantial baseline anti-spike IgG was detected in both SARS-CoV-2-positive (68% serum, 58% saliva) and negative (40% serum, 36% saliva) patients, irrespective of disease severity. Lower expression of salivary inflammatory proteins was associated with severe disease (p < 0.05), independent of SARS-CoV-2 status. Disease severity was associated with differences in mucosal inflammatory protein expression rather than antibody levels, irrespective of SARS-CoV-2 status. These findings highlight the potential value of salivary biomarkers for understanding mucosal immune regulation and identifying children at risk of severe respiratory infection outcomes in LMICs.
Sub-Saharan Africa (SSA) has the highest incidence and mortality rates of cervical cancer (CC), largely due to limited screening coverage. Community health workers (CHWs) are lay health providers who strengthen healthcare delivery; however, their influence on cervical cancer screening (CCS) uptake remains insufficiently explored. This systematic review evaluates the impact of CHW-involved interventions on CCS uptake in SSA. A systematic search of MEDLINE, EMBASE, and Cochrane databases was conducted in June 2023 and updated in May 2025. Studies were included if they: (1) were conducted in SSA among females eligible for CCS and published between January 2003 and May 2025; (2) compared CHW-based interventions with standard or non-CHW approaches; and (3) reported CCS uptake, linkage to triage and/or treatment after primary screening or attendance to follow-up visits. Only studies using a controlled design were included. A descriptive analysis was performed. PROSPERO registration: CRD42024495220. Six studies met the inclusion criteria. Despite methodological limitations, all studies involved CHWs in health education and counseling. CHWs conducted home visits to recruit participants for CCS, rescheduled follow-up appointments, facilitated access to care, and provided childcare during screening attendance. Interventions involving CHWs significantly increased CCS uptake in three of the five studies assessing it as the primary outcome and improved follow-up attendance in the single study examining this indicator. The effectiveness of CHW-based interventions varies by type and context but shows potential to enhance CCS uptake in SSA.
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Human T-lymphotropic virus 1 (HTLV-1) infection is estimated to affect at least 5-10 million people globally and can cause adult T-cell leukaemia/lymphoma. The global distribution of HTLV-1 is characterised by endemic foci (prevalence confined to specific populations) in Japan, Africa, the Americas, the Middle East, and Oceania. Transmission occurs through vertical, sexual, bloodborne, and zoonotic routes, but their relative contributions are poorly characterised and depend on the setting. This study aims to quantify the relative contributions of vertical, sexual, bloodborne, and zoonotic transmission routes across HTLV-1 endemic foci. Following a systematic literature review, we analysed seven age-stratified and sex-stratified HTLV-1 seroprevalence surveys including nine subpopulations in French Guiana, rural Gabon, rural Cameroon, Japan (Miyazaki, Iriomote, and Ishigaki), and central Australia; Bantu and Pygmy participants in Gabon and Cameroon were considered as distinct subpopulations. We used a multiroute serocatalytic model incorporating vertical, sexual, and hospital-related (transfusion-anchored) routes of transmission in all settings, with additional non-human-primate (NHP) bite-related transmission in central Africa, and a male-specific route in central Australia. The primary outcome was the model-estimated route-specific force of infection by age, sex, and subpopulation, from which we derived the attributable fraction of infections due to each transmission route. The estimated vertical transmission probability, conditional on a mother with HTLV-1 infection, was 17% (95% credible interval 15-20). Sexual infection probabilities in males ranged from 0·02% to 0·68% per year, and were 1·6 times (1·4-1·8) higher in females. Hospital admission infection probability ranged from 0·05 (in central Australia) to 125 (in Miyazaki, Japan) per 100 000 hospital admissions. NHP bites in males in central Africa carried a 7% (3-13) infection probability per bite. In adults aged 25-69 years, sexual transmission accounted for 85% (79-87) and vertical transmission for 8% (7-9) of infections across populations. Hospital-related transmission contributed to around 2% of all infections in Japan (pre-HTLV-1 blood-safety measures), around 5% in Cameroonian Bantu communities, and less than 1% elsewhere. NHP bite-related transmission accounted for up to 26% of adult male infections in Cameroonian Bantu rural communities and up to 9% elsewhere in central Africa. In central Australia, most adult male infections could not be accounted for by sexual or vertical transmission. Sexual and vertical transmission dominate HTLV-1 spread, but context-specific exposures add substantial local burdens in central Africa and central Australia. These route-specific estimates support intervention prioritisation and the design of setting-specific control strategies. EU and Agence Nationale de la Recherche. For the French translation of the abstract see Supplementary Materials section.
Infectious Bursal Disease (IBD), caused by Infectious Bursal Disease Virus (IBDV), remains a major threat to poultry industry worldwide, leading to immunosuppression, secondary infections, and resulting in economic losses. This study reports the molecular characterisation and phylogenetic classification of IBDV strains circulating in broilers from different Kenyan counties. Between 2022 and 2024, 44 broiler flocks (19-31 days old) suspected of IBD and vaccinated with an immunocomplex vaccine were sampled across six Kenyan counties. Bursal imprints on QIAcard FTA™ Classic were analysed by RT-PCR targeting the VP2 gene (segment A). Positive samples were further characterised by amplification and sequencing of the VP1 gene (segment B). IBDV was detected in 24/44 clinically suspected flocks (54.5%; 95% CI: 39.7-68.6%) submitted for molecular testing. Phylogenetic analysis revealed that 23 of these belonged to genotype A3B2 (very virulent IBDV, vvIBDV) and were closely related to strains circulating in Sub-Saharan Africa, while one detection matched the applied vaccine strain. Amino acid analysis confirmed conserved virulence markers in vvIBDV: A222, I242, Q253, I256, D279, I294, S299, and the serine-rich heptapeptide SWSASGS (aa 326-332) in segment A, as well as the TDN motif (aa 145-147) in segment B. Unique African mutations (S254 and A/Q300 in segment A) were also identified. To our knowledge, this represents the first report on the molecular characteristics of IBDV strains circulating in Kenyan broilers. The predominance of vvIBDV highlights the persistent challenge posed by highly virulent strains in Africa, underscoring the need for continuous monitoring, enhanced biosecurity, and more effective vaccination strategies.
Nitroimidazole-refractory giardiasis is an increasing problem. We present data on efficacy of a treatment ladder and on clinical characteristics and assemblage types in nitroimidazole-refractory giardiasis. We conducted a prospective clinical observational study of adult patients with giardiasis at four centres in Norway and England during 2009 - 2024. Patients with nitroimidazole-refractory giardiasis were treated with albendazole plus a 5-nitroimidazole followed by quinacrine (mepacrine) if failure. Treatment efficacy was defined as negative stool microscopy and/or PCR four to six weeks after treatment. For analyses of assemblage types and risk factors for treatment failure, patients from a previously published Swiss treatment study were additionally included. Assemblage typing of Giardia isolates was performed collectively in the same laboratory by real-time PCR targeting the glutamate dehydrogenase gene (gdh). Predictors identified by univariate analyses were analysed by multivariate logistic regression for association with nitroimidazole failure. A total of 120 patients were prospectively included; 59 of these had nitroimidazole refractory giardiasis and were treated according to the treatment ladder. In addition, 20 patients from the Swiss cohort were included for assemblage and risk factor analyses. A repeated course of nitroimidazole cured only 24% (5/21). Metronidazole or tinidazole in combination with albendazole cured 76% (35/46). Quinacrine was effective in 100% (15/15). Assemblage B was more common in travellers from India and Africa, but only acquisition of infection in India (aOR 11.9; 95%CI 2.94, 47.6) and more recent year of diagnosis (aOR 1.18, 95% CI 1.03, 1.35) were associated with nitroimidazole failure in multivariate analysis. Second line treatment with nitroimidazole in combination with albendazole, and third line treatment with quinacrine, are effective options in nitroimidazole-refractory giardiasis. Nitroimidazole failure seems to be highly associated with infection acquired in India, but not with assemblage A or B. Further studies of resistance mechanisms are needed.
Differences in body composition during childhood can influence long-term health, with notable links to cardiometabolic disorders in later life. While genetic associations with body composition traits are well-studied, less is known about the role of epigenetic mechanisms, particularly in low- and middle-income countries where the burden of cardiometabolic disease is high. We investigated links between DNA methylation and three compartments of body composition: fat mass, lean mass, and bone measures using data from children enrolled in the Epigenetic Mechanisms linking Pre-conceptional nutrition and Health Assessed in India and Sub-Saharan Africa (EMPHASIS) study. We conducted an epigenome-wide association study of 11 body composition traits assessed through dual-energy X-ray absorptiometry in children from India (mean [range] age = 5.8 [5-7] years; n = 686) and The Gambia (age = 9.0 [7-9] years; n = 284), with blood DNA methylation measured at ~ 800,000 CpGs sites on the Illumina EPIC array. Cohort-specific analysis identified 8 unique differentially methylated CpGs associated with traits across all three body composition compartments (p < 3.6 × 10-8), with none overlapping both cohorts. Cross-cohort meta-analysis revealed four CpGs associated with lean mass and bone area mapping to SOCS3 and ZBTB16. Region-level analyses identified 29 differentially methylated regions (DMRs) in India and 18 in The Gambia. 29 DMRs were identified in the meta-analysis, 25 of which were not detected in either cohort individually. Many DMRs were associated with more than one body composition trait. We report novel DNA methylation signatures associated with body composition traits in children from two low- and middle-income countries. Identified loci map to genes linked to inflammatory signalling, energy metabolism and cellular stress response pathways, highlighting a potential role for epigenetic mechanisms in shaping early-life body composition.
Adverse Childhood Experiences (ACEs) have been consistently linked to poor mental health outcomes, yet research on their impact in low- and middle-income countries (LMICs) settings of Africa, remains relatively unexplored. In Kenya, where childhood adversity is widespread, there is a critical need to examine the validity of ACE measures and their associations with mental ill health. This study aimed to validate the Adverse Childhood Experiences questionnaire (ACE-10) in a Kenyan adolescent sample and assess its associations with symptoms of depression and anxiety, bullying, and sociodemographic factors. Data was collected from N = 2,842 adolescents and young adults aged 11 to 25 years attending 42 secondary schools across four counties in Kenya. We conducted Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to assess the factor structure of the ACE questionnaire. Internal consistency was evaluated using Cronbach's alpha. Linear mixed-effects models were used to examine associations between ACEs and sociodemographic factors, bullying, depression (PHQ-8) and anxiety (GAD-7) symptoms. EFA initially yielded a three-factor model, but a two-factor model provided better fit (CFI = 0.962, TLI = 0.948, RMSEA = 0.033, SRMR = 0.028). Higher ACE scores were significantly associated with depressive symptoms (β = 0.05, p < 0.001), anxiety symptoms (β = 0.08, p < 0.001), and bullying (β = 0.06, p < 0.001). Bullying was more strongly associated with ACE scores among males (β = 0.05, p < 0.001). This study provides the first validation of the ACE questionnaire in Kenya and highlights the significant associations between childhood adversity and adolescent mental ill health. Findings underscore the need for trauma-informed interventions and further research into protective factors that may mitigate the effects of ACEs in LMICs. This study was pre-registered under a larger study with the Pan African Clinical Trials Registry, trial number: PACTR202305589854478 in accordance with WHO and ICMJE standards.
Sub-Saharan Africa continues to face significant challenges with low birth weight (LBW). Factors such as antenatal care (ANC) utilization and socioeconomic status play critical roles in birth outcomes. It is therefore imperative to understand these relationships, which are crucial to developing tailored, workable interventions to improve maternal and child health outcomes in Ghana. This study aimed to examine the association between ANC utilization patterns, socioeconomic disparities, and low birth weight outcomes among women in Ghana. The study included 6,965 observations, with 4,056 complete cases. Due to substantial missingness in key variables (LBW, adequate ANC), a monotone missing data pattern consistent with Missing at Random (MAR) was observed. Multiple Imputation by Chained Equations (MICE) was employed using Fully Conditional Specification across 20 imputed datasets. Survey-weighted logistic regression was performed on each imputed dataset, with estimates pooled via Rubin's Rules. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test. The slope index of inequality was calculated to examine socioeconomic disparities. The prevalence of LBW was 10.0% in complete cases and 19.2% in imputed data. Socioeconomic inequality analyses revealed significant pro-rich gradients in ANC utilization. The disparities were more pronounced for optimal ANC (8 + visits; SII: 0.431; RII: 1.538) than adequate ANC (4 + visits; SII: 0.203; RII: 1.224). LBW was disproportionately concentrated among women of lower socioeconomic status (SII: -0.159; RII: 1.172). The adjusted multivariable model showed inadequate ANC (aOR: 1.97; 95% CI: 1.34-2.90), suboptimal ANC (aOR: 1.73; 95% CI: 1.27-2.36), and poor wealth status (aOR: 1.79; 95% CI: 1.18-2.72) were independently associated with higher odds of LBW. ANC visit frequency and household wealth are independently associated with LBW among Ghanaian women. These findings underscore the need for targeted interventions to improve ANC attendance and address socioeconomic disparities to reduce the burden of LBW in Ghana.
Lablab purpureus (hyacinth bean) is a multifaceted legume traditionally integrated into diverse food systems and sustainable agricultural practices, particularly in Asia and Africa. Known for its adaptability to harsh environments, nitrogen-fixing ability, and use as both food and fodder, this crop holds untapped potential for addressing modern nutritional and health challenges. Recent scientific investigations have brought L. purpureus into the spotlight due to its impressive phytochemical profile, which includes phenolics (phenolic acids and flavonoids). These constituents are associated with a wide range of therapeutic properties, such as antioxidant, antimicrobial, anti-inflammatory, antidiabetic, and hepatoprotective activities. Nutritionally, L. purpureus is rich in proteins, essential amino acids, dietary fiber, vitamins, and minerals, making it a valuable candidate for combating malnutrition and enhancing food security, particularly in regions with limited access to diverse food sources. Furthermore, its functional properties suggest promising applications in nutraceutical and pharmaceutical product development. However, despite these attributes, L. purpureus remains largely underutilized and insufficiently represented in mainstream agricultural, food, and biomedical research. This review consolidates and synthesizes current knowledge on the phytochemical composition, nutritional value, and therapeutic potential of L. purpureus, while also identifying critical knowledge gaps and research priorities. By drawing attention to this overlooked legume, the review encourages greater scientific interest and investment in its study and application. As global demand grows for plant-based functional foods and sustainable crop alternatives, L. purpureus presents itself as a viable, eco-friendly, and health-promoting resource worthy of renewed focus and broader utilization across multiple sectors.
Methadone Maintenance Treatment (MMT) is a global evidence-based treatment intervention combining pharmacological and psychological approaches for the management of opioid use disorder. MMT in Sub-Saharan Africa currently faces significant sustainability challenges amid donor funding transitions. This study examined user perceptions of affordability for MMT services in Kenya using an adapted socio-ecological framework to inform sustainable financing models. An explanatory mixed-methods design was employed with 44 MMT participants interviewed at an urban facility in Nairobi, Kenya. Contingent valuation methods assessed user perceptions of affordability through focus group discussions, while quantitative analysis examined socio-demographic correlates. Analysis compared participant affordability based on a threshold identified in the study (USD 3.9) and compared to government costs of treatment per patient per month (USD 32). Framework and thematic analyses were aligned with socio-ecological levels to explore nuances in perceived affordability. Median perceived affordability was USD 0.8 monthly for clinic-based services and USD 2.3 for community-based services. Participant affordability sharply declined at a critical threshold of USD 3.9 with only 2% demonstrating perceived ability to absorb the equivalent of government cost recovery amounts. Transportation burden emerged as the strongest predictor of affordability (p≤0.001), with associations with individual income and prior opioid use disorder showing statistical significance (p≤0.05). Female participants were three times more willing to absorb treatment costs compared to males. Economic constraints, intersectional stigma, and employment discrimination created systematic barriers to participant affordability. The substantial gap between patient perceptions of affordability and service provision costs provides evidence that patient fees alone cannot sustain MMT programs. Transport burden represents the most significant modifiable barrier, while community-based delivery models show promise for enhancing sustainability. Findings support maintaining free or highly subsidized services combined with decentralized delivery approaches for sustainable MMT financing in resource-limited settings.
Childhood experiences of intimate partner violence (CEIPV) remain under-documented from the perspectives of children and youth in Rwanda, and East Africa in general. Most existing research often relies on adult proxies, overlooking the narrative agency and lived experiences of young people (YP). This study explores how Rwandan youth with CEIPV, name, story and historicize their experiences and responses to harm. It examines how storytelling, memory work, and peer witnessing contribute to meaning-making, resistance, and healing. Thirteen Rwandan youth (ages 22-25) participated in a series of storytelling circles over three months. All had experienced CEIPV before age 18 and were recruited through youth peer-support organizations and professional networks. A participatory and collective narrative approach grounded in Ubuntu ontology and extended epistemology was used. Data included participants' firsthand stories, transcripts, reflections, and peer feedback. Collective narrative analysis was applied to co-create a collective narrative document. Nine themes were collectively developed: a lexicon of situational knowledges, sensory comfort, seeking safety amidst chaos, speaking out, learning from adversity, cultural and spiritual strength, envisioning a future free from violence, self-reliance, and the role of supportive others. Across these themes, youth demonstrated relational response-abilities, situational knowledges, and creative expression. Findings highlight the importance of youth-centered narrative approaches in understanding CEIPV beyond harm-focused frameworks. Youth storytelling offers critical insights into how children actively respond to violence and has implications for strengthening child protection, mental health, and psychosocial interventions.
Vaccination remains one of the most effective public health interventions, saving millions of lives worldwide. Despite its success, vaccine-preventable diseases continue to pose significant threats in Nigeria. As the vaccination landscape in Nigeria continues to evolve, pharmacists are emerging as key advocates for expanding immunisation coverage. In the heart of Nigeria's healthcare landscape lies a tapestry of opportunities and challenges, where the intersection of vaccination initiatives, pharmacy education, and regulatory measures shapes the nation's public health narrative. As we delve deeper into the progress achieved, the hurdles faced, and the path forward, a narrative emerges-one of resilience, innovation, and collective action to enhance healthcare outcomes and foster a culture of well-being in Nigeria. Limited access to vaccination education has been identified as a barrier to widespread implementation of pharmacists as community vaccinators in African countries, including Nigeria. There have been numerous interventions to increase vaccination coverage and pharmacy education in Nigeria, but the country still faces numerous and formidable public health challenges. Political and economic barriers must be addressed to empower pharmacists as vaccinators and expand access to vaccinations in Nigeria.
Childhood immunization through the Expanded Programme on Immunization (EPI) remains central to reducing vaccine-preventable disease morbidity and mortality in sub-Saharan Africa. Zimbabwe's national EPI coverage for pentavalent 3 stood at 83% in 2023, below the 90% global target. Nyaure Clinic in Goromonzi District, Mashonaland East Province, recorded coverage of 65%, 62%, and 67% for pentavalent 3 in 2021, 2022, and 2023 respectively. This study investigated factors affecting access to EPI services at Nyaure Clinic and identified strategies to improve coverage. A quantitative cross-sectional survey design was used. The study population comprised 261 caregivers, 10 community health workers (CHWs), and 3 nurses in the Nyaure catchment area. A stratified random sample of 61 participants was selected using the Raosoft sample size calculator at a 90% confidence level. Data were collected in October 2024 using structured, self-administered questionnaires. Descriptive analysis was performed using Microsoft Excel and results are presented in tables and figures. Of 61 respondents, 93.4% were female. Among caregivers (n = 55), 96.4% reported receiving information about EPI, with 70.9% citing health facility workers as the primary source. Vaccines were reported as unavailable 14.5% of the time. Distance was reported as a barrier by 29.1% of caregivers and all 6 health workers. Religious and cultural beliefs, particularly among Apostolic sects, were reported as contributing to vaccine hesitancy. Poverty and political interference were not perceived as barriers. The leading strategies proposed by caregivers were outreach programmes (92.7%), health education (70.9%), and door-to-door vaccination (58.2%). The six health workers also endorsed building more clinics and recruiting more CHWs; support for legislation against vaccine hesitancy was expressed only by this small subgroup. Distance, religious and cultural beliefs, and intermittent vaccine shortages were the barriers most commonly reported by caregivers and health workers at Nyaure Clinic. Intensified outreach programmes, health education, and door-to-door vaccination were the strategies most frequently proposed by respondents. These reported barriers and preferred strategies may inform the work of EPI programme managers and district health teams in rural Zimbabwe, though the descriptive, single-site design means findings should be interpreted with caution.
Posterior urethral valves (PUV) represent the most common cause of lower urinary tract obstruction in male infants and are a leading contributor to chronic kidney disease (CKD) in children. This systematic review and meta-analysis aimed to synthesize and quantify the available evidence regarding the risk of long-term CKD in children with posterior urethral valves and to identify factors associated with adverse renal outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines. PubMed, Embase, Web of Science were searched from inception to January 31, 2026 for observational studies evaluating long-term renal outcomes in pediatric patients with posterior urethral valves. Eligible studies reported CKD outcomes, renal function decline, end-stage kidney disease, or need for renal replacement therapy with corresponding effect estimates or extractable data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute appraisal tools. Nine cohort studies published between 1988 and 2024 met the inclusion criteria, representing pediatric populations from Europe, North America, South America, and Africa. Across studies, children with PUV demonstrated a substantial risk of long-term CKD, with many progressing to renal impairment or end-stage kidney disease during extended follow-up. Meta-analysis of within-study comparisons demonstrated that PUV children with adverse prognostic features (absence of pop-off mechanisms, elevated nadir creatinine, or established renal dysplasia) had a significantly higher risk of CKD compared with PUV children with more favorable prognostic profiles (pooled OR: 1.44, 95% CI: 1.20-1.73). Although effect sizes varied, the overall trend consistently indicated adverse renal outcomes. Studies identified important prognostic factors, including renal dysplasia, elevated nadir creatinine, bladder dysfunction, and delayed diagnosis, while the presence of pop-off mechanisms was frequently associated with improved renal prognosis. Substantial heterogeneity was observed among studies (I² = 89%). Funnel plot assessment suggested no significant publication bias. This systematic review and meta-analysis demonstrates that children with posterior urethral valves remain at significant risk for developing long-term chronic kidney disease despite advances in early diagnosis and management. Future prospective studies are needed to refine prognostic models, standardize outcome reporting, and evaluate strategies aimed at preserving renal function and improving long-term health outcomes.
Unintended pregnancy (UIP) remains a persistent public health concern among young women in sub-Saharan Africa, including Tanzania. This study examined Sexual Health Literacy for Pregnancy Prevention (SHLPP) and engagement in Sexual Behaviours potentially leading to UIP (referred to in this study as Risky Sexual Behaviours [RSB]) among female university students using a Social Ecological Model (SEM). Specifically, it assessed (i) levels of SHLPP and RSB, (ii) differences across individual, interpersonal, and contextual factors, and (iii) the predictive effects of these factors on SHLPP and RSB, including the influence of SHLPP on RSB. A cross-sectional study was conducted involving 255 female university students at Sokoine University of Agriculture, Tanzania. Data were collected using a structured questionnaire and analysed using descriptive statistics, factorial ANOVA, and hierarchical multiple regression. Most participants (75.6%) exhibited low-to-moderate SHLPP, while 63.7% reported moderate-to-high RSB. Upbringing environment significantly influenced both RSB (F(1,165) = 17.817, p < .001, η2 = .097) and SHLPP (F(1,218) = 4.124, p < .05, η2 = .019), with urban students reporting higher levels of both. Year of study showed a small, albeit significant effect on RSB (F(2,165) = 3.246, p < .05, η2 = .038) only. Parental education and accommodation type did not have significant independent effects on SHLPP and RSB. However, they exerted significant interaction effects between: (i) parental education and upbringing environment, and between parental education and accommodation type on RSB and (ii) upbringing environment and accommodation on SHLPP. Parent-daughter communication emerged as the strongest predictor of both SHLPP (β = .318, p < .001) and RSB (β = .402, p < .001). Notably, SHLPP did not significantly predict RSB (β = .088, p = .221), indicating a disconnect between knowledge and behavior. CONCLUSION AND IMPLICATIONS: Sexual behaviour among FUS is more strongly shaped by interpersonal and contextual factors than by individual knowledge alone. These findings underscore universities' need to enhance parent-child communication, deliver targeted sexual health education, and consider student backgrounds when allocating housing.