Attitudes towards animal welfare depend on people's lifestyles and education levels, yet little is known about the attitudes of nomadic people. We distributed a questionnaire and collected 1660 valid responses, representing individuals with or without nomadic connections and varying education levels and genders. We used ordinal logistic regression to analyze the impact of these two factors on perceptions, attitudes, and behavioral intentions related to animal welfare. Women and those with higher education levels tended to hold more positive attitudes toward animal welfare, but for farm animals, this was only extended to common female reproducing animals, such as cows, sheep, goats, and laying hens, but not other farm animals, such as beef cattle and broiler chickens. This may reflect a greater sensitivity towards reproducing animals. The influence of nomadic connections on attitudes towards animal welfare was not linear-respondents with nomadic connections themselves or family members of the same generation generally had more negative attitudes, while those with grandparents with nomadic connections had more positive attitudes on several animal welfare issues. This may reflect a generational change in the attitudes of nomadic people towards animals.
Yellow fever (YF) remains a major public health concern in Ghana, with periodic outbreaks despite ongoing vaccination efforts. Nomadic populations, due to their mobility and remote settlements, are often underserved by vaccination campaigns, posing challenges to achieving herd immunity. The objective of the study was to estimate yellow fever vaccination coverage among nomadic populations in the Savannah Region of Ghana and compare it with the national average, and identify reasons for non-vaccination to inform future outbreak response strategies. a community-based cross-sectional study was conducted among 2,914 individuals from 414 nomadic households across 22 affected communities using a modified WHO vaccination coverage survey. Data were analyzed in Stata version 15. Descriptive statistics and t-tests were used to assess differences in vaccination coverage and associated factors. overall vaccination coverage was 80.3% (SD = 0.24), significantly lower than the national average of 88% (t(413) = -4.00, p < 0.001), though within the WHO-recommended threshold for herd immunity. A significant inverse relationship was observed between household size and vaccination coverage (p < 0.001). Most respondents (93.2%) presented vaccination cards for verification, while 4.8% reported verbally. The main reasons for non-vaccination included absence during campaigns, lack of transportation, and limited information about the campaign. Perceptions of vaccine effectiveness were largely positive (67.5%), though 25.1% expressed doubts about efficacy. yellow fever vaccination coverage among nomadic populations in the Savannah Region, though adequate for herd protection, remains below national targets. Strengthened outreach strategies, tailored health promotion, and targeted catch-up campaigns are essential to sustain high coverage and prevent future outbreaks among mobile and hard-to-reach populations.
The importance of palliative care for Intensive Care Unit (ICU) patients/families is known. Little is known about implementing this care in practice, and how to support healthcare professionals in this implementation. This study uses survey methodology informed by Normalisation Process Theory to assess implementation processes for providing palliative care in the ICU. A descriptive cross-sectional survey was conducted with UK healthcare professionals involved in providing or organising palliative care in the ICU. Implementation processes were assessed using the validated 23-item Normalisation MeAsure Development (NoMAD) instrument. Absolute (n) and relative frequencies, median and interquartile ranges were reported. Mann-Whitney U Test assessed differences between specialist palliative care and ICU respondents. One open-ended item captured free-text responses, analysed using NPT-guided framework analysis. From 153 completed surveys, 69% of respondents were ICU professionals, 31% were specialist palliative care professionals. There was no statistically significant difference between responses from ICU and specialist palliative care professionals. Likert responses showed that respondents felt familiar with palliative care in the ICU and felt it was part of their normal work. Positive tendency was found toward implementation of palliative care in the ICU with coherence (sense-making work), cognitive participation (relational work) and reflexive monitoring (appraisal work). Rating of collective action (operational work) showed a more neutral tendency, highlighting this as a potential target for improvement. Free-text responses were categorised into themes within Normalisation Process Theory constructs: Coherence-recognising and stratifying need, and nuances within palliative care in the ICU; Cognitive participation-interdisciplinary interfaces and building capacity; Collective action-procedures for provision, pressures on provision, and perceived capability; Reflexive monitoring-perceived value. This novel study uses NPT to assess professional processes relating to implementation of palliative care in the ICU. Findings suggest important perceived implementation gaps may lie within operational work such as tailoring utilisation of existing resources, ensuring leadership support, and building skill sets. Dedicated qualitative research is needed to explain how these issues operate in context and to examine potential patient- and family-related influences.
Accurately detecting cancer through gene expression analysis is crucial for early diagnosis and effective treatment. However, gene expression data's high dimensionality and redundancy pose significant challenges, such as overfitting and computational inefficiency. To address these issues, we propose a hybrid feature selection framework that integrates a filter-wrapper approach with swarm intelligence for optimized gene selection. The proposed method utilizes the Nomadic People Optimizer (NPO) in conjunction with Mutual Information (MI) to identify a relevant subset of genes from high-dimensional datasets. An optimized Support Vector Machine (SVM) is employed to further enhance classification accuracy, with its hyperparameters fine-tuned using an enhanced Salp Swarm Algorithm (SSA) incorporating a crossover operator. This hybrid approach not only reduces the search space but also mitigates overfitting by leveraging the exploration and exploitation capabilities of the NPO and SSA. Experimental results on five cancer gene expression datasets-lung adenocarcinoma (LUAD), breast cancer (GSE2034), glioblastoma multiforme (GBM), ovarian cancer (GSE2109), and colorectal adenocarcinoma (COAD)-demonstrate that the proposed NPO-SSVM achieves classification accuracies ranging from 91.25% to 97.02% with AUC-ROC values between 0.85 and 0.97. The framework achieves an average feature reduction of 51% while outperforming state-of-the-art methods (GA, PSO, GWO, SSA) by 3-12% in classification accuracy and 15% in computational efficiency. These findings confirm that NPO-SSVM provides a robust and efficient solution for gene selection in cancer detection, offering significant advancements for personalized medicine and early diagnosis.
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We propose elements of a political economy of One Health for Switzerland. It is derived from more than 25 years of collaborative research and development with an interdisciplinary research team at the interface between human and veterinary medicine and several other sciences in Africa and Asia. It is based on work on mixed vaccination services for nomads and their animals in Chad and the cross-sectoral economic analysis of brucellosis control in Mongolia. This was later supplemented by conceptual work on human- environment systems and a new game-theoretical approach to One Health. We refer to the new definition of One Health by the One Health High Level Expert Panel (OHHLEP), the European Union's advisory body on the implementation (operationalization) of One Health, and new integrated surveillance and response systems for humans, animals, and the environment in Ethiopia. A political economy of One Health emerges inductively from the above-mentioned research and consists of core elements of governance, economic guidelines, and principles of implementation. One Health governance works participatively with consultative processes that involve social actors. It is cross-sectoral and involves human and veterinary medicine, agriculture, the environment, and other areas in finding solutions. A key element is cooperation at all levels of society, from village communities to cantons, the national government, and international bodies. A One Health approach should be economically profitable while preserving natural resources. It should benefit all population groups, animals, and the environment equally. Existing policies can be adapted for implementation and do not necessarily have to be developed from scratch. It is important to clarify the respective responsibilities and then divide up the cooperation accordingly. The political economy of One Health thus has great potential to contribute to solving major pressing problems such as climate change, species loss, increasing antibiotic resistance, and the prevention of pandemics. Wir schlagen Elemente einer politischen Ökonomie von One Health für die Schweiz vor. Sie wird aus der Erfahrung von mehr als 25 Jahren partnerschaftlicher Forschung und Entwicklung mit einem interdisziplinären Forschungsteam an der Schnittstelle zwischen Human- und Tiermedizin und mehreren anderen Wissenschaften in Afrika und Asien abgeleitet. Sie basiert auf Arbeiten über gemischte Impfdienste für Nomaden und ihre Tiere im Tschad und der sektorübergreifenden ökonomischen Analyse der Brucellosebekämpfung in der Mongolei. Später kamen konzeptuelle Arbeiten zu Mensch-Umwelt-Systemen und einem neuen spieltheoretischen Ansatz zu One Health hinzu. Wir nehmen Bezug zur neuen Definition von One Health des One Health High Level Expert Panels (OHHLEP), der Beratung der Europäischen Union zur Umsetzung (Operationalisierung) von One Health, sowie neuer integrierter Überwachungs-Reaktionssysteme für Menschen, Tiere und die Umwelt in Äthiopien. Eine Politische Oekonomie von One Health ergibt sich induktiv aus den oben erwähnten Forschungsarbeiten und setzt sich aus Kernelementen der Regierungsführung (Gouvernanz), ökonomischen Richtlinien und Prinzipien der Umsetzung zusammen. Eine One-Health-Gouvernanz arbeitet partizipativ mit konsultativen Prozessen, welche die gesellschaftlichen Akteure einbeziehen. Sie ist sektorübergreifend und bezieht Human- und Veterinärmedizin, Landwirtschaft, Umwelt und weitere Bereiche in die Lösungsfindung mit ein. Ein zentrales Element ist die Zusammenarbeit auf allen gesellschaftlichen Ebenen von Dorfgemeinschaften zu Kantonen, zu der nationalen Regierung und zu internationalen Gremien. Ein One-Health-Ansatz soll wirtschaftlich gewinnbringend sein und gleichzeitig die natürlichen Ressourcen erhalten. Er soll allen Bevölkerungsgruppen, Tieren und der Umwelt gleichermassen zu Gute kommen. Für die Umsetzung können bestehende Politiken angepasst werden und müssen nicht notwendigerweise von Grund auf neu entwickelt werden. Es ist wichtig, die jeweiligen Zuständigkeiten zu klären und die Zusammenarbeit danach aufzuteilen. Damit hat eine politische Ökonomie von One Health ein grosses Potenzial zur Lösung grosser anstehender Probleme wie dem Klimawandel, dem Artenverlust, den zunehmenden Antibiotikareistenzen und der Prävention von Pandemien beizutragen. Nous proposons des éléments d’une économie politique de «One Health» pour la Suisse. Celle-ci est le fruit de plus de 25 ans de recherches et de développements collaboratifs avec une équipe interdisciplinaire à l’interface entre la médecine humaine et la médecine vétérinaire ainsi que plusieurs autres sciences en Afrique et en Asie. Elle s’appuie sur des travaux consacrés aux services de vaccination mixte pour les nomades et leurs animaux au Tchad et sur l’analyse économique intersectorielle de la lutte contre la brucellose en Mongolie. Ces éléments ont ensuite été complétés par des travaux conceptuels sur les rapports homme-environnement et sur une nouvelle approche de One Health fondée sur la théorie des jeux. Nous nous référons à la nouvelle définition de One Health donnée par le One Health High Level Expert Panel (OHHLEP), l’organe consultatif de l’Union européenne sur la mise en œuvre (opérationnalisation) de One Health, et aux nouveaux systèmes intégrés de surveillance et d’intervention pour les humains, les animaux et l’environnement en Éthiopie. Une économie politique de «One Health» émerge de manière inductive des recherches susmentionnées et comprend des éléments fondamentaux de gouvernance, des lignes directrices économiques et des principes de mise en œuvre. La gouvernance «One Health» fonctionne de manière participative avec des processus consultatifs qui impliquent les acteurs sociaux. Elle est intersectorielle et implique la médecine humaine et vétérinaire, l’agriculture, l’environnement et d’autres domaines dans la recherche de solutions. Un élément clé est la coopération à tous les niveaux de la société, des communautés villageoises aux cantons, jusqu’au gouvernement national et aux organismes internationaux. Une approche «One Health» doit être économiquement rentable tout en préservant les ressources naturelles. Elle doit profiter de manière égale à tous les groupes de population, aux animaux et à l’environnement. Les politiques existantes peuvent être adaptées pour être mises en œuvre et ne doivent pas nécessairement être élaborées à partir de zéro. Il est important de clarifier les responsabilités respectives puis de répartir la coopération en conséquence. L’économie politique de «One Health» a donc un grand potentiel pour contribuer à la résolution de problèmes urgents majeurs tels que le changement climatique, la disparition d’espèces, l’augmentation de la résistance aux antibiotiques et la prévention des pandémies. In questo lavoro definiamo i principali elementi di un’economia politica di One Health applicata alla Svizzera. La nostra proposta si basa su oltre 25 anni di esperienza in progetti di ricerca e sviluppo condotti in stretta collaborazione con un team interdisciplinare, attivo tra medicina umana, medicina veterinaria e altre discipline scientifiche in Africa e Asia. Le basi empiriche includono, tra l’altro, esperienze di servizi vaccinali integrati rivolti a popolazioni nomadi e ai loro animali in Chad, nonché un’analisi economica inter- settoriale dei programmi di controllo della brucellosi in Mongolia. A queste si aggiungono contributi teorici sui sistemi uomo-ambiente e l’elaborazione di un approccio innovativo ispirato alla teoria dei giochi applicato a One Health. Il lavoro si inserisce nel dibattito internazionale, richiamando la recente definizione di One Health formulata dall’One Health High Level Expert Panel (OHHLEP), le raccomandazioni dell’Unione Europea per la sua attuazione operativa e le esperienze di sistemi integrati di sorveglianza e risposta per la salute umana, animale e ambientale sviluppati, ad esempio, in Etiopia. L’economia politica di One Health qui delineata emerge in modo progressivo dall’analisi di queste esperienze e si fonda su tre pilastri principali: una governance inclusiva, principi economici e linee guida chiare per l’attuazione. La governance deve essere partecipativa e basata su processi consultivi che coinvolgano i diversi attori della società. L’approccio è per definizione intersettoriale e integra medicina umana e veterinaria, agricoltura, ambiente e altri ambiti rilevanti nella definizione delle soluzioni. L’elemento centrale è la cooperazione tra tutti i diversi livelli sociali: dalle comunità locali ai cantoni, fino al governo federale e agli organismi internazionali. Un’autentica strategia One Health deve essere economicamente sostenibile, contribuire alla tutela delle risorse naturali e garantire benefici equi per le persone, gli animali e l’ambiente. Dal punto di vista operativo, non è sempre necessario creare nuove politiche da zero: spesso è possibile adattare e coordinare strumenti già esistenti. Fondamentale è chiarire ruoli e responsabilità e strutturare la collaborazione in modo coerente. In questa prospettiva, un’economia politica di One Health rappresenta uno strumento promettente per affrontare grandi sfide contemporanee, quali il cambiamento climatico, la perdita di biodiversità, l’aumento delle resistenze antimicrobiche e la prevenzione di future pandemie.
Access to adequate sanitation remains a critical public health challenge in Somalia, where a large portion of the population relies on unimproved facilities due to persistent conflict, climate shocks, and political instability. This reliance contributes to a high burden of waterborne diseases. This study aimed to assess the spatial distribution of unimproved sanitation and identify its individual and community-level determinants using recent national data to inform targeted interventions. This study is a secondary analysis of the 2022 Somalia Integrated Household Budget Survey (SIHBS), which included 7,212 households. The primary outcome was the use of unimproved sanitation facilities, categorized according to the WHO/UNICEF Joint Monitoring Programme (JMP) definitions. We employed a multilevel logistic regression model to identify individual and community-level determinants associated with unimproved sanitation. To analyze the spatial patterns of unimproved sanitation, we used Global Moran's I for spatial autocorrelation and the Getis-Ord Gi* statistic for hotspot analysis. Overall, 36.87% of Somali households use unimproved sanitation facilities. There are significant disparities across residence types, with the highest prevalence among nomadic populations (83.28%), followed by rural (51.10%) and urban (23.88%) residents. The multilevel analysis revealed that households in permanent/formal housing (AOR: 3.42) and those with IDP status (AOR: 3.18) had significantly higher odds of using unimproved sanitation. At the community level, urban residence was paradoxically associated with higher odds of unimproved sanitation (AOR: 7.99) compared to rural areas, while nomadic populations had significantly lower odds (AOR: 0.04), likely reflecting a high prevalence of open defecation not captured as a "facility." Spatial analysis identified significant hotspots of unimproved sanitation in the Hiraan (90.65%) and Bay (80.39%) regions, and cold spots in Banadir (5.37%) and Lower Shabelle (3.70%). The findings highlight deep inequalities in sanitation access across Somalia, driven by geographic location, socioeconomic status, and population group. The high prevalence of unimproved sanitation, especially among nomadic, rural, and displaced populations, calls for urgent, geographically-targeted interventions. A multi-pronged approach is necessary, focusing on the specific needs of different communities and addressing the underlying structural and individual-level drivers of poor sanitation to advance public health and sustainable development goals in the region.
Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M). To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template. Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis. Primary care (general practices) in three English regions. Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).Qualitative: Staff at implementation practices. A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training. Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices. Measures of reach, fidelity, acceptability and sustainability. Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual. In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation. Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training. https://doi.org/10.1186/ISRCTN40295449 (2022-08-03, retrospectively registered.).
Brucellosis remains a major zoonotic threat in Iran, where sheep and goat farming play a crucial role in agricultural production. This study examines the relationship between vaccination coverage and brucellosis prevalence at animal and herd levels across Iran's diverse small ruminant production systems. Our cross-sectional study (2021-2024) included 389,225 animals from 3929 herds across rural, traditional, and nomadic systems. Tests such as the Rose Bengal Plate, Wright, and 2-mercaptoethanol (2-ME) detected brucellosis, and bacteria from clinical samples were isolated. Multivariable mixed-effects logistic regression was used to analyze factors such as vaccination coverage, production system, species, and brucellosis positivity. Results showed low vaccination coverage across all systems (8-19.1%), well below the threshold for herd immunity. Traditional farms had 3.4 times higher odds of animal- level brucellosis (95% CI: 2. 98-3. 93, p < 0. 001) and 2.9 times higher odds of herd- level positivity (95% CI: 2. 21-3. 78, p < 0. 001) compared to rural areas, while nomadic systems exhibited scattered, episodic foci. A 1% increase in vaccination coverage was associated with an odds ratio of 0.94 for herd-level brucellosis positivity (p = 0.02) and an OR of 0.96 for animal-level brucellosis positivity (p = 0.06), indicating a non-significant tendency. Goats had higher vaccination coverage than sheep. Most positive cultures originated from aborted fetuses, which were the main source of Brucella melitensis biovar 1. This study indicates that vaccination coverage in Iran is inadequate to control brucellosis, especially on traditional farms where vaccination's protective effects are most noticeable.
Couple-based collaborative management (CCMM) has shown promise in supporting chronic disease self-management among older adults and addressing the growing public health burden, but its integration into primary care remains uncertain. This study explored primary care providers' (PCPs) perceptions of CCMM using normalization process theory (NPT) to identify key factors influencing its routine implementation. Thirty five PCPs involved in a community-based randomized controlled trial completed the Normalization Measure Development (NoMAD) questionnaire. Descriptive statistics and Cronbach's alpha were used to assess quantitative data. Semi-structured interviews were conducted with five purposively selected PCPs and were analyzed thematically according to NPT constructs. PCPs reported high familiarity with CCMM (mean = 8.03, SD = 1.36) and positive views regarding its potential integration into practice. Mean scores for the four NPT constructs ranged from 1.76 to 2.47, and internal consistency of the NoMAD was strong (Cronbach's alpha = 0.94). PCPs recognized CCMM as distinct from usual practice and valued its relevance (coherence), which encouraged engagement (cognitive participation). However, barriers included heavy workloads, staff shortages, limited confidence in some clinical tasks, challenges in sustaining continuity, and concerns about patient adherence and couple relationships. These factors hindered collective action and reflexive monitoring. PCPs understood and supported CCMM conceptually and expressed willingness to adopt it, yet structural and organizational barriers limited its practical implementation. Implementing CCMM in primary care could improve chronic disease management and promote healthy aging. Addressing workload pressures, enhancing provider training, and ensuring continuity will be essential to normalize CCMM in primary care.
The Kura-Araxes Culture (3500-2500 BCE) is often depicted as a homogeneous pastoralist horizon, yet its internal economic and mobility strategies remain poorly understood. This study for the first time introduces an integrative framework for reconstructing site-specific pastoral practices through a detailed case study of Maxta I (Nakhchivan). It represents the first study in the Kura-Araxes context and more broadly in the Caucasus to combine zooarchaeology, Zooarchaeology by Mass Spectrometry (ZooMS), stable isotope analysis, and settlement data. This multi-method approach offers a comprehensive view of livestock management, seasonal movement, and socio-economic organisation. The results reveal a seasonally flexible agro-pastoral system that blends permanent settlement features with structured herd mobility, birthing seasons, and possible targeted secondary product exploitation strategies for fleece. Rather than adhering to a binary model of nomadic versus sedentary lifeways, Maxta I demonstrates how Kura-Araxes communities dynamically adapted to diverse ecological and social landscapes. This research challenges assumptions of cultural uniformity and establishes a new comparative model for understanding the diversity of pastoral strategies across Southwest Asia.
Intimate partner violence is a major public health issue, affecting around 10% of women each year in France. Its consequences extend beyond the psychological sphere, directly influencing the control of chronic diseases and the occurrence of psychosomatic disorders frequently encountered in internal medicine. Prolonged exposure to stress and partner coercion perpetuates a vicious cycle between chronic illnesses, diffuse pain, unexplained fatigue, and somatic decompensations. Internists, given the comprehensive nature of their practice and the regular follow-up of vulnerable patients, are often confronted with the challenge of identifying such situations. Screening relies on attentive history-taking, observation of suggestive signs (social isolation, anxiety, medical nomadism), and the use of validated tools such as the WAST or the Violentomètre. Management should be multidisciplinary, integrating psychological, social, and legal support, through referral to specialized structures such as Maisons des Femmes, and through the training of healthcare professionals to improve detection and help break the cycle of violence.
Nigeria bears the highest burden of zero-dose and under-immunized children. This paper characterizes archetypes of zero-dose and under-immunized children in Nigeria through a stakeholder-engaged process, to inform policy and programmatic responses toward reaching the unreached. A qualitative approach was used, comprising a rapid literature review and a qualitative survey over a two-day multi-sector stakeholder co-creation workshop. The workshop involved immunization stakeholders from a variety of sectors. Participants worked in near-homogenous groups to explore four archetypes of exclusion identified from literature, guided by a structured template. Narrative synthesis of group reports was performed and problem definitions for each archetype were discussed and validated in plenary. Each archetype of zero-dose and under-immunized children were linked to broader determinants of health including poverty, education, geography and displacement. Children residing in hard-to-reach rural areas faced significant logistical barriers, difficult terrain and inadequate transportation options including long travel distances to reach health facilities. Urban poor children, while geographically closer to health centres, often encounter affordability issues, misinformation, and competing livelihood priorities of caregivers that hinder immunization uptake. For the conflict-affected, nomadic, and migrant children, frequent displacement, insecurity, and lack of stable healthcare access were reported as primary barriers. Culturally excluded children experience hesitancy due to religious or traditional beliefs, social stigma, and distrust of caregivers in modern medicine. There are hidden dimensions of immunization inequity that should be fully explored in solving the problem of zero dose and non-vaccination. Addressing underlying causes of non-vaccination requires strengthened collaboration across sectors.
Malaria poses a major threat to pregnant women in Ghana, especially among marginalized nomadic Fulani communities. This study examined factors influencing insecticide-treated net (ITN) ownership and use among Fulani pregnant women in northern Ghana. A cross-sectional survey was carried out between April and June 2022 among Fulani pregnant women in the West Gonja Municipality. Recruitment combined a limited community census with peer-assisted snowball sampling to capture this mobile population. Data were collected through structured, face-to-face interviews in local languages after obtaining informed consent. Multivariable binary logistic regression was applied to identify factors associated with ITN ownership and, among owners, predictors of utilization. Statistical significance was set at p ≤ 0.05. Of 159 participants, 54.7% (n = 87) reported owning an ITN. Among owners, usage was 52.9% (n = 46/87). Predictors of ITN ownership included awareness that ITNs prevent malaria ([adjusted odds ratio, AOR] = 3.45, 95% [confidence interval, CI]: 1.33-8.94), prior counseling on ITN use (AOR = 4.52, 95% CI: 1.53-13.34), and lower wealth status (AOR = 0.21, 95% CI: 0.09-0.49). Utilization was linked to knowledge of malaria symptoms (AOR = 0.18, 95% CI: 0.05-0.64), having more than three children (AOR = 0.02, 95% CI: 0.002-0.12), and owning multiple ITNs (AOR = 0.07, 95% CI: 0.02-0.28). ITN ownership and use among Fulani pregnant women were far below national and global targets. Possession did not translate into consistent use. Strengthened health education and tailored, mobile-responsive distribution strategies are essential to improve malaria prevention in this underserved population.
Saxony was ruled by two cousins in 1544: John Frederick I (Elector of Saxony) and his cousin Maurice (Duke of Saxony). Both rulers' names appear on each side of the quarter thalers produced in this year. They were enemies involved in religious wars, although they were both Protestants. Two types of quarter thalers from 1544 occur: a pierced random find from Transylvania (Romania) with four shields on the reverse, heavily worn, and another one with three shields on the obverse side, found in the Głogów Hoard (Poland), which is well preserved. Why did they issue two types in the same year? Was it a matter of silver title or other historical factors? Nondestructive investigation methods were used: XRD revealed the phases within the alloy and patina layer; SEM-EDS revealed the morphological aspects and their elemental compositions, which were correlated with XRF results. The results show that both coins have closer silver amounts, from 91 to 96 wt.%. The EDS results were in good agreement with the XRF results. Lead traces indicated a difference between them: the four-shielded coin is lead-free, while the three-shielded coin has a moderate amount of lead, about 0.5 wt.%. The archeological data evidence that the four-shielded coin issued in 1544 is rarer than the three-shielded one because it was issued during specific historical conditions. Black patina is formed by a mixture rich in copper oxides mixed with silver oxides and Ag2S. The presence of silver sulfide in the patina layer confirms that the pierced coin was in prolonged contact with the skin surface. Also, the finest traces of minerals embedded in the patina layer (e.g., quartz, kaolinite, and calcite) suggest that they were embedded in the patina via prolonged exposure to particulate matter. The mineral inclusions in the patina would have been more numerous if they were formed underground. Thus, the pierced four-shielded coin was probably worn as jewelry by nomads, while the three-shielded coin was most likely treasured in a well-preserved hoard.
Optimal maternal infant and young child nutrition is a cornerstone of child survival and development. Kenya adapted the Baby Friendly Hospital Initiative (BFHI), to strengthen maternal, infant, and young child nutrition through community level interventions, multisectoral engagement, and integration within the Community Health Strategy and Primary Health Care. Despite strong policy support, scale-up and sustainability remain uneven. This study examined enablers, barriers, and gaps influencing the implementation of Baby Friendly Community Initiative (BFCI) in Kenya. A qualitative, cross-sectional study was conducted between February 3 and 21, 2025, as part of a larger study of Baby Friendly Community Initiative. Forty-one key informant interviews and 37 focus group discussions were conducted with policymakers, development and implementing partners, county and sub-county health teams, community health actors, and beneficiaries. Nine counties were purposively selected to capture diverse geographic and health system contexts. Qualitative data was analyzed thematically using predefined matrices. Baby Friendly Community Initiative implementation was supported by policy integration and a strong community health strategy platform. Enablers included availability of guiding documents and integration into strategic frameworks, enhanced capacity through donor supported training, and community structures such as mother to mother and community mother support groups. However, barriers included inadequate domestic funding, delayed stipends for community health promoters, limited multisectoral integration, and a cumbersome manual reporting system. Context specific challenges, including food insecurity, gender dynamics, nomadic lifestyles, and geographic inaccessibility in arid and semi-arid lands, further constrained program reach and sustainability. BFCI has achieved policy alignment and community acceptance but faces systemic and contextual barriers that threaten long term sustainability and impact. Strengthened domestic financing, integration of digital reporting systems, simplified training, and enhanced multisectoral approaches to address food insecurity and gender inequities are essential for scaling and sustaining the initiative.
Somalia has one of the lowest childhood immunization coverage rates globally, with only 34.8% of children aged 0-59 months having received at least one vaccine and a high burden of zero-dose children. Immunization uptake is influenced by socioeconomic, maternal, healthcare access, and geographic factors. This study examined determinants of childhood immunization coverage in Somalia to inform equity-focused strategies. A cross-sectional analysis was conducted using nationally representative data from the 2020 Somalia Demographic and Health Survey (SDHS), including 7,373 mother-child pairs. bivariate and multivariable logistic regression models assessed associations between sociodemographic, economic, maternal, healthcare access, and geographic characteristics and child vaccination status, accounting for survey design and confounders. Overall vaccination coverage was 34.8%. Health facility delivery was the strongest independent predictor (AOR = 1.93; 95% CI:1.68-2.22; p < 0.001). Children from the highest household wealth quintile had higher odds than the poorest (AOR = 2.45; 95% CI:2.00-3.00; p < 0.001). Maternal primary and secondary education were positively associated with vaccination (AOR = 1.58; 95% CI:1.34-1.87 and AOR = 1.94; 95% CI:1.40-2.67; respectively; p < 0.001). Nomadic residence was associated with higher odds compared with rural residence (AOR = 1.69; 95% CI:1.46-1.96; p < 0.001). Compared with infants aged 0-11 months, children aged 12-23 months (AOR = 1.36; 95% CI:1.10-1.69; p = 0.005) and 24-59 months (AOR = 1.33; 95% CI:1.12-1.59; p = 0.001) were more likely to be vaccinated. Lack of radio exposure was associated with lower vaccination odds (AOR = 0.64; 95% CI:0.50-0.82; p < 0.001). Children living in Gedo region had markedly lower odds of vaccination than those in Awdal region (AOR = 0.26; 95% CI:0.17-0.39; p < 0.001). Childhood immunization coverage in Somalia remains critically low, reflecting socioeconomic, maternal, healthcare access, and geographic inequalities that require strategies targeting disadvantaged populations and regions.
The transition from foraging to farming occurred throughout the Neolithic was characterized by an increase in oral pathologies, such as caries and antemortem tooth loss, due to the consumption of softened foods rich in starch and sugars. The introduction of agricultural foods led to a disequilibrium in the masticatory apparatus, which is ultimately reflected in their dental wear. Here we analyze the molar macrowear patterns of the Warlpiri people (N = 33) from Yuendumu (Central Australia), a contemporary population that was at an early stage of transition from a nomadic and hunter-gatherer existence to a more westernized lifestyle. We employ the occlusal fingerprint analysis with the aim of tracking dental functional aspects associated with diet and cultural changes. The results show that the Warlpiri macrowear pattern was more similar to hunter-gatherers with a mixed diet, reflecting thus the consumption of hard (forager) and soft (westernized) foods. Moreover, we found a more oblique wear in the Warlpiri people if compared to those of recent hunter-gatherers. We also observed a high prevalence of tooth chipping, which is likely related to mastication of gritty and hard foods, and to a wide variety of non-masticatory uses. The analysis of the molar macrowear patterns indicate little changes in the masticatory system of the Warlpiri people, typical of a forager population. However, we do observe variations in tooth wear, which are probably caused by the introduction of softer foods in their daily diet, which is especially evident in younger individuals.
Female genital mutilation is a major public health and human rights concern, with the highest burden reported in countries of the Horn of Africa. Despite long-standing legal bans and prevention efforts, the practice remains nearly universal in Somaliland, driven by deeply rooted social and cultural norms. Evidence on the prevalence, types, and population-level determinants of female genital mutilation in Somaliland remains limited. This study assessed the prevalence, types, and associated factors of female genital mutilation among women of reproductive age in Somaliland. This population-based study analyzed data from 5,143 women aged 15-49 years who participated in the 2020 Somaliland Demographic and Health Survey. A two-stage cluster sampling design was used, involving the selection of enumeration areas followed by households. Descriptive analyses were conducted to estimate prevalence and types of female genital mutilation. Binary logistic regression was used to identify factors associated with the pharaonic type of female genital mutilation in comparison with other types. The overall prevalence of female genital mutilation was 99.49% (95% confidence interval: 99.30-99.70). The most common form was type three (pharaonic), affecting 66.97% of women, followed by type one (sunni) at 22.01% and type two (intermediate) at 9.50%. Women from nomadic communities, those with no formal education, those in lower wealth households, women who had never used the internet, and those circumcised by traditional practitioners had significantly higher odds of experiencing the pharaonic form of female genital mutilation. Female genital mutilation remains nearly universal among women of reproductive age in Somaliland, with severe forms predominating. Social disadvantage, limited access to education and information, and reliance on traditional circumcisers are key population-level drivers of harmful practices. Interventions that expand educational and digital access and engage traditional practitioners may be critical to reducing the persistence and severity of female genital mutilation in Somaliland.
To describe the epidemiology, ecological determinants and public-health response to a yellow-fever (YF) outbreak in Wa East District (WED), Ghana, and to identify operational gaps to strengthen surveillance and immunisation in high-risk rural settings. A cross-sectional descriptive outbreak investigation integrating epidemiological, entomological, vaccination-coverage and community knowledge assessments, conducted under Ghana's Integrated Disease Surveillance and Response framework. WED, located in the Upper West Region of Ghana, is an agrarian, forest-fringe area bordering the Mole National Park, characterised by limited access to health services and seasonal nomadic movements. All suspected YF cases (N=57) reported between epidemiological weeks 41-46 of 2021; 50 community respondents interviewed for knowledge and awareness and 52 households inspected for entomological indices. Demographic and clinical characteristics of cases, spatial-temporal distribution, vaccination coverage, Aedes vector indices, community knowledge and awareness levels and response interventions. A total of 57 suspected cases (33 males 24 females) were identified, of which 12 (21.1%) were laboratory-confirmed. The case-fatality ratio among confirmed cases was 33.3% (95% CI 9.7% to 65.1%). Most cases occurred in individuals aged 6-30 years and were clustered in the Ducie community. The epidemic curve, based on confirmed cases, showed a single focal wave between epidemiological weeks 41 and 46 of 2021, peaking in week 45 and declining thereafter following intensified outbreak response activities, particularly surveillance and risk communication. Routine YF vaccination coverage was 25% before the outbreak, increasing to 95% after the mass campaign. The district's composite risk score was 83%, indicating very high transmission risk. Entomological indices (House Index=48.5%, CI=36.1%, Breteau Index=159.6) exceeded WHO thresholds, confirming intense Aedes proliferation. Community awareness was low, with only 22% recognising the viral cause, 16% identifying mosquitoes as vectors and 10% knowing that vaccination prevents YF. The outbreak reflected the convergence of ecological vulnerability, low baseline immunity and poor community awareness. Sustained high routine immunisation, structured Aedes surveillance and continuous risk communication are essential to prevent recurrence and advance Ghana's commitment to the WHO Eliminate Yellow Fever Epidemics strategy.