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by Bwambale Jonani, Emmanuel Charles Kasule, Bwire Roman Herman, Joel Fredrick Arturo, Mwesigwa Calvin Mugambwa, Ssebulime Stephen, John Bosco Mundaka, Richard Kwizera, Gerald Mboowa, Felix Bongomin
IntroductionSickle Cell Anemia (SCA) is a significant genetic disorder in Africa; however, comprehensive data on its prevalence and geographic distribution remain limited. We aimed to estimate the pooled prevalence of SCA (HbSS) in African populations and examine regional, demographic, and temporal variations from 1994–2024.
MethodsWe systematically searched PubMed, Scopus, Google Scholar, and BASE databases for studies reporting SCA prevalence in African populations. Screening and quality assessments were performed using JBI tools. A random-effects meta-analysis with logit transformation was performed, with subgroup analyses by region, age, sex, and study design. Meta-regression explored heterogeneity sources, including geographic region, age category, diagnostic method, study design, and publication year.
ResultsFrom 115 studies with 1,203,839 participants and 17,458 confirmed HbSS cases, the pooled prevalence was 1.43% (95% CI: 1.08%–1.88%), with substantial heterogeneity (I2 = 99.1%) and a prediction interval of 0.21%–8.91%. Central Africa showed the highest prevalence (1.99%), and Southern Africa showed the lowest (0.59%). Children exhibited a higher prevalence (1.65%) than adults (0.45%), while sex differences were non-significant (males 2.71%, females 1.74%; p = 0.694). The prevalence has remained stable over three decades despite a six-fold increase in research output, although wide prediction intervals indicated substantial between-study variability. Electrophoretic techniques predominated (86.4% of cases). Diagnostic method (χ² = 16.73, p = 0.033) and age category (χ² = 33.66, p 2 = 98.6%). Leave-one-out sensitivity analysis showed that no single study significantly impacted the pooled estimates.
ConclusionSCA represents a substantial and geographically variable public health challenge across Africa. These findings highlight the need for region-specific interventions, expanded newborn screening programs, improved diagnostic accessibility with quality assurance for point-of-care technologies, and continued surveillance to address geographic gaps.
by Emmanuel O. Adewuyi, Asa Auta, Olumuyiwa Omonaiye, Mary I. Adewuyi, Victory Olutuase, Kazeem Adefemi, Olumide A. Odeyemi, Yun Zhao, Gizachew A. Tessema, Gavin Pereira
IntroductionNigeria currently has the highest maternal mortality ratio and one of the highest neonatal mortality rates worldwide. Home birth—childbirth outside health facilities, often without skilled attendance or timely access to emergency obstetric care—may contribute to these disproportionate and avoidable adverse maternal and neonatal outcomes. National estimates often mask substantial sub-national disparities. This study examines the prevalence of home birth and associated factors across national, rural, and urban settings in Nigeria.
MethodsWe analysed data from the nationally representative cross-sectional Nigeria Demographic and Health Survey 2018, guided by Andersen’s Behavioural Model. Multivariable logistic regression was used to examine the associations between home birth and various predictor variables at the national level, as well as separately for rural and urban areas in Nigeria.
ResultsNationally, 58.1% (95% CI: 56.5, 59.7) of mothers gave birth at home, with prevalence twice as high in rural areas (72.4%, 95% CI: 70.7, 74.0) compared to urban areas (36.1%, 95% CI: 33.6, 38.7) (p Conclusion
Home birth remains highly prevalent in Nigeria, particularly in rural settings and in the northern and South-South regions, where prevalence is disproportionately high. Reducing home births requires a comprehensive approach that addresses the interplay of factors identified in this study. From a social justice and health determinants perspective, these factors are interconnected and can influence both access to and use of services. In rural areas, policies should enhance women’s decision-making autonomy, reduce distance barriers, and address region-specific challenges (e.g., insecurity in northern regions). In urban areas, it is essential to address financial barriers, support young mothers, and provide culturally and religiously sensitive care. Nationally, efforts should focus on improving education, expanding and strengthening antenatal care, and increasing access to media and the internet. From an equity perspective, interventions must be tailored to specific contexts to reduce unsafe home births and ensure that all mothers, regardless of location, have equitable access to skilled, respectful, and high-quality childbirth care.
by Emmanuel Timmy Donkoh, Iddrisu Wahab Abdul, Abraham Kwadzo Ahiakpa, Isaac Williams, Rita Nyaaba Akologo, Stephen Danyo, Chrysantus Kubio, Kofi Effah, Joseph Emmanuel Amuah
BackgroundCervical cancer, though preventable, remains the second most diagnosed cancer and the primary cause of cancer-related deaths among females in Sub-Saharan Africa. The significance of coordinated screening programmes for reducing the burden of cervical cancer in Africa is not well documented. This systematic review will summarize published reports from key databases, grey literature and programme reports to assess the performance of cervical cancer prevention programmes in Ghana.
MethodsTo be eligible for inclusion, interventions must target Ghanaian women with cervical cancer screening and prevention strategies using methods such as visual inspection with acetic acid (VIA), mobile colposcopy, HPV DNA testing, cytology (Pap smear), and treatment approaches such as cryotherapy, thermal ablation, loop electrosurgical excision procedure (LEEP). A comprehensive electronic search strategy will be used to identify studies published since database inception, and indexed in MEDLINE, EMBASE, CINAHL and Web of Science. The search strategy will include MeSH terms (and synonyms) relevant to cervical cancer, screening/treatment methods, geographic focus and implementing institution. We will include searches for grey literature, recognizing the value of programmatic and governmental reports that might not appear in traditional databases. Search results will be summarized in line with PRISMA guidelines. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to evaluate and document evidence certainty for all outcomes, internal validity of included reports, inconsistency, indirectness, imprecision, and publication bias. Where sufficient homogeneity exists among included studies in terms of interventions, study designs, populations, and outcome measures, we will perform a meta-analysis to calculate pooled effect estimates and their corresponding 95% confidence intervals.
SignificanceThis systematic review will assess the performance and impact of cervical cancer screening and prevention programmes conducted in Ghana to date and identify what contextual strategies have delivered the most impact as well as highlight what gaps remain in our understanding of how a nationwide screening programme can be properly construed for maximum impact.
by Emmanuel Kumah, Dorothy Serwaa Boakye, Eunice Agyei, Richard Boateng, Veronica Penaman Asamoah, Emmanuel Osei Tutu
IntroductionSince its emergence, HIV/AIDS has remained one of the most significant global health challenges, with key populations—such as sex workers, men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and individuals in prisons or other closed settings—disproportionately bearing the burden of the epidemic. These groups, often at heightened risk due to social, legal, and structural vulnerabilities, face persistent barriers to accessing prevention, treatment, and care services. Despite progress in reducing new infections and improving treatment outcomes, these disparities, exacerbated by stigma, structural inequalities, and insufficient political commitment, continue to limit the effectiveness of global HIV responses.
AimThis scoping review protocol aims to systematically map the range of HIV prevention, treatment, and care interventions and strategies targeting key populations worldwide. Rather than formally evaluating effectiveness, the review will describe the nature, extent, and types of interventions implemented, identify barriers to implementation, and highlight gaps in research and practice.
MethodsFollowing the Joanna Briggs Institute (JBI) guidelines for scoping reviews, the study will systematically identify and analyze evidence from multiple databases, including PubMed, Embase, CINAHL, Scopus, and PsycINFO, alongside regional and grey literature sources. The review will include studies focusing on key populations and evidence-based interventions, such as prevention tools, treatment strategies, and policy or structural interventions. Data will be extracted and synthesized using quantitative and qualitative approaches, with results presented through descriptive statistics and thematic analysis. Findings will inform the development of a comprehensive, evidence-based framework tailored to the unique needs of key populations.
ConclusionBy mapping available interventions and strategies for HIV prevention, treatment, and care among key populations, this review will provide a comprehensive overview of existing approaches, barriers, and gaps. The findings will inform future research, policy, and practice, supporting more targeted, inclusive, and sustainable HIV responses that contribute to global efforts to end AIDS as a public health threat by 2030.
by Claude Emmanuel Koutouan, Marie Louisa Ramaroson, Angelina El Ghaziri, Laurent Ogé, Abdelhamid Kebieche, Raymonde Baltenweck, Patricia Claudel, Philippe Hugueney, Anita Suel, Sébastien Huet, Linda Voisine, Mathilde Briard, Jean Jacques Helesbeux, Latifa Hamama, Valérie Le Clerc, Emmanuel Geoffriau
Resistance of carrot to Alternaria leaf blight (ALB) caused by Alternaria dauci is a complex and quantitative trait. Numerous QTL for resistance (rQTLs) to ALB have been identified but the underlying mechanisms remain largely unknown. Some rQTLs have been recently proposed to be linked to the flavonoid content of carrot leaves. In this study, we performed a metabolic QTL analysis and shed light on the potential mechanisms underlying the most significant rQTL, located on carrot chromosome 6 and accounting for a large proportion of the resistance variation. The flavonoids apigenin 7-O-rutinoside, chrysoeriol 7-O-rutinoside and luteolin 7-O-rutinoside were identified as strongly correlated with resistance. The combination of genetic, metabolomic and transcriptomic approaches led to the identification of a gene encoding a bHLH162-like transcription factor, which may be responsible for the accumulation of these rutinosylated flavonoids. Transgenic expression of this bHLH transcription factor led to an over-accumulation of flavonoids in carrot calli, together with significant increase in the antifungal properties of the corresponding calli extracts. Altogether, the bHLH162-like transcription factor identified in this work is a strong candidate for explaining the flavonoid-based resistance to ALB in carrot.The healthcare landscape in South Africa is challenging with a complex patient population and a stressed healthcare system. Negative pressure therapy-based systems such as negative pressure wound therapy with instillation and dwell (NPWTi-d) and closed incision negative pressure therapy (ciNPT) can help manage wounds or incisions. However, guidelines for South Africa-specific use are limited. An in-person meeting was held with 10 experts to develop South Africa-specific therapy use recommendations for NPWTi-d and ciNPT. Panel members recommended NPWTi-d use for wounds in need of cleansing. Normal saline and a 10-min dwell time were recommended with the caveat that the instillation solutions and dwell times can be changed based on the wound bed condition and the features of the instillation solution. A negative pressure cycle of 2–3 h and a negative pressure of −125 mmHg were also recommended for NPWTi-d. In patients, incisions, and surgical procedures at high risk of developing surgical site complications, ciNPT use was recommended. These general recommendations serve as a framework for NPWTi-d and/or ciNPT use in South Africa and should be updated as more region-specific evidence becomes available.
by Claire Teillet, Héloïse Pottier, Rodolphe Devillers, Alexandre Defossez, Thibault Catry, Alexandre Kerr, Frederic Jean, Gregory L’Ambert, Nicolas LeDoeuff, Emmanuel Roux
The global spread of Aedes albopictus raises growing public health concerns due to its role in transmitting dengue, chikungunya, and Zika. In southern France, the increase in imported dengue cases and local transmission underlines the urgent need for effective vector control. While efforts primarily target private breeding sites, public spaces also contribute notably to larvae presence. Understanding the impact of urban landscapes on the distribution of breeding sites is crucial for optimizing vector control strategies, identifying high-risk areas, and reducing mosquito populations. This study aims to investigate how urban landscapes impact the distribution of Ae. albopictus larvae in public spaces, with a focus on storm drains and telecom cable chambers in Montpellier, France. Very high-resolution satellite imagery was used to characterize urban landscapes through textural analyses of spectral indices. Environmental bias was assessed by analyzing the representativity of sampled breeding sites within the diverse urban landscapes. Species distribution models (SDMs) were built, their predictive accuracy was evaluated, and an ensemble model was created to predict larval presence across the study area. SDMs predicted a high probability of larval presence in the western and northeastern parts of Montpellier, with low uncertainty. The most influential variables for predicting larval presence were the mean of Normalized Difference Vegetation Index (NDVI), texture indices from both NDVI, brightness index (BI), and the panchromatic image. Urban vegetation significantly influences larval presence, although higher vegetation index values correlate with a decreased probability of larval occurrence. Additionally, the combination of vegetation and urban structures plays a crucial role in determining the presence of Ae. albopictus larvae in public spaces, where small, organized urban objects and large patches of vegetation increase the likelihood of larval presence. This study highlights the potential of very high-resolution remote sensing and species distribution modeling for enhancing urban mosquito control strategies, ultimately contributing to improved public health policies outcomes in the face of vector-borne disease threats.Community health workers (CHWs) are critical to healthcare delivery in low-resource settings but often lack formal clinical training, limiting their decision-making. Large language models (LLMs) could provide real-time, context-specific support to improve referrals and management plans. This study aims to evaluate the potential utility of LLMs in assisting CHW decision-making in Rwanda.
This is a prospective, observational study conducted in Nyabihu and Musanze districts, Rwanda. Audio recordings of CHW-patient consultations will be transcribed and analysed by an LLM to generate referral decisions, differential diagnoses and management plans. These outputs, alongside CHW decisions, will be evaluated against a clinical expert panel’s consensus. The primary outcome is the appropriateness of referral decisions. Secondary outcomes include diagnostic accuracy, management plan quality, and patient and user perceptions to ambient recording of consultations. Sample size is set at 800 consultations (400 per district), powered to detect a 15–20 percentage point improvement in referral appropriateness.
Ethical approval has been obtained from the Rwandan National Ethics Committee (RNEC) (Ref number: RNEC 853/2025) in June 2025, recruitment started in July 2025 and results are expected in late 2025. Results will be disseminated via stakeholder meetings, academic conferences and peer-reviewed publication.
PACTR202504601308784.
by Adedapo Olufemi Bashorun, Larry Kotei, Abdoulie F. Jallow, Ousubie Jawla, Emmanuel U. Richard-Ugwuadu, Muhammed Jagana, Lamin Bah, Amadou Tijan Bah, Karamo Conteh, Mamadou S.K. Jallow, Mehrab Karim, Bai Lamin Dondeh, Anne Segonds-Pichon, Gary M. Clifford, Iacopo Baussano, Bruno Pichon, David Jeffries, Ed Clarke
Human papillomavirus (HPV) infection is a primary cause of preventable deaths from cervical cancer, a condition of profound inequality with approximately 90% of deaths occurring in low- and middle-income countries, particularly in sub-Saharan Africa. In May 2018, the WHO Director-General declared a Joint Global Commitment to Cervical Cancer Elimination, highlighting the critical role of HPV vaccines in achieving this goal. However, there is a lack of systemically collected data on HPV prevalence in The Gambia, and impact data from high-income countries may not be reliably extrapolated to West African settings due to geographical variation in HPV types and distinct behavioural, biological, and sociodemographic exposures. The Gambia introduced a two-dose HPV vaccination schedule in 2019, but coverage has been very low, interrupted mainly by the COVID-19 pandemic. This presents a key opportunity to generate vital baseline data on HPV prevalence in the population before potential scale-up of vaccination efforts. The PHASE survey, a multi-stage cluster survey, aims to establish the baseline, population prevalence estimates of high-risk and low-risk, vaccine-type and non-vaccine-type HPV infection in 15- to 49-year-old females in The Gambia by measuring urinary HPV-DNA. The survey will also quantify the effects of various exposures on HPV prevalence, including sexual behaviour, the presence of other sexually-transmitted infections (STIs) - Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), syphilis, as well as blood borne viruses, human immunodeficiency virus (HIV), hepatitis B and hepatitis C; obstetric history, socio-demographic characteristics, and cervical cancer screening and/or treatment. Additionally, the study will provide important antimicrobial resistance (AMR) data for NG and MG in sub-Saharan Africa, a region poorly represented in global surveillance programs. This data is needed to guide regional treatment guidelines and advocate for new solutions, including gonococcal vaccines. The AMR data are expected to immediately influence recommendations regarding the appropriate choice of antibiotics for syndromic STI management in West Africa and hence to address an important driver of AMR in the sub-region. Leveraging on the Medical Research Council Unit The Gambia funded Health Demographic Surveillance system (HDSS) as its sampling frame, the survey will utilize validated diagnostic assays and culturally sensitive data collection methods, to ensure both scientific rigor and local relevance. Tools such as Audio Computer-Assisted Self-Interviewing (ACASI) technology, developed in consultation with local community advisory boards, are included to reduce social desirability bias in reporting sexual behaviour. This approach aims to maximize both the reliability and cultural appropriateness of the findings. This study directly addresses the critical need for baseline epidemiological data on HPV in a West African setting to accelerate vaccine impact and drive new interventions towards cervical cancer elimination. By understanding other factors that influence HPV (like other STIs, sexual behaviour, etc.), the study aims to ensure that, when the vaccine’s impact is measured later, changes in other confounding factors that may impact on HPV prevalence can be accounted for. The study will also establish the population prevalence of the measured STIs and their relationship to common symptoms and other adverse health outcomes related to STIs.by Esther Ba-Iredire, James Atampiiga Avoka, Luke Abanga, Abigail Awaitey Darkie, Emmanuel Junior Attombo, Eric Agboli
IntroductionThe alarming rate of drug-resistant tuberculosis (DR-TB) globally is a threat to treatment success among positive tuberculosis (TB) cases. Studies aimed at determining the prevalence, trend of DR-TB and socio-demographic and clinical risk factors contributing to DR-TB in the four regions of Ghana are currently unknown. This study sought to determine the prevalence and trend of DR-TB, identify socio-demographic and clinical risk factors that influence DR-TB, and analyse the relationship between underweight and adverse drug reactions and treatment outcomes among DR-TB patients in four regions of Ghana.
MethodIt was a retrospective review conducted over 5 years, from January 2018 to the end of December 2022. The data were retrieved from the DR-TB registers and folders at the Directly Observed Treatment (DOT) centres in the four regions. Analysis of the data was conducted using STATA version 17.
ResultsThe prevalence of DR-TB in Ashanti was 10.1%, Eastern 5.3%, 27.8% in Central, and 2.7% in the Upper West region for the year 2022. The overall prevalence rate of DR-TB for the period 2018–2022 was 13.8%. The socio-demographic and clinical risk factors that influence DR-TB in the four regions are: age, marital status (aOR 3.58, P-value Conclusion
The study shows that the prevalence of DR-TB in Ghana is low, probably not because the cases have reduced but due to inadequate GeneXpert machines to detect the cases. Age, marital status, education, alcohol intake, previously treated TB cases, adverse drug reactions, underweight, and treatment outcome are factors influencing the development of DR-TB. Therefore, interventions aimed at improving the nutritional status of DR-TB cases and minimising adverse drug reactions will improve treatment outcomes.
Commentary on: Yoshimoto, H., Kawaida, K., Dobashi, S. et al. Effect of provision of non-alcoholic beverages on alcohol consumption: a randomized controlled study. BMC Med 2023; 21, 379. https://doi.org/10.1186/s12916-023-03085-1
Implications for practice and research There is scope for public health to consider non-alcoholic beverages as a potential strategy to reduce alcohol consumption in adults who drink excessively. Future research should explore whether non-alcoholic beverages can reduce alcohol consumption in a wider range of countries and in different population groups, such as individuals with a diagnosis of alcohol dependence.
Alcohol is a risk factor in over 200 health conditions, and 2016 data shows it accounts for 5.3% of overall deaths worldwide.
To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time.
A cross-sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses.
We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis.
Eight hundred and seventy-three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated ‘low travel costs’ and ‘better ability to do paid overtime’ with long shifts and ‘healthy diet/exercise’ with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: ‘When I want to work’, ‘Impacts to my life outside work’ and ‘Improving my work environment’. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work-life balance.
General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters.
This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers.
The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting.
Objetivo principal: Evidenciar la seguridad del inicio de vasopresores mediante un catéter venoso periférico corto en pacientes adultos con diagnóstico de choque séptico, a través de la metodología Enfermería Basada en Evidencia. Metodología: Revisión sistemática. La búsqueda de evidencia se realizó en dos periodos, del 15 al 23 de septiembre del 2022 y del 3 al 20 de octubre del 2022, se utilizaron fuentes de búsqueda e información: base de datos PubMed y el buscador Google académico. Resultados principales: Se evaluaron 19679 pacientes, el tiempo de administración de la infusión fue de 101.05 horas, con una duración media de 22.63 horas, el evento adverso con más incidencia fue la extravasación con duración media de 7.5 horas, el vasopresor más utilizado fue la norepinefrina. Conclusión principal: Administrar vasopresores por vía periférica es seguro, considerando factores que reducirían significativamente el riesgo de complicaciones.
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