To evaluate the performance of Ghana’s environmental surveillance (ES) system for poliovirus (PV) detection from 2018 to 2022 using standardised indicators developed by the WHO and the US Centers for Disease Control and Prevention.

A retrospective performance evaluation using 10 key indicators benchmarked against global targets for PV surveillance.

Seven regions across Ghana, participating in the national ES programme implemented under the Global Polio Eradication Initiative.

Wastewater sampling was conducted at designated ES sites, supported by field collection teams and laboratory personnel responsible for sample acquisition, processing and reporting of PV detection results.

Detection rates of PV and non-polio enteroviruses (NPEVs), timeliness of sample collection and reporting, data quality and system stability.

A total of 738 wastewater samples were collected. The system demonstrated high sensitivity, detecting circulating vaccine-derived PV type 2 in 51 (6.9%) of samples, Sabin PV types 1 and 3 in 61 (9.5%) and 114 (17.8%), respectively, and NPEVs in 491 (66.5%) of samples. Over 80% of samples met the recommended 21-day collection-to-reporting time frame. Data quality exceeded the ≥80% threshold, and workflows remained stable throughout the evaluation period.

Ghana’s ES system for PV was found to be flexible, stable and effective in generating high-quality data for early detection and public health response. These findings underscore the system’s critical role in supporting polio eradication efforts and highlight its potential as a model for surveillance in similar settings.

Malnutrition among under-5 children is a major challenge in low-income and middle-income countries, contributing to poor growth and development. Growth monitoring and promotion (GMP) is recommended by WHO for early detection, yet its implementation remains weak due to limited resources and health system gaps. While many studies focus on utilisation, little is known about facility readiness, especially from multicountry analyses. This study aimed to assess the readiness of health facilities to provide growth monitoring (GM) service and associated factors using nationally representative data.

Secondary analysis of existing cross-sectional survey data.

Secondary data from service provision assessment surveys of Afghanistan, Bangladesh, Ethiopia, Haiti, Nepal and Tanzania was used.

We included 6595 health facilities, which have complete information. Health facilities’ readiness score was constructed as a counting score with regard to the availability of essential indicators required to provide GM services by using WHO service availability and readiness assessment.

Among 6595 health facilities, 28.5% (95% CI 27.4% to 29.6%) of the facilities reported at least 75% of the relevant items for GM service provision. The factors associated with health facilities’ readiness to provide GM service were quality assurance activities (incident rate ratio (IRR): 1.15; 95% CI 1.07 to 1.24), separate user fees (IRR: 1.10; 95% CI 1.00 to 1.20), fixed user fees (IRR: 1.20; 95% CI 1.10 to 1.31) and presence of trained health provider at facility 24 hours (IRR: 1.09; 95% CI 1.02 to 1.17).

Health facilities in six countries showed low readiness for GMP services. Strengthening facility capacity, staffing, equipment and quality assurance is essential to improve readiness.

To evaluate the effects of liberal transfusion strategy (trigger haemoglobin ≤90–100 g/L) compared with a restrictive strategy (trigger haemoglobin ≤70–80 g/L) on long-term neurological functional outcome in anaemic adult patients with acute acquired brain injury (ABI).

Systematic review and study-level meta-analysis of randomised controlled trials (RCTs).

MEDLINE, EMBASE, Cochrane from inception to 6 February 2025.

RCTs enrolling patients with acute ABI and anaemia (haemoglobin ≤100 g/L), comparing a liberal vs restrictive transfusion strategy.

Two reviewers independently identified eligible studies, extracted data and assessed risk of bias. We performed random-effects meta-analysis of RCTs and applied Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the certainty of evidence. Our primary outcome was an unfavourable neurological functional outcome, using the Glasgow Outcome or modified Rankin scales.

Five trials enrolling 2364 patients with acute ABI and anaemia were included in the primary analysis. Liberal transfusion reduces the risk of unfavourable neurological outcome (risk ratio (RR)=0.89, 95% CI 0.84 to 0.95, high certainty). Liberal transfusion may reduce severe disability (RR=0.82, 95% CI 0.66 to 1.02, moderate certainty), and increase good recovery compared with restrictive transfusion (RR=1.29, 95% CI 0.95 to 1.76, low certainty). We found no difference in the risk of most adverse events, including death. Statistical heterogeneity was low (I²=0%–36%) for neurological outcomes.

In adults with acute ABI and anaemia, liberal transfusion reduces the risk of unfavourable outcome (high certainty) and possibly improves the chances of good recovery (low certainty) when compared with restrictive transfusion.

CRD42025628732.