Dual cross-linked magnetic gelatin/carboxymethyl cellulose cryogels for enhanced Congo red adsorption: Experimental studies and machine learning modelling.

To achieve highly efficient and environmentally degradable adsorbents for Congo red (CR) removal, we synthesized a dual-network nanocomposite cryogel composed of gelatin/carboxymethyl cellulose, loaded with Fe3O4 nanoparticles. Gelatin and sodium carboxymethylcellulose were cross-linked using transglutaminase and calcium chloride, respectively. The cross-linking process enhanced the thermal stability of the composite cryogels. The CR adsorption process exhibited a better fit to the pseudo-second-order model and Langmuir model, with maximum adsorption capacity of 698.19 mg/g at pH of 7, temperature of 318 K, and initial CR concentration of 500 mg/L. Thermodynamic results indicated that the CR adsorption process was both spontaneous and endothermic. The performance of machine learning model showed that the Extreme Gradient Boosting model had the highest test determination coefficient (R2 = 0.9862) and the lowest root mean square error (RMSE = 10.3901 mg/g) among the 6 models. Feature importance analysis using SHapley Additive exPlanations (SHAP) revealed that the initial concentration had the greatest influence on the model's prediction of adsorption capacity. Density functional theory calculations indicated that there were active sites on the CR molecule that can undergo electrostatic interactions with the adsorbent. Thus, the synthesized cryogels demonstrate promising potential as adsorbents for dye removal from wastewater.

Re-emergence of vaccine-derived polio in the demographic Republic of Congo: Causes and consequences.

Poliovirus is a deadly disease that needs to be eradicated in the world. Recently, issues with circulating vaccine-derived polioviruses (cVDPVs) in the Democratic Republic of the Congo (DRC) have been raised in the country. This article aims to determine the increase in Type 1 cVDPV1 and Type 2 cVDPV2 in the DRC. Relevant articles on PubMed, Google Scholar, ResearchGate, and Web of Science were searched from 2010 to 2023. Our findings indicate that the Democratic Republic of Congo has struggled with polio outbreaks, with the virus primarily linked to cVDPVs produced from vaccines rather than wild poliovirus. These cVDPVs have the potential to revert to their paralyzing capabilities by evolving from the weakened virus seen in the oral polio vaccination (OPV). Several regions in DRC have reported cVDPV outbreaks of cVDPVs. Numerous cVDPV2 outbreaks were documented in various provinces during the 2017-2018 period. Addressing the cVDPV outbreak in the DRC requires a concerted global effort, involving collaboration among governments, international health organizations, and donor agencies. There should be global support and collaboration among governments, international health organizations, and donor agencies to address the cVDPV outbreak in the DRC.

Hidden species diversity in the Enteromius Cope, 1867 (Teleostei: Cyprinidae) from the Aruwimi basin (Middle Congo) in the Okapi Wildlife Reserve (Democratic Republic of the Congo).

Two new African minnow species, Enteromius cerinus sp. nov. and Enteromius ruforum sp. nov., are described for science from the Angadiko River, a left-bank sub-affluent of first order of the Nepoko River, draining the north-eastern part of the Okapi Wildlife Reserve (OWR). Both new species belong to the group of Enteromius for which the last unbranched dorsal-fin ray is flexible and underrated. Within this morphological group, both are most similar to Enteromius kamolondoensis, especially in life colour pattern characteristics. However, Enteromius cerinus sp. nov. differs from E. kamolondoensis by its low number of circumpeduncular scales, 10-11 (vs. 12), low maximum body depth, 22.8%-25.7% standard length (Ls) (vs. 26.1%-30.0%), and long anterior and posterior barbel lengths, 32.6%-35.3% head length (LH) (vs. 23.6%-27.2%) and 41.6%-43.9% LH (vs. 30.3%-34.9%), respectively. Further, E. ruforum sp. nov. is also easily distinguished from E. kamolondoensis by its high maximum body depth, 30.6%-33.3% Ls (vs. 26.1%-30.0%), and small, isometric, eye diameter, 26.2%-28.0% LH (vs. 29.1%-31.9%). A barcoding study (mtDNA, cytochrome oxidase subunit I [COI]) revealed that specimens of both new species form lineages well differentiated from those of other available species. As such, (i) E. cerinus sp. nov. diverges from E. kamolondoensis by a K2P genetic distance (GD) of 10.3% and (ii) E. ruforum sp. nov. by a K2P GD of 11.2%. To the present day, the fish fauna of the left-bank sub-affluents of the Nepoko River, in general, remains poorly known or undocumented. Unfortunately, at the same time, multiple anthropogenic impacts are affecting this fauna, such as (i) the destruction of habitats along the river banks for agriculture and fishing and (ii) the use of illegal fishing practices, such as fishing with plant-based ichthyotoxins during ecopage, which is combined with dam building. As a result of the demographic growth, this ecopage results in overfishing and thus is threatening both new species in particular, but all other co-occurring fish species as well. Both new species, E. cerinus sp. nov. and E. ruforum sp. nov., should thus be considered Vulnerable (VU) according to IUCN criterion D2. It is therefore hoped that their discovery highlights the urgent need for a better protection and further in situ exploration of the reserve's freshwater (fish) biodiversity, in general, and that of those small sub-affluents, in particular.

Rapid Decision Algorithm for Patient Triage during Ebola Outbreaks.

The low specificity of Ebola virus disease clinical signs increases the risk for nosocomial transmission to patients and healthcare workers during outbreaks. Reducing this risk requires identifying patients with a high likelihood of Ebola virus infection. Analyses of retrospective data from patients suspected of having Ebola virus infection identified 13 strong predictors and time from disease onset as constituents of a prediction score for Ebola virus disease. We also noted 4 highly predictive variables that could distinguish patients at high risk for infection, independent of their scores. External validation of this algorithm on retrospective data revealed the probability of infection continuously increased with the score.

Factors associated with pelvic organ prolapse: case-control study in two hospitals of Bon-Berger and Saint Georges of the city of Kananga in the Democratic Republic of the Congo.

Introduction: pelvic organ prolapse is a disease or disorder of the pelvic floor that can both worsen or regress, especially in the postpartum period. It carries a high risk of recurrence after surgical treatment. The objective of this study is to identify the factors associated with pelvic organ prolapse in the two hospitals of Bon-Berger and Saint-Georges in the town of Kananga in the Democratic Republic of Congo. Methods: this is a case-control study that is carried out on the medical records of 134 patients admitted to the gynecology departments of the Bon-Berger Hospitals of Tshikaji and Saint Georges of Katoka, from January 1st to July 31st, 2023 and based on non-probability convenience sampling for case selection. The ANOVA test, Chi-test and logistic regression with adjustment are used in the statistical analyses. Results: the factors associated with the occurrence of pelvic organs prolapse are heavy physical work (aOR: 4.031, 95% CI: 2.760-9.212; p: 0.004), malnutrition in the form of BMI less than 18.5 (aOR: 2.550, 95% CI: 1.360-5.840; p: 0.023), multiparity (aOR: 1.520, 95% CI: 1.234-4.320; p: 0.015), vaginal delivery (aOR: 3.020, 95% CI: 0.063-14.470; 0.002), fetal macrosomia (aOR: 4.290, 95% CI: 3.320-5.550; p: 0.032), pelvic tears (aOR: 2.910, 95% CI: 2.090-5.930, p: 0.006) and menopause (aOR: 3.110, 95% CI: 1.040-9.250, p: 0.001). Conclusion: these results can serve as a basis for screening women at high risk of suffering from pelvic organ prolapse during gynecological and obstetrical consultations and for in-depth studies seeking the matrix metalloproteinases associated with pelvic organ prolapse to improve its treatment in hospitals of our town of Kananga.

'Those MONUSCO agents left while we were still pregnant': Accountability and support for peacekeeper-fathered children in the DRC.

The Democratic Republic of Congo hosts the longest-running and largest United Nations peacekeeping mission in history. The United Nations also has reckoned with sexual exploitation and abuse in its own ranks and, in 2003, recognized its importance with a Bulletin which became known as the 'zero tolerance policy'. Policymakers and researchers have paid little sustained attention, however, to children fathered by peacekeepers. In this article, we share the results of our mixed-methods SenseMaker® research with community members who interact with peacekeeping personnel and interviews with 58 women who are raising children fathered by peacekeepers. Despite the United Nations policies in place, most women did not report children fathered by peacekeepers and did not receive systematic support. The analysis reveals a large gap between the aspirations of the 'zero tolerance policy' and its operationalization in the Democratic Republic of Congo. We uncovered deep poverty and insecurity as both driving and resulting from women's sexual encounters with peacekeepers, with support needs largely unmet. We argue that there is a lack of enforcement of the United Nations policies, jurisdictional complexity and inaccessible justice, as well as significant gaps between the United Nations' approach to investigating and supporting children fathered by peacekeepers and the expectations of mothers, resulting in worsened life conditions for mothers and their children.

The silent spread: why we need increased awareness of Crimean-Congo haemorrhagic fever.

Crimean-Congo Hemorrhagic Fever (CCHF) presents significant global health challenges, highlighted by its sporadic nature and high fatality rates. The manuscript emphasizes the disease's tendency to be under-recognized and the diagnostic challenges it poses, often mimicking other illnesses and leading to frequent misdiagnosis. There is a noted absence of robust diagnostic tools, specific treatments, or vaccines, leaving only supportive care generally available. The necessity for increased international cooperation and a coordinated strategy to enhance disease surveillance, public health preparedness, and community education is stressed.

Clade I mpox virus genomic diversity in the Democratic Republic of the Congo, 2018-2024: Predominance of zoonotic transmission.

Recent reports raise concerns on the changing epidemiology of mpox in the Democratic Republic of the Congo (DRC). High-quality genomes were generated for 337 patients from 14/26 provinces to document whether the increase in number of cases is due to zoonotic spillover events or viral evolution, with enrichment of APOBEC3 mutations linked to human adaptation. Our study highlights two patterns of transmission contributing to the source of human cases. All new sequences from the eastern South Kivu province (n = 17; 4.8%) corresponded to the recently described clade Ib, associated with sexual contact and sustained human-to-human transmission. By contrast, all other genomes are clade Ia, which exhibits high genetic diversity with low numbers of APOBEC3 mutations compared with clade Ib, suggesting multiple zoonotic introductions. The presence of multiple clade I variants in urban areas highlights the need for coordinated international response efforts and more studies on the transmission and the reservoir of mpox.

[Amyloidosis - The pathologist's perspective]. / L'amylose ­ point de vue du pathologiste.

Despite the advent of scintigraphic diagnosis of transthyretin amyloidosis, the role of pathologists remains central for the diagnosis and typing of amyloidosis. The anatomo-pathological diagnosis and typing of amyloidosis are hindered by pitfalls that should be known, linked to the Congo red staining (technical implementation and interpretation) and the difficulties of immunohistochemistry. The use of expert centers is recommended for difficult cases and when the type cannot be confirmed.

Preparation of new green poly (amino amide) based on cellulose nanoparticles for adsorption of Congo red and its adaptive neuro-fuzzy modeling.

In this study, a novel green poly(amino amide) nanoparticle based on cellulose nanoparticles (Cell-PAMN) was developed for the efficient adsorption of Congo Red dye. Cellulose nanocrystals obtained from acid hydrolysis of cotton linter were functionalized via Oxa-Michael addition of acrylamide on their surface hydroxyl groups, followed by transamidation with ethylenediamine. The resulting nanoparticles were characterized using FT-IR spectroscopy, SEM, and X-ray diffraction techniques. The as-prepared Cell-PAMN exhibited considerably higher adsorption capacity compared to unmodified cellulose nanoparticles due to the presence of amino and amide functional groups. The adsorption kinetics and the effects of parameters such as contact time and initial dye concentration on the adsorption capacity were investigated. An adaptive Neuro-Fuzzy model was used to study the efficiency of dye removal, accurately predicted the adsorption behavior of Cell-PAMN. The kinetic study results showed that the adsorption process followed a pseudo-second-order kinetic model, with a maximum adsorption capacity of around 40 mg/g. The results demonstrated the potential of the synthesized material for the removal of Congo Red from aqueous solutions, highlighting its applicability in wastewater treatment. This research contributes to the development of sustainable and eco-friendly materials for environmental remediation applications.

Biofabrication of highly effective and easily regenerated CuO nanoparticles as adsorbents for Congo red and malachite green removal.

An effective and easily regenerated adsorbent is the one for which scientists are making an effort to explore. In this study, copper oxide nanoparticles (CuO NPs) were synthesized in a green manner from a leaf extract of Moringa stenopetala and used for dye adsorption. XRD, FTIR, and SEM were employed for the characterization of CuO NPs. The crystallite size of the CuO NPs was calculated via Debye-Scherrer equation from the XRD data and was found to be 8.33 nm. The Cu-O bonding bending vibration at 1116 cm- 1 and stretching vibration at 1649 cm- 1 observed from the FTIR data strongly confirmed the formation of CuO NPs. SEM morphology analysis confirmed the formation of nanoparticles with a plate-like morphology and a spherically random orientation. The zero-point charge of CuO NPs was investigated and reported to be at pH 7. The adsorption of dyes on the greenly produced CuO NPs was studied by optimizing different adsorption parameters. The removal efficiencies of the green CuO NPs adsorbent were 99.54% at the optimum conditions (pH, 4; dye concentration, 30 mg/L; amount of adsorbent, 0.25 g; and contact time, 80 min) and 98.33% at the optimum conditions (pH, 11; dye concentration, 20 mg/L; amount of adsorbent, 0.4 g; and contact time, 80 min) for congo red and malachite green, respectively. The adsorption efficiency of the biosynthesized CuO NPs for the mixture of the two dyes was 92.3%. The green synthesized adsorbent was regenerated and able to work effectively for four cycles for the two dyes. The results of the kinetics-type investigation indicate that the adsorption of both dyes by the CuO NPs adsorbent best fits a pseudo-second-order model. The isotherm model-type investigation resulted in the fitting of the Langmuir adsorption isotherm for both the congo red and malachite green dyes.

Classification of amyloidosis and protein misfolding disorders in animals 2024: A review on pathology and diagnosis.

Amyloidosis is a group of diseases in which proteins become amyloid, an insoluble fibrillar aggregate, resulting in organ dysfunction. Amyloid deposition has been reported in various animal species. To diagnose and understand the pathogenesis of amyloidosis, it is important to identify the amyloid precursor protein involved in each disease. Although 42 amyloid precursor proteins have been reported in humans, little is known about amyloidosis in animals, except for a few well-described amyloid proteins, including amyloid A (AA), amyloid light chain (AL), amyloid ß (Aß), and islet amyloid polypeptide-derived amyloid. Recently, several types of novel amyloidosis have been identified in animals using immunohistochemistry and mass spectrometry-based proteomic analysis. Certain species are predisposed to specific types of amyloidosis, suggesting a genetic background for its pathogenesis. Age-related amyloidosis has also emerged due to the increased longevity of captive animals. In addition, experimental studies have shown that some amyloids may be transmissible. Accurate diagnosis and understanding of animal amyloidosis are necessary for appropriate therapeutic intervention and comparative pathological studies. This review provides an updated classification of animal amyloidosis, including associated protein misfolding disorders of the central nervous system, and the current understanding of their pathogenesis. Pathologic features are presented together with state-of-the-art diagnostic methods that can be applied for routine diagnosis and identification of novel amyloid proteins in animals.

Guardians under pressure, a spotlight on hypertension among healthcare workers in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Hypertension is one of the main risk factors for cardiovascular disease impacting over a billion people worldwide. Work environment factors could adversely affect workers' cardiovascular health, including contributing to hypertension. Healthcare workers who treat patients are also affected. In the Democratic Republic of Congo, limited studies explored the work environment factors associated with hypertension. This study aimed to examine hypertension prevalence and determine the associated risk factors among healthcare workers in Kinshasa. METHODS: A cross-sectional study was conducted in Kinshasa's healthcare facilities from December 2023 to January 2024 among healthcare workers selected by multistage stratified random sampling. Data was collected through a structured questionnaire using a modified WHO STEPwise approach and Karasek questionnaire. Anthropometric parameters, blood pressure, and fasting blood sugar were measured. The prevalence of hypertension was assessed. All sociodemographic, occupational, and lifestyle variables associated with hypertension were included in multivariable logistic regression analysis at the 5% significance level. RESULTS: The study encompassed 614 participants, comprising 55.2% females and 44.8% males. The mean age of participants was 38.8 ± 10.4 years, ranging from 20 to 78 years. The prevalence of hypertension was 22.6% and over half of those with hypertension (56.1%) were unaware of their condition. Of the known hypertensive participants before the study, 60.7% had uncontrolled blood pressure. In the multivariable analysis, identified risk factors for hypertension were age ≥ 40 years (aOR = 2.75, 95% CI: 1.64-4.61), seniority ≥ 10 years (aOR = 2.65, 95% CI: 1.54-4.58), multiple job holding (aOR = 3.11, 95% CI: 1.81-5.34), job stress (aOR = 1.84, 95% CI: 1.17-2.89), physical inactivity (aOR = 1.67, 95% CI: 1.03-2.68), overweight (aOR = 1.75, 95% CI: 1.06-2.90) and obesity (aOR = 3.75, 95% CI: 2.10-6.70). CONCLUSION: Our results underline an important prevalence of hypertension among healthcare workers in Kinshasa, despite their medical knowledge of the causes and the risks. A healthy lifestyle among healthcare workers is fundamental for ensuring the efficiency and productivity of the healthcare system. Regulating multiple job holding and implementing a hypertension prevention intervention encompassing their holistic support is crucial for reducing job stress and promoting well-being.

Great ape surveys and the implications of long-term monitoring in the Djéké Triangle, Republic of Congo.

Existing protected areas are anchors for conservation. Safeguarding flora and fauna within their peripheral areas is essential to maintaining their integrity and to potential increases to the area under effective conservation. With the decline in tropical forests, initiatives to increase the area of undisturbed forests under strict protection, particularly those neighboring protected areas, is of critical importance. Applied research has informed such land-management decisions for areas surrounding the Nouabalé-Ndoki National Park (NNNP) in Republic of Congo since the park's inception three decades ago. Here, we present results of the first systematic line transect survey of great ape nests conducted in the Djéké Triangle, a 100 km2 unlogged continuous forest in the Kabo Forestry Management Unit adjacent to the NNNP. Distance sampling methods applied along 26 line transects on two different occasions (2016 and 2018, with total effort of 69.4 km) provided density estimates of 0.75 (95% confidence interval (CI) 0.52-1.09) and 0.61 (95% CI 0.40-0.92) chimpanzees/km2 and 2.15 (95% CI 1.36-3.40) and 1.19 (95% CI 0.78-1.82) gorillas/km2 for each of the two surveys, respectively. Estimated ape densities were compared to others across the landscape. The findings provide a unique baseline in an area that supports ongoing behavioral research and future gorilla tourism opportunities in the Djéké Triangle. More importantly, results provided empirical evidence of the environmental value and strategic conservation importance supporting inclusion of the Djéké Triangle into the NNNP in 2023. These long-term monitoring results inform best-practice standards and ape tourism certification.

Activity-based contracting for optimization of the mass distribution of insecticide-treated nets in the Democratic Republic of Congo: pilot implementation in Kwilu province.

BACKGROUND: Promoting the use of insecticide-treated mosquito nets (ITNs) is one of the main strategies for reducing malaria-related morbidity. An innovative activity-based contracting (ABC) approach has been implemented in Kwilu Province, Democratic Republic of Congo to optimize ITN mass distribution campaigns, with payments based on contractually defined programmatic outcomes for key campaign activities following independent verification of results. METHODS: This internal evaluation was carried out using a mixed methods approach combining qualitative and quantitative document and content analysis from a series of three workshops: validation workshops for campaign results at provincial level for the 2021 and 2022 campaigns; internal evaluation workshop for the Kwilu campaign as part of the ABC approach organized by "Santé pour tous en milieu rural" (SANRU) with its sub-contractors; and national campaign evaluation workshop organized by the National Malaria Control Program. RESULTS: The pilot campaign with the ABC approach in Kwilu has demonstrated better results than campaigns conducted using the standard, non-ABC, approach: better household coverage (99.9% vs. 97.3%) and improved compliance with ITN allocation to households based on the household size (98. 9% vs. 84.7%); lower loss of ITNs (0.3% vs. 0.5%) with immediate penalties for lost ITNs in the province under the ABC approach; shorter campaign lead times (14 vs. 28 weeks from the start of training to the launch of distribution). This last point is crucial, as it is likely to generate efficiencies and contribute to ensuring timely ITN replacement campaigns. CONCLUSION: The challenges encountered and the lessons learned in the implementation of the pilot ABC approach in Kwilu could guide future distribution campaigns in the DRC and other African countries that would like to engage in distribution campaigns based on performance-based incentive contracts.

Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019-2020 targeted preventative mass campaigns.

Background: In 2019-2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-contiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially influencing success of the delivery strategy. Methods: We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population movement, diarrhea history, and reasons for non-vaccination. Results: 603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8-51.0), and 50.1 % (95 %CI: 45.4-54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2-34.9) in non-targeted areas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported history of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination. Conclusion: Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting entire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational recommendations to reach higher coverages arising from the study.

Potential thioflavin T false positives in lipomembranous changes in adipocytes during systemic amyloidosis diagnosis.

The diagnosis of systemic amyloidosis relies on the detection of amyloid deposition in the tissue, often utilizing biopsy specimens from the abdominal skin owing to their minimal invasiveness. Several amyloid staining methods, including Congo Red, Direct Fast Scarlet (DFS), and Thioflavin T (ThT), have been employed for visualization. Lipomembranous fat necrosis (LFN) is a non-specific reaction pattern of adipose tissue to injury, typically derived from blood insufficiency across a wide range of clinical conditions or diseases. It is characterized by the presence of eosinophilic, crenulated, and/or serpiginous membranes in fat lobules. We encountered a patient in whom ThT yielded suspiciously positive results in amyloidosis screening tests. Furthermore, our retrospective observations suggested that ThT staining was positive for LFN, whereas DFS and Congo red staining yielded negative results. The awareness that LFN can result in false-positive ThT staining during amyloid screening is crucial to avoiding the misdiagnosis of systemic amyloidosis. Furthermore, skin samples should not be collected from areas prone to developing lipomembranous changes. The use of more than two different stains for skin biopsy specimens is recommended.

Immunogenicity of a Birth Dose of Hepatitis B Vaccine in Kinshasa, Democratic Republic of Congo: A Randomised, Controlled Trial.

The WHO recommends hepatitis B birth-dose vaccination (HepB-BD), but it is not routinely given in most sub-Saharan African countries. We aimed to assess the immunogenicity of HepB-BD in addition to the existing hepatitis B vaccine (HepB3) schedule in Kinshasa, Democratic Republic of Congo among HBV-unexposed and HBV-exposed infants. Using an open-label, randomised, controlled design, HBV-unexposed infants were randomised (1:1) to receive the standard HepB3 vaccine series (group U3), or to receive HepB-BD in addition to HepB3 (group U4). A supplemental cohort of HBV-exposed infants (group E4) received HepB-BD and HepB3. We compared the proportion of infants with protective antibodies against HBV (HBV surface antibody ≥ 10 mIU/mL) between groups U3 and U4 and groups U4 and E4 at 12 months of age. Between August 20 and October 9, 2019, we enrolled 281 mother/infant dyads; 88 (31.3%) returned at 12 months. Most infants had protective antibodies against HBV at 12 months: 92.9% (75.7%-98.2%) in group U3, 85.7% (67.5%-94.5%) in group U4 and 96.9% (95% CI: 81.2%-99.6%) in group E4. Trends held in estimates adjusted for loss-to-follow-up (LTFU) and baseline imbalance across groups. In this first randomised trial assessing the addition of HepB-BD to the hepatitis B vaccine schedule in SSA, we found that HBV-unexposed infants who received the 3-dose and 4-dose vaccine series had similar immunogenicity against HBV at 12 months. A high proportion of infants, and notably HBV-exposed infants, had protective antibodies. Though extrapolation of findings may be limited by LTFU, this study adds real-world evidence regarding HepB-BD implementation in sub-Saharan Africa. Trial Registration: ClinicalTrials.gov identifier: NCT03897946.