Rural women's voices revealing perceptions about decisions on where to give birth in Gabon: A qualitative study.

OBJECTIVE: This study aimed to clarify the perceptions of rural women about their decisions on where to give birth in Gabon. METHOD: This study used a qualitative descriptive design using semi-structured interviews. Study participants were women at least 20 years old and had given birth within the past 2 years. The study area was approximately 25-30 km from the capital of Gabon. Data collection was conducted between May and mid-July 2023. The interview guide was based on the Ottawa Decision Support Framework (ODSF) 2020 model. The data obtained were analyzed using content analysis for "perceptions in deciding the place of birth." RESULTS: A total of 18 women participated in the study. Six categories of reasons were identified for women's choice of birth location: (1) childbirth environment with physical safety; (2) childbirth environment with psychological safety; (3) physical accessibility; (4) affordable health facilities; (5) concerns about homebirth risks; and (6) unpleasant aspects of the hospital. Items (1)-(4) were the reasons for actively choosing the hospital as a birth location, whereas items (5) and (6) were the reasons for avoiding a place to give birth. CONCLUSIONS: Women positively perceived and chose facilities that offer physical and mental safety, geographic accessibility, and affordable costs. Conversely, an environment where the safety of the mother and the child is threatened and the lack of respectful maternity care by the medical staff served as deterrents to facility use.

The distribution of work-related musculoskeletal disorders among nurses in sub-Saharan Africa: a scoping review.

BACKGROUND: Musculoskeletal injuries are noticeably high among the nursing fraternity, with lower back pain (LBP) being the most prevalent. Therefore, this study aimed to map evidence on the burden of occupational musculoskeletal disorders (MSD) among nurses in sub-Saharan Africa (SSA). METHODS: This scoping review was guided by Arksey and O'Malley's framework. We conducted a comprehensive literature search with no date limit from the following databases: Science Direct, PubMed, Sabinet (SA ePublications), EBSCOhost platform, World Health Organization (WHO) Library, Google Scholar, SCOPUS, Taylor and Francis, and WorldCat Academic Search with full text for published studies. The search took place from May 2022 to December 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results, and a thematic content analysis was used to present the emerging themes from the included studies. RESULTS: A total of 16,714 studies were identified after the database search. Only 29 studies met the inclusion criteria after full-article screening and were included for data extraction. The studies reported a total of 6343 participants from different regions in SSA. The 29 included studies showed evidence on the prevalence of MSD, associated risk factors of MSD and LBP among nurses in SSA with some recommendations on how to reduce the prevalence of MSD among nurses. CONCLUSION: The study findings reveal that there is a high prevalence of MSD among nurses, especially LBP. The etiology of MSD among nurses is multifactorial, and multifaceted strategies to address MSD are recommended. Further research is recommended to explore strategies that can be used to curb the high prevalence of MSD among nurses.

Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers.

BACKGROUND: Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts. METHODS: This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software. RESULTS: Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'. CONCLUSIONS: This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.

Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. AIMS AND METHODS: Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n = 55; WC2: Adolescents user committee (AUC) n = 63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. RESULTS: Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49 years old (increase of 283% for Makala and 23% for Maluku II)). CONCLUSIONS: Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.

Link between pregnancy planning and antenatal care utilization in sub-Saharan Africa: An analysis of DHS data (2010-2023).

This study aims to analyse the relationship between pregnancy planning and antenatal care in sub-Saharan Africa and to identify which categories of mothers are most likely to make inadequate use of antenatal care in the event of a mistimed or unwanted pregnancy. The latest data from the Demographic and Health Surveys of 32 countries were analysed using bivariate and multivariate descriptive methods. The results show that compared with planned births, mistimed and unwanted births are respectively 27% (OR=0.733) and 29% (OR=0.711) less likely to have an antenatal visit in the first three months of pregnancy, and 25% (OR=0.752) and 29% (OR=0.705) less likely to have the four recommended antenatal visits. In addition, the births of the most privileged women (richest, educated and exposed to the media) are the least likely to have an adequate prenatal visit in the event of mistimed or unwanted pregnancies, probably due to an increased psychosocial impact linked to school dropouts, damage to professional projects and a desire to hide the pregnancy from those around her.

Cette étude vise à analyser la relation entre planification de la grossesse et recours aux soins prénataux en Afrique subsaharienne et à déterminer les catégories de mères les plus enclines à ne pas recourir adéquatement aux soins prénataux en cas de grossesse mal planifiée ou non désirée. Les dernières données en date des enquêtes démographiques et de santé de 32 pays ont été analysées à travers des méthodes descriptives bivariées et multivariées. Les résultats obtenus indiquent que comparativement aux naissances planifiées, celles mal planifiées et non désirées ont respectivement 27% (OR=0,733) et 29% (OR=0,711) moins de chances de recourir à une visite prénatale dans les trois premiers mois de la grossesse et 25% (OR=0,752) et 29% (OR=0,705) moins de chances de recourir aux quatre visites prénatales recommandées. En outre, les naissances des femmes les plus favorisées (riches, instruites et exposées aux médias) sont celles qui bénéficient le moins de visites prénatales adéquates en cas de grossesse mal planifiées ou non désirée du fait probablement d'un impact psychosocial accru liés aux abandons scolaires, atteintes aux projets professionnels et volontés de cacher la grossesse à son entourage.

Prevalence and management of cataracts among older adults in Sub-Saharan Africa: a scoping review.

INTRODUCTION: Cataract is a leading cause of visual impairment and blindness, mainly affecting older adults in sub-Saharan Africa (SSA). This scoping review aims to map evidence on the prevalence, contextual factors, and management strategies for cataracts among older adults in SSA. METHOD: Four central databases (PubMed, Scopus, Medline, and Google Scholar) were searched, yielding 383 records. Additional searches produced eight records. After screening and applying inclusion criteria, 26 full-text articles were eligible for further review. Finally, seven full-text records were included in the thematic analysis and synthesis. RESULTS: Cataract prevalence among older adults in SSA ranged from  13.5-62.5% across different countries. Surgery remains the primary management strategy, but cataract surgical coverage varies widely (12.1-96%). Significant barriers to effective management include lack of awareness, limited access to healthcare, economic constraints, gender disparities, and cultural misconceptions about cataract surgery. CONCLUSION: There is a significant burden of cataracts among older adults in SSA, with considerable variations in prevalence and surgical coverage across the region. Comprehensive strategies addressing awareness, accessibility, affordability, and cultural factors are needed to improve cataract management and reduce visual impairment in SSA.

Climate and conflict-induced child nutrition crisis in Sub-Saharan Africa.

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach-climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs-as solutions to enhance child nutrition and build climate resilience.

Radiographically confirmed pneumonia in Malawian children and associated pneumococcal carriage after introduction of the 13-valent pneumococcal conjugate vaccine.

BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced in Malawi in 2011 with an expected impact of reducing pneumococcal pneumonia in children. We aimed to describe clinical characteristics and nasopharyngeal (NP) carriage of pneumococcus by serotype in children hospitalized with primary end-point pneumonia (PEP) between 2013 and 19 after the introduction of PCV-13. METHODS: We conducted a secondary analysis of children aged under-5-years hospitalized with acute respiratory illness (ARI) in Malawi. Chest radiographs conducted at admission were read by two independent clinicians according to WHO criteria for PEP, and a third reviewer resolved discordant diagnoses. NP swab specimens were processed and Streptococcus pneumoniae growth was serotyped. Multivariable regression analysis was conducted to assess the association between clinical characteristics, NP serotypes, and PEP. RESULTS: We had complete radiographic and NP serotype data for 500 children, of which 54 isolates were vaccine-type (VT) (10.8%), 165 were non-VT (NVT; 33.0%), and 281 had no pneumococcal growth (56.2%). Among these, 176 (35.2%) had PEP on chest x-ray. Among those with PEP, pneumococcal carriage was documented in 43.8% of cases, and VT serotypes accounted for 10.8%. For children with PEP, we found no association between clinical characteristics and carrying either VT, NVT, or no pneumococcus. CONCLUSION: Carriage of S. pneumoniae remains high among children hospitalized with ARI in Malawi, but children with VT carriage were no more likely to have PEP than children carrying no pneumococcus or those with NVT carriage. There were no differences in clinical characteristics between those carrying VT, NVT, or no pneumococcus.

Postpartum Women's Experiences of Postnatal Care in Sub-Saharan Africa: A Qualitative Evidence Synthesis.

BACKGROUND: Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA. METHODS: This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer-reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data. RESULTS: Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed-method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high. CONCLUSION: Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.

Lymphoma in Sub-Saharan Africa: a scoping review of the epidemiology, treatment challenges, and patient pathways.

PURPOSE: Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022. METHODS: A comprehensive three-step search was conducted without language restrictions. RESULTS: Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4-2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways. CONCLUSION: Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.

Compliance with the 2016 WHO's antenatal care recommendation and its determinants among women in Sub-Saharan Africa: a multilevel-analysis of population survey data.

BACKGROUND: Despite the positive impact of adhering to the new antenatal care model on pregnancy outcomes and maternal health service uptake, women in resource-limited settings exhibit low levels of compliance with this recommendation. Previous studies on women's adherence to the new antenatal care recommendation have been limited to individual countries, with no evidence available at Sub-Saharan Africa (SSA) level. Therefore, this study sought to investigate compliance with the 2016 WHO's recommendation of at least eight antenatal care contacts among women in SSA countries and identify its determinants. METHODS: The study utilized a weighted sample of 101,983 women who had received antenatal care during their index pregnancy, drawn from recent DHS data of sixteen SSA countries. A multilevel mixed-effect analysis was conducted to identify factors that influence compliance with new antenatal care recommendations. Model comparison was performed using deviance and log-likelihood values, and statistical significance was determined at a P-value of less than 0.05. RESULTS: The level of compliance with the recommended antenatal care contacts among women in SSA was 9.9% (95% CI: 9.7-10.1%), with the highest rate in Sierra Leone (26.1%) and lowest in Rwanda (< 1%). A multivariable logistic regression analysis showed that age, education, employment status, household wealth, healthcare decisions, the timing of antenatal contacts, consumption of nutritional supplements, residence, community-level women illiteracy, and media exposure were the significant determinants of compliance. CONCLUSION: Only one in ten pregnant women in SSA countries had attended the recommended number of antenatal contacts, with Sierra Leone having the highest compliance rate and Rwanda and Senegal having the lowest. Therefore, policymakers should focus on improving access to education, especially for women and their partners, and providing exempted services for pregnant women from low-income households. Interventions that target communities with low levels of literacy and media exposure could also be effective in improving the uptake of the services.

Bridging the Gap: Immune Checkpoint Inhibitor as an Option in the Management of Advanced and Recurrent Cervical Cancer in Sub-Saharan Africa.

Cervical cancer remains a leading cause of cancer-related mortality in women in low and middle-income countries despite efforts to improve prevention and standard-of-care interventions. Sub-Saharan Africa (SSA) leads the numbers for global cervical cancer incidence and mortality, with the majority of the incidence diagnosed in the late stage of the malignancy. Although the global cervical cancer death rate has been on the decline for the last two decades owing to advancements in screening and treatment options, the mortality rate in SSA has not declined very much. Chemotherapy has been the treatment of choice for cervical cancer in SSA without meeting the expected survival outcomes in these patients, with the majority having advanced diseases at diagnosis. Immune checkpoint inhibitors have recently shown clinical promise in improving the survival of patients with advanced cervical cancer and have been integrated into the treatment guidelines in most high-income countries, which have helped further reduce the mortality rate of cervical cancer. However, many SSA countries are yet to fully benefit from using immune checkpoint inhibitors in cervical cancer. In this review, we discuss the challenges hindering the effective use of immune checkpoint inhibitors for advanced cervical cancer in Africa and possible solutions.

Edited eukaryotic translation initiation factors confer resistance against maize lethal necrosis.

Maize lethal necrosis (MLN), which is caused by maize chlorotic mottle virus along with a potyvirus, has threatened the food security of smallholders in sub-Saharan Africa. Mutations in eukaryotic translation initiation factors (eIFs), which also facilitate virus genome translation, are known to confer variable resistance against viruses. Following phylogenetic analysis, we selected two eIF4E proteins from maize as the most likely candidates to facilitate MLN infection. A knockout (KO) of each of the corresponding genes in elite but MLN-susceptible maize lines conferred only partial protection. Our inability to knockout both the genes together suggested that at least one was required for survival. When we edited (ED) the eIF4E genes in Mini Maize, however, the plants with the eif4e1-KO became highly resistant, whereas those with the eif4e2-KO remained susceptible. Neither of the causal viruses could be detected in the MLN-inoculated eif4e1-KO plants. The eIF4E2 cDNA in Mini Maize lacked the entire 4th exon, causing a 22-amino acid in-frame deletion, which shortened the protein to 198 amino acids. When we introduced mutations in the 4th exon of the eIF4E2 gene in two elite, MLN-susceptible lines pre-edited for an eif4e1-KO, we obtained as strong resistance against MLN as in eif4e1-KO Mini Maize. The MLN-inoculated lines with eif4e1-KO/eIF4E2-exon-4ED performed as well as the uninoculated wild-type lines. We demonstrate that the C-terminal 38 amino acids of eIF4E2 are dispensable for normal plant growth but are required for the multiplication of MLN viruses. Our discovery has wide applications across plant species for developing virus-resistant varieties.

Baseline characteristics of Ghanaian children and adults enrolled in PIVOT, a randomised clinical trial of hydroxyurea in HbSC disease in sub-Saharan Africa.

HbSC disease is a common form of sickle cell disease with significant morbidity and early mortality. Whether hydroxyurea is beneficial for HbSC disease is unknown. Prospective Identification of Variables as Outcomes for Treatment (PIVOT, Trial ID PACTR202108893981080) is a double-blind, randomised, placebo-controlled phase II trial of hydroxyurea for people with HbSC, age 5-50 years, in Ghana. After screening, participants were randomised to placebo (standard of care) or hydroxyurea. The primary outcome is the cumulative incidence of haematological toxicities during 12 months of blinded treatment; secondary outcomes include multiple laboratory and clinical assessments. Between April 2022 and June 2023, 112 children and 102 adults were randomised, including 44% females and average age 21.6 ± 14.5 years. Participants had substantial morbidity including previous hospitalisations (93%), vaso-occlusive events (86%), malaria (79%), often received transfusions (20%), with baseline haemoglobin 11.0 ± 1.2 g/dL and foetal haemoglobin 1.8% ± 1.5%. The spleen was palpable in six children and one adult, and ultrasonographic volumes were collected. Proliferative sickle retinopathy was common (30% children, 75% adults), but proteinuria was less common (3% children, 8% adults). Whole blood viscosity, ektacytometry, point-of-sickling, transcranial Doppler, near-infrared spectrometry (NIRS), 6-minute walk, and quality of life were also measured. Now fully enrolled, PIVOT will document the safety and potential benefits of hydroxyurea on clinical and laboratory outcomes in HbSC disease.

The Fertility Transition in Sub-Saharan Africa: The Role of Structural Change.

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children.

HIV and body mass index are associated with prolonged corrected QT interval among people with drug-resistant tuberculosis on bedaquiline-containing regimen in Uganda.

Objectives: People with drug-resistant tuberculosis (DR-TB) on bedaquiline-containing regimens are at risk for a prolonged corrected QT (QTc) interval but this problem is understudied in low-resource countries. We determined the magnitude and risk factors for QTc interval prolongation among people with DR-TB on bedaquiline-containing regimens at three referral hospitals in Uganda. Methods: Using retrospectively collected data, we designed a matched case-control study, with cases as participants with prolonged QTc interval and controls as those with normal QTc interval in 1:1. QTc interval prolongation was defined as an increase in QTc interval by 60 milliseconds in electrocardiogram from the baseline or ≥500 milliseconds during follow-up for men and women. Factors associated with cases compared with controls were identified using a multivariable conditional regression analysis at a 5% significance level, reported using odds ratio (OR) and the 95% confidence interval (CI). Results: Of 153 participants, 39 (25.5%) had a prolonged QTc interval. We matched 30 participants with prolonged QTc interval (cases) with 30 participants with normal QTc interval (controls). Cases and controls were similar in several sociodemographic and clinical characteristics but different regarding the baseline body mass index (BMI), baseline weight, and HIV infection. Increasing BMI (adjusted OR 1.29, 95% CI 1.02-1.63) and HIV infection (adjusted OR 0.27, 95% CI 0.08-0.96) were associated with the cases compared with the controls. Conclusions: We found a relatively high prevalence of QTc interval prolongation among people with DR-TB on a bedaquiline-containing regimen compared with the prevalence in healthy individuals, with a higher likelihood in those with increasing BMI and a lower likelihood in those with HIV. We recommend routine anthropometric measurements to identify individuals with DR-TB at a high risk for QTc interval prolongation. In addition, tuberculosis/HIV treatment guidelines for people with DR-TB on bedaquiline-containing regimens should include risk assessment for prolonged QTc intervals.

Prevalence and Factors Associated With Abnormal Cerebroplacental Ratio Among Women With Hypertensive Disorders of Pregnancy at a Tertiary Referral Hospital in Southwestern Uganda.

Background: Hypertensive disorders of pregnancy (HDP) are associated with placental insufficiency and adverse perinatal outcomes-over half (58.9%) of women with HDP at Mbarara Regional Referral Hospital (MRRH) have adverse perinatal outcomes. The cerebroplacental ratio (CPR) is an important predictor and prevents approximately 30% of these adverse perinatal outcomes. We determined the prevalence and factors associated with abnormal CPR among women with HDP at MRRH. Methods: We conducted a cross-sectional study from December 2022 to May 2023 at the high-risk obstetrics unit of MRRH. We consecutively enrolled all women with hypertensive disorders and gestational ages ≥ 26 weeks and performed obstetric Doppler studies to document the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and then calculated the CPR as a ratio of the MCA-PI and UA-PI. The prevalence of women with an abnormal CPR ≤ 1.0 was expressed as a percentage. We used robust modified Poisson regression analysis to determine the factors associated with abnormal CPR. Results: We enrolled 128 women with hypertensive disorders in pregnancy, with a mean age of 28.8 ± 6.3 years. Of these, 67 (52.3%) had abnormal CPR. The factors associated with abnormal CPR were severe pre-eclampsia (adjusted prevalence ratio (aPR): 5.0, 95% CI: 1.28, 29.14) and eclampsia (aPR: 5.27, 95% CI: 1.11, 34.27). Conclusion: On average, half of the women with hypertensive disorders have abnormal CPR. Women with severe pre-eclampsia or eclampsia are more likely to have abnormal CPR. Obstetric Doppler studies with CPR may be warranted for all pregnant women with severe pre-eclampsia and eclampsia. We recommend further research to assess perinatal outcomes among those with and without abnormal CPR to profile women with HDP at increased risk of adverse perinatal outcomes.

Explainable machine learning for modeling predictors of unintended pregnancy among married/in-union women in sub-Saharan Africa, a multi-country analysis of MICS 6 survey.

Introduction: Unintended pregnancy is defined as a pregnancy that is either mistimed (wanted at a later time) or unwanted (not wanted at all). It has been a concerning issue for reproductive health and public health, with significant negative effects on the mother, child, and the public at large. It is a worldwide public health issue that can have a major impact on the health of pregnant women and newborns. Methods: The study was conducted using secondary data from IPUMS Multiple Indicator Cluster Surveys round 6. The analysis was based on a data merged from six sub-Saharan Africa countries such as Gambia, Ghana, Lesotho, Malawi, Nigeria, and Sierra Leone. A total weighted sample of 28,027married/in-union reproductive-age women was included in the study. Seven machine learning algorithms were trained and their performance compared in predicting unintended pregnancy. Finally, Shapley Additive exPlanations model explanation technique was used to identify the predictors of unintended pregnancy. Results: XGBoost was the top-performing model, achieved the highest area under receiver operating characteristic curve (0.62) and accuracy (65.92%), surpassing all other models. SHAP global feature importance identified top predictors of unintended pregnancy, with women from Malawi, Ghana, and Lesotho, women having primary education and secondary education, with parity of more than three, have higher likelihood of unintended pregnancy. In the other hand, women from Nigeria and Sierra Leone, whose husband/partner has more wives or partners (polygamy relation), and women who owns mobile phone had lower risk of unintended pregnancy. Conclusion: These findings highlight the importance of considering contextual factors, such as country-specific sociocultural norms and individual characteristics, in understanding and addressing unintended pregnancies. By strategically addressing the identified predictors, policymakers, and healthcare providers can develop impactful programs that address the root causes of unintended pregnancies, ultimately contributing to improved reproductive health outcomes worldwide.

Factors affecting Kaposi's sarcoma-associated herpesvirus transmission in rural Ugandan households, a longitudinal study.

BACKGROUND: We report the impact of HIV infection within a household on oral Kaposi's sarcoma-associated herpesvirus (KSHV) shedding. METHODS: We enrolled 469 individuals from 90 households. Mouthwash rinse samples collected at three monthly visits were analyzed for KSHV DNA using quantitative polymerase chain reaction (qPCR). Generalized linear mixed effects logistic models were applied to analyze factors associated with KSHV ever shedding, and among shedders, always versus intermittent shedding. Linear mixed effects models were applied to models of KSHV viral loads. Intraclass correlation coefficients (ICCs) were calculated to assess the contribution of household-level factors to variations in shedding probabilities. Hotspot analyses of geospatial feature clusters were calculated using Getis-Ord Gi* statistic and visualized using inverse distance weighted interpolation. RESULTS: Analyses included 340 KSHV seropositive individuals, aged 3 + years, with qPCR results from 89 households. Forty households had 1 + persons living with HIV (PLWH), while 49 had none. Among participants, 149(44%) were KSHV ever shedders. Of 140 who shed KSHV at two or more visits, 34(24%) were always shedders. Increasing number of KSHV seropositive household members was significantly associated with ever shedding [Odds ratio(OR) (95% Confidence Interval(95%CI)):1.14(1.03,1.26);p = 0.013]. Among KSHV shedders, a statistically significant age-related trend was identified with 10-19 years being more likely to be always shedders (type III test p = 0.039) and to have higher viral loads (type III test p = 0.027). In addition, higher viral loads were significantly associated with increasing number of household members [coefficient(95%CI):0.06(0.01,0.12);p = 0.042], increasing number of KSHV seropositive members [coefficient(95%CI):0.08(0.01,0.15);p = 0.021], and living in households with 1 + PLWH [coefficient(95%CI):0.51(0.04,0.98);p = 0.033]. Always shedders exhibited higher viral loads than intermittent shedders [coefficient(95%CI):1.62(1.19,2.05);p < 0.001], and viral loads increased with the number of visits where KSHV DNA was detected in saliva (type III test p < 0.001). Household-level factors attributed for 19% of the variability in KSHV shedding (ICC:0.191;p = 0.010). Geospatial analysis indicated overlapping hotspots of households with more KSHV seropositive individuals and KSHV shedders, distinct from areas where PLWH were clustered. DISCUSSION: KSHV oral shedding is influenced by multiple factors at the individual, household, and regional levels. To mitigate ongoing KSHV transmission a comprehensive understanding of factors contributing to oral KSHV reactivation and transmission within households is needed.

Utilization of birth companionship and its associated factors among laboring mothers during facilities birth in sub-Saharan Africa. Systematic review and meta-analysis.

Introduction: Birth companionship is one strategy for improving maternal and neonatal quality of care, as well as their outcomes. It is a low-cost and effective care that provide mothers with evidence-based practices throughout labor and delivery in health facilities. WHO has suggested that birth companionship can be given by a family member, spouse, friend, and doula. They support laboring mothers by offering comfort via touch, massage, warm baths, encouraging mobility, promoting fluid intake and output, supplying information about the status of labor and suggestions for coping strategies, and providing a communication channel between mothers and their caregivers that helps to reduce mother and newborn mortality on a globally and regionally. Despite this benefit, no systematic review and meta-analysis studies have been conducted on this topic in study area. Therefore, this study may give the pooled utilization and associated factors of birth companionship among laboring mothers during facility birth in Sub-Saharan Africa. Methods and materials: A systematic review and meta-analysis was conducted using preferred reporting items for systematic review and meta-analysis guidelines. Data base such as PubMed with Medline, Cochrane library, direct science, google scholar and different gray works of literature/email were used on the utilization of birth companionship and associated factors of studies from 2010 to 2023 in sub-Saharan Africa. A weighted inverse variance random effect model with DerSimonian-Laird method was used to estimate pooled utilization of birth companionship Cochrane Q-test, I 2, and p-value were computed to detect heterogeneity. Egger test and funnel plot were used to detect the evidence of publication bias. We did subgroup analysis, sensitivity analysis, and meta regression to identify source heterogeneity. The protocol has been registered in PROSPERO database "CRD42024503048." Results: In sub-Saharan Africa, laboring mothers giving delivery in a facility utilized birth companionship at a rate of 34% (95% CI: 26-42, I 2 = 98.90%, p < 0.01). Subgroup analysis revealed that South Africa had the largest pooled utilization of birth companionship (49%), while Rwanda had the lowest (14.5%). Having ANC (AOR = 2.69, 95% CI: 1.66-3.73, I 2 = 10.36%), having an obstetric complication (AOR = 2.55, 95% CI: 1.69-3.4, I 2 = 0%), desiring birth companionship (AOR = 2.46, 95% CI: 1.17-3.74, I 2 = 38.46%), and being prime para (AOR = 2.51, 95% CI: 1.83-3.19, I 2 = 0%) were significantly associated with pooled utilization of birth companionship. Conclusions: There is low pooled utilization of birth companionship among laboring mothers giving delivery in an institution in sub-Saharan Africa. Factors linked to the use of birth companionship included being primipara, having antenatal care, having complications during pregnancy, and desiring companionship. The management team and healthcare personnel must take the initiative to educate mothers during antenatal care about the benefits of having a birth companion.