Search

Objectives. Congenital anomalies are an important cause of infant morbidity and mortality in Brazil. The aim of this study was to describe the prevalence of and main outcomes related to these anomalies in Brazil. Methods. This descriptive study was carried out using data from the Brazilian Information System on Live Births (known as Sinasc) and the Brazilian Mortality Information System (known as SIM) for births occurring from 2010 to 2022. Results. During this period, 37 126 352 live births were registered in Sinasc, and 309 140 live births were reported with congenital anomalies, accounting for approximately 1% of all births, and representing about 24 000 per year (prevalence: 83/10 000 live births). Limb defects were the most prevalent anomaly, occurring in 26/10 000 live births, followed by heart defects (11/10 000) and oral clefts (7/10 000). A higher prevalence of congenital anomalies was found among infants born prematurely (202/10 000), with Apgar scores ≤7 at 1 minute after birth (216/10 000) and at 5 minutes (540/10 000), and among those with low birth weight – that is, < 2 500 g – (250/10 000). A higher prevalence of congenital anomalies was observed among low birthweight infants born to mothers aged ≥35 years (115/10 000), or with a history of ≥2 miscarriages (109/10 000) or in multiple pregnancies (>120/10 000). During this period, 23 798 fetal deaths (6% of all fetal deaths) and 103 642 infant deaths (22% of all infant deaths) due to congenital anomalies were registered. The fetal mortality rate due to congenital anomalies was

Objective. To analyze a community of practice, the Global Alliance for Nursing and Midwifery (GANM), and illustrate the evolution and sustainability of a virtual community of practice aimed at enhancing knowledge acquisition and dissemination. Methods. Retrospective content analysis of data gathered from the online tracking of GANM’s community activities, engagement data, and platform logistics was conducted and analyzed. Results. The GANM hosts a diverse community of over 4 300 members from 160 countries. Members benefit from opportunities for knowledge sharing, access to evidence-based tools and materials, and the ability to engage in a creative space for asking questions, discussing current issues, networking, and forming collaborative professional relationships. The discussion forum is frequently used for disseminating new information about evidence-based practice and announcing educational opportunities. Conclusions. Through a wide variety of activities, the GANM engages a diverse community and provides an opportunity for nurses, midwives, and allied healthcare professionals around the world to network, engage in discussions, and build collective knowledge. The development of future communities of practice can be guided by existing evidence and the GANM’s collective experiences, to maintain and enhance community engagement and prevent dormancy.

The establishment of a biobank in the Caribbean represents a vital opportunity to enhance biomedical research and tackle health issues in the area. The Caribbean’s unique genetic diversity, shaped by migration and environmental factors, underscores a well-managed biobank’s potential impact on global health, especially for underrepresented groups. This paper examines biobanking’s potential in the Caribbean, focusing on precision medicine, public health improvements and regional scientific self-sufficiency. It analyzes successful models such as the UK Biobank, the All of Us Research Program at the United States’ National Institutes of Health, and Human Heredity and Health in Africa (known as H3Africa), hosted at the University of Cape Town, pinpointing key lessons on data-sharing, ethical governance and infrastructure that could be applied to the Caribbean context. The UK Biobank and H3Africa are relevant examples due to their contributions to large-scale data and health research in diverse populations. The UK Biobank project is a large-scale study with deep genetic and phenotypic data from about 500 000 participants in the United Kingdom. It offers unprecedented insights into health data through extensive follow up and collection of genome-wide genotype data. H3Africa focuses on genomics research that addresses health disparities among African populations, which parallels the Caribbean’s challenges. Its ethical governance and community engagement focus are crucial for Caribbean biobank development. This article highlights the challenges of developing biobanks, including ensuring sufficient sample storage and data security, and the need for strong governance. It recommends solutions that involve regional collaboration, stakeholder engagement and increased investment in infrastructure. Establishing a Caribbean biobank with equitable data-sharing principles can significantly enhance global genomic data sets and ensure that the benefits of precision medicine reach the Caribbean. This study promotes a strategic, ethical and inclusive approach to biobanking for long-term success.

Objectives. This study had two objectives: first, to estimate trends in affordability of sugar-sweetened beverages and nonessential energy-dense foods from 2010 to 2022 in Mexico, both nationally and by household income level. The second was to simulate the effects of different tax increases for these foods and beverages to observe how much their affordability would change compared with the current scenario. Methods. We used the 2010 to 2022 rounds of the Mexican National Survey of Household Income and Expenditures. The affordability ratio was estimated as the proportion of monthly income required to purchase 16 L of sugar-sweetened beverages and 2.8 kg of nonessential energy-dense foods, amounts that reflect median monthly consumption per household. Trends in the affordability ratio and its components (e.g. income and costs) are reported. Additionally, different tax increases were simulated for 2014–2022. Results. Nationally and among low-income households, the affordability of these foods and beverages did not show significant changes before and after the implementation of the taxes on these introduced in 2014. The simulation scenarios showed that a tax of 3 pesos/L for sugar-sweetened beverages and 32% for nonessential energy-dense foods would be effective in reducing affordability at all income levels. Conclusions. Current taxes are not high enough to significantly reduce the affordability of these foods and beverages. For low-income households, increases in income were greater than the increases in prices, thus sugar-sweetened beverages and nonessential energy-dense foods did not become less affordable, even after taxes were introduced in 2014. Tax rates would need to increase significantly to reduce affordability, and they should be adjusted for economic growth to compensate for increases in household income.

Objective: To identify barriers to and facilitators of access to perinatal mental health services among pregnant adolescents and young mothers in Belize. Methods: This was an exploratory descriptive qualitative study using focus group discussions conducted in August 2023. The study sample was selected through purposeful sampling. Participants included pregnant adolescents, adolescent mothers and young mothers from rural and urban areas in three regions of the country (Southern, Northern, and Western). The data were analyzed using thematic analysis and the results were organized into themes. Results: The barriers and facilitators identified fell into four themes. The first theme was individual factors and showed that respondents had good knowledge about mental health problems and a desire to seek mental health services. However, awareness about their availability was limited. The second theme was health systems and highlighted a lack of trust and confidence in health care providers, as well as limited access to mental health services due to insufficient human resources, long waiting times, and transportation costs. The third theme was stigma about teenage pregnancy and mental health issues. The fourth theme was social support, with both family and peer group support identified as facilitators for help-seeking among the respondents. Conclusion: This study highlights important barriers to using mental health services for pregnant adolescents and young mothers in Belize. These include stigma, lack of awareness of mental health services, and limited access to them. Implementing targeted strategies to address the barriers are recommended to improve provision and uptake of mental health services among the study population.

In October 2024, the Pan American Health Organization (PAHO) formally integrated surgical, intensive, and emergency care into its health agenda. This followed important events, including the June 2024 endorsement of the Strategy on Integrated Emergency, Critical and Operative Care 2025–2030 by the PAHO Executive Committee. This strategy builds on the 2015 World Health Assembly (WHA) Resolution 68.15, which recognized surgery as essential to universal health coverage, and the 2023 WHA Resolution 76.2, which called for standardized emergency preparedness and response. With 365 million Latin Americans lacking access to essential surgical services, the need for a regional action plan is urgent. Ecuador, the first country in Latin America to develop a national surgical, obstetric, and anesthesia plan (NSOAP), highlighted the need for integrated surgical care to address health disparities in the region. While PAHO’s formal integration is commendable, its success will rely on sustained political engagement, financial commitment, and robust monitoring. This article outlines the foundations for this strategy, the mechanisms required for successful implementation, and the role of PAHO and its Member States in strengthening surgical systems as a public health priority. By focusing on vulnerable groups and leveraging collaboration, this initiative can reduce health inequities across the Americas, reinforcing universal health coverage and access to safe, timely, and affordable surgical care.

Objetivo. Avaliar o sistema de Vigilância em Saúde das Populações Expostas a Substâncias Químicas (Vigipeq) no Brasil no período de 2011 a 2021. Métodos. Foram avaliados atributos qualitativos (simplicidade de uso; aceitabilidade/engajamento de pessoas e instituições na vigilância; flexibilidade/capacidade de adaptação; e utilidade/cumprimento dos objetivos aos quais o sistema se propõe) utilizando um questionário semiestruturado e anônimo respondido por representantes das vigilâncias em saúde ambiental nas capitais. Os atributos quantitativos sensibilidade (detecção de casos), representatividade (geração de informações precisas sobre eventos quanto a tempo, lugar e pessoa) e valor preditivo positivo (VPP, eventos verdadeiros de áreas contaminadas e populações expostas) foram derivados do Sistema de Informação de Vigilância em Saúde de Populações Expostas a Solo Contaminado. As intoxicações exógenas foram extraídas do Sistema de Informação de Agravos de Notificação. Resultados. De 2011 a 2021, houve 16 029 intoxicações exógenas e 17 753 registros de áreas contaminadas/potencialmente contaminadas no Brasil. Conforme os questionários, o sistema Vigipeq é complexo, pouco flexível e tem baixa aceitabilidade. Entretanto, a sensibilidade para reconhecer exposição foi elevada. Os VPP para detectar tanto áreas contaminadas quanto populações expostas e potencialmente expostas e contaminadas foram baixos. O cumprimento dos objetivos demonstrou a utilidade da Vigipeq. Conclusões. A Vigipeq é útil, porém pode melhorar quanto a aspectos operacionais de uso e direcionamento dos dados obtidos. O monitoramento de ações de vigilância em saúde ambiental pode ser otimizado pelo estabelecimento de indicadores de desempenho e implementação de ferramentas de previsão e intervenção em eventos futuros.

Abstract Background In sub-Saharan Africa, malaria remains a public health problem despite some reports of declining incidence in the period 2000–2018. Since 2019, there have been some reports of disease epidemics and resurgences in areas that had registered steep declines and unusual clinical presentations. This study aimed to describe the epidemiology, clinical spectrum, and outcomes of severe malaria in children among malaria-endemic Eastern Uganda, a region that has recently experienced disease epidemics. Methods This prospective study was conducted at Mbale Regional Referral Hospital, Uganda, from 08th May 2019 to August 15, 2023, as part of the Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda (EDCTP–TMA2016SF-1514-MEPIE Study). Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical World Health Organization criteria for surveillance of severe malaria were enrolled into the study following appropriate informed consent. Data were collected using a customized proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, lactate, glucose, blood gases, electrolytes, metabolites, and coagulation markers. In addition, urinalysis using dipsticks was done. Data were analysed using STATA V15. The study had ethical and regulatory approval before data collection commenced. Results A total of 1,379 participants were recruited. The median age was 4 years (2 months–12 years). Most children 757/1379 (54.9%) were under 5 years, and 825/1379 (59.8%) were males. The common symptoms were fever 1368 (99.2%), poor appetite 1095 (79.5%), inability to sit upright 1051 (76.2%), vomiting 944 (68.4%) and yellow eyes 833 (60.4%). The common signs included prostration, haemoglobinuria and jaundice. Prolonged hospitalization was found in 284/1339 (21.2%) and was associated with impaired consciousness 116/166 (30.1%), P = 0.003; haemoglobinuria 514/705 (27.1%), P 1 severity feature were at a higher risk of mortality. Conclusion In this prospective study of children with severe malaria in Eastern Uganda, the overall mortality was 3.0% and the more the disease clinical syndromes the higher the risk of death.

Abstract Background Tanzania is a malaria-endemic country that relies solely on anti-malarial drugs and vector control measures, including insecticide-treated bed nets and indoor residual spraying. However, the growing resistance to these interventions threatens their effectiveness, highlighting the need for additional strategies to accelerate malaria eradication efforts. Currently, malaria vaccines have begun to roll out in endemic areas. However, hesitancy emanating from misinformation on vaccine efficacy and safety has been recorded in various parts of the world. In this context, this study investigated the knowledge and willingness of caregivers towards the malaria vaccine. Methods This is a health facility-based cross-sectional survey conducted from September 2022 to March 2023. In total, 293 caregivers attending Ante-Natal Clinics (ANC) in selected health facilities in Dar es Salaam were recruited. A semi-structured questionnaire was used to collect caregivers’ demographic information, knowledge of malaria, knowledge of malaria vaccines and willingness to receive malaria vaccines. Results The respondents were predominantly women (97.3%) aged 18 to 52 years. Overall, 87.4% had knowledge of malaria disease, while 14% did not know how malaria is transmitted. Most respondents (86.3%) knew about malaria prevention/control methods. However, only 14.7% of the recruited caregivers were aware of the malaria vaccine. Of those exposed to vaccine messages, 67.4% were aware that the vaccine was for children under 5 years of age, while 53.5% knew that the vaccine was for pregnant women. Despite their low exposure, most respondents (92.8%) were willing to receive the malaria vaccine for their children under five years. Conclusion Malaria knowledge and willingness to vaccinate against malaria was high among Tanzanian caregivers despite the low awareness of malaria vaccines. This suggests the need for targeted information, education and communication strategies (IECs) for communities to curb misconceptions and complement their high willingness to accept the malaria vaccine in Tanzania.

Abstract Background A significant portion of malaria-related deaths occur in Africa, and Uganda is an endemic region where malaria remains a public health concern. This study aimed to determine the prevalence of malaria and its associated factors among febrile children under 15 years of age at Bududa General Hospital, Eastern Uganda. Methods This cross-sectional study was conducted between April and June 2023. Informed consent was obtained from parents/guardians before 250 febrile children below 15 years were enrolled in this study. A structured questionnaire was administered to parents/guardians to collect sociodemographic characteristics and identify factors associated with malaria. Venous blood samples were collected from the children and screened for the presence of malaria parasitaemia using blood smear microscopy. The data collected were entered into an Excel spreadsheet and analysed using STATA version 14. Logistic regression models were used to determine the factors associated with malaria, and we considered ≤ 0.05 as the level of significance. Results Out of the 250 study participants, the overall prevalence of malaria was 111(44.4%). Among the children who tested positive for malaria, 98 (88.3%) had Plasmodium falciparum, 11 (9.9%) had Plasmodium malariae, and (1.8%) had Plasmodium ovale infection. The mean parasite count was 21,951 parasites/µL of blood. The highest parasite count was 154,387 parasites/µL of blood, and the lowest count was 146 parasites/µL of blood. The prevalence rates of low, moderate, and high malaria parasitaemia were 46.8%, 28.0%, and 25.2%, respectively. In the multivariate analysis, the factors associated with malaria infections were older age; 1 to 5 years (p = 0.013), 6 to 10 years (p = 0.000), 11 to 15 years (p = 0.000), secondary education (p = 0.050), and no use of insecticide-treated bed nets (p = 0.002). Conclusion The prevalence of malaria among febrile children in this study was high, with nearly half of the participants showing severe infections. Health education on the correct use of insecticide-treated mosquito nets should be prioritized to help control malaria.

Abstract Background Restricting the placement of active ingredients (AIs) to specific panels on insecticide-treated nets (ITNs) has the potential to reduce the amount of AI required to treat a net. If the restricted placement of the AIs can exploit mosquito behaviour, particularly where they interact with the bed net interface, and not impact the net’s effectiveness, then the reduction in AI could result in cost reductions. Methods Nine individual experimental hut trials were conducted to compare the efficacy of three different partially-treated net relative to fully treated nets; roof-only treated nets, side-only treated nets, and nets with treated roof and pyrethroid-only side panels. These trials were conducted on a range of net products with different AIs, across a range of geographies in Africa (East and West), vector species (Anopheles gambiae, Anopheles coluzzii, Anopheles arabiensis, and Anopheles funestus), hut designs (East and West African style) and hosts (cows and humans). The combined data from these trials were analysed in a meta-analysis, and odds ratios for the effect of the different net designs on mortality and blood-feeding were estimated using mixed effects logistic regression. Results The results of this meta-analysis demonstrated that fully treated nets provide greater mosquito killing and reduction in blood-feeding effects than any configuration of insecticide treatment restricted to specific panels. Conclusions This meta-analysis showed that partially-treated net that restrict the insecticide treatment to specific panels of an ITN do not give equivalency or superiority in either mortality or blood-feeding inhibition to fully treated nets. The implications of these findings are discussed.

Abstract Background With the recent approval of the malaria vaccine by the World Health Organization, it is expected that global acceptance and subsequent uptake of the intervention can help to reduce the burden of the disease in Africa. This study adopted a proactive approach in assessing parents' acceptance of the malaria vaccine, alongside their willingness to pay for the novel public health intervention. Methods A national cross-sectional survey was undertaken in Nigeria using a questionnaire as the data collection instrument. The study tool was administered to parents of child-bearing age. Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) software version 25. Results A total of 1413 valid responses were received with male (49.5%) and female (50.5%) participants represented by similar proportions. Close to two-thirds (62.5%) of the participants were between the ages of 31 and 40 years, and 47.4% of the participants were educated up to national diploma level. More than two-thirds (69.6%) of the participants indicated that they were worried about side effects that may be associated with the malaria vaccine. A strong majority (90%) of the participants indicated that the vaccine should be administered at no cost to citizens, while 46.7% of the respondents were willing to pay for the malaria vaccination. Levels of education attained by the respondents influenced their willingness to pay for malaria vaccination. This variable also underpinned participants' reasons for non-acceptance of the vaccine. Those who attained only primary and secondary levels of education were significantly more likely to reject the malaria vaccine because they were against vaccines in general (AOR = 6.63; 95% CI = 1.33 – 39.25; p = 0.021). Conclusion This study provides critical novel insights which could influence vaccination efforts aimed at reducing the burden of malaria in Nigeria, as well as similar settings.

Abstract Background Obstructive sleep apnea (OSA) is a common condition in pediatrics that requires prompt recognition and management to minimize its negative impact on their health and development. Data on the prevalence of OSA among school-age minors in Jordan is scarce. This study aims to estimate the prevalence of OSA in children and adolescents and identify factors that make them more likely to have OSA and its impact on academic achievement. Methods This school‐based cross‐sectional study was conducted from January to March 2023. A questionnaire including information on demographic variables, school performance, and a validated sleep-related breathing disorder (SRBD) scale for pediatrics was distributed to 1798 students in schools all over Amman. The prevalence of OSA (defined as SRBD score > 33%) was reported as a proportion along with its 95% confidence interval. Results Out of the 2000 questionnaires distributed, 1798 were analyzed. Among these, 1079 (60%) were from children aged 5 to 10 years, and 719 (40%) were from adolescents aged 11 to 18 years. The prevalence of high risk for OSA (HR-OSA) was higher among adolescents than in children (25.6% vs. 20.8%). Adolescents with unemployed fathers were more likely to be HR-OSA (33.70 vs 17.57%, p

Abstract Objective This research reports the incidence, mortality, and disability-adjusted life years (DALYs) associated with urinary tract infections (UTIs) in the Middle East and North Africa (MENA) region, stratified by sex, age, and Socio-demographic Index (SDI) from 1990 to 2021. Methods Data were sourced from the Global Burden of Disease 2021 study, encompassing all 21 countries in the region. Metrics such as absolute counts, age-standardised rates, and percentage changes from 1990 to 2021 are presented with 95% uncertainty intervals (UIs). Results In 2019, the MENA region recorded an incidence rate of 4,033.4 per 100,000 (95% UIs: 3,553.7–4,548.7) and 7,687 deaths (95% UIs: 6,663–8,969). The DALY rate was 41.3 per 100,000 (95% UIs: 36.1–47.2), which was highest among older adults, reaching a peak in the 80–89 age range, and increasing with age, particularly from the 50 + age groups. A non-linear relationship was identified between the burden of UTIs and the SDI, with higher-than-expected rates in lower SDI countries such as Syria and Lebanon. Conclusion Despite a substantial increase in the total number of UTI cases and DALYs in the region from 1990 to 2021, the age-standardised rates remained stable. The larger burden in lower SDI countries highlights the urgent need for targeted public health interventions. Improving healthcare access and antibiotic stewardship is crucial to mitigating the growing burden of UTIs, particularly among older populations in the region.

Abstract Background Brucellosis remains a persistent public health challenge in Iran, particularly in rural regions such as Lorestan province, due to systemic, economic, and cultural barriers. Effective disease control requires multisectoral collaboration among stakeholders. This study aimed to map the stakeholder network involved in brucellosis prevention in Lorestan province, identify gaps in coordination, and provide actionable recommendations for improving control strategies. Methods This cross-sectional study employed social network analysis (SNA) to explore the relationships among key stakeholders in brucellosis prevention. Data were collected through a structured questionnaire administered to 75 experts from various sectors, including health, veterinary, agriculture, and non-governmental organizations. The SNA evaluated network density, clustering coefficient, and centrality metrics to determine the levels of collaboration and influence among stakeholders. Results The analysis revealed a moderately dense network (density: 0.2745; clustering coefficient: 0.2839) with central roles played by the Veterinary Organization of Lorestan Province, Lorestan University of Medical Sciences, and the Ministry of Agriculture. These organizations exhibited high levels of influence, support, and interest in brucellosis prevention. However, limited involvement of community-based organizations and environmental agencies was identified, highlighting a critical gap in grassroots engagement. Fragmented coordination was particularly evident in rural areas, where traditional livestock practices, inadequate veterinary services, and the consumption of unpasteurized dairy products perpetuate disease transmission. Economic constraints, such as the high cost of vaccines, along with limited public awareness, further hinder effective control efforts. Conclusions Brucellosis prevention in Lorestan province requires a comprehensive, multisectoral approach. The adoption of a One Health framework can improve collaboration among stakeholders, enhance resource allocation, and address systemic barriers. Community engagement and intersectoral coordination are essential for improving public awareness and compliance with preventive measures. These findings provide a foundation for developing a National Brucellosis Control Program and inform strategies to mitigate zoonotic diseases in similar high-risk regions.

Abstract Background Yellow fever surveillance systems are designed to identify cases of acute febrile jaundice, a clinical syndrome used to monitor the emergence of yellow fever outbreaks. However, this syndrome has diverse etiologies, particularly viral hepatitis. This study investigates the seroepidemiology of viral hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) among cases initially suspected to be yellow fever, aiming to elucidate the epidemiology of viral hepatitis in the Democratic Republic of Congo (DRC) and provide insights for improving public health interventions. Methods A retrospective cross-sectional study was conducted using serum samples collected between 2017 and 2018 through national yellow fever surveillance in the DRC. Samples from individuals testing negative for yellow fever were tested for IgM antibodies against HAV, HBc, HCV, and HEV and HBs antigen using validated ELISA kits. Acute HBV infection was defined by both HBc IgM and HBs antigen positivity. Multivariable logistic regression was used to assess the association of demographic, geographic, and environmental factors with each hepatitis type. Results Among 1239 participants (58.8% male; median age: 16 years), seroprevalence was 16.1, 11.2, 5.0, and 3.1% for HAV, HBV, HCV and HEV, respectively. HAV prevalence was highest in the youngest age group and rural residents. In contrast, the youngest group was most protected from HBV. HCV prevalence was highest in the oldest age groups. HEV exhibited higher prevalence during the dry season and in a humid subtropical climate. Several provinces were identified as hotspots of HAV, HCV and HEV. Conclusions Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province.

Abstract Pharmacy-based vaccination (PBV) programs have proven to be a promising strategy for improving vaccination coverage, particularly in resource-limited countries. These programs increase accessibility and convenience, increase vaccination rates, and benefit vulnerable populations. However, successful implementation requires addressing gaps in regulatory oversight, pharmacists training, inter-professional collaboration, and public awareness. With proper regulatory frameworks, advocacy, enhanced training programs, public education, and establishment of well-designed database, PBV can achieve outcomes comparable to high-resource settings. This commentary aims to inform stakeholders and offer practical recommendations to minimize risks while leveraging its benefits.

Abstract Background Tuberculosis (TB) is a major public health problem in South Sudan. Inadequate knowledge, negative attitudes and perceived stigma may complicate the prevention efforts. This study describes knowledge, attitude, and stigma associated with TB among communities in Wau and Jur River, South Sudan. Methods From March to May 2023, a cross-sectional study was conducted among 352 community members randomly selected from residential blocks. A validated structured questionnaire was used to collect the required data. Descriptive, bivariate and multivariate analyses were performed. Results Out of 352 respondents, 51% (n = 180) were males and 49% (n = 172) were females. Majority 227 (64.5%) had poor knowledge about TB, meanwhile hearing about TB, age and level of education were associated factors. Fear of having TB was the major negative attitude (57.1%; n = 218), and most of the respondents (n = 327; 92.9%) had a perceived stigma towards TB, voicing that they disliked drinking or eating with people with TB and/or felt uncomfortable and kept their distance from people with TB. Conclusions Communities have little knowledge, negative attitude and perceived stigma towards people with TB. Hence, tailored health messages using local languages, training of community volunteers to reach villages without accessibility and communication network are essential to improve TB prevention and control in South Sudan.

Objective: To investigate the effect of Rosa moschata (R. moschata) extract on haloperidol-induced Parkinson’s disease (PD) in rats. Methods: Haloperidol (1 mg/kg) was given to rats intraperitoneally for 3 weeks for induction of PD. R. moschata extract (150, 300 and 600 mg/kg) was administered orally for 21 days. The neuroprotective role of R. moschata leaf extract in PD was explored by performing neurobehavioral tests and RT-PCR analysis and measuring neurotransmitters and oxidative stress biomarkers. Results: An improvement in motor functions and muscle strength was observed in PD rats treated with R. moschata extract. The levels of dopamine, serotonin, noradrenaline, superoxide dismutase, catalase, glutathione, and superoxide dismutase were significantly increased (P < 0.001), whereas acetylcholinesterase and malondialdehyde levels were markedly decreased by treatment with R. moschata extract (P < 0.001). The extract also markedly downregulated the mRNA expressions of IL-1β, α-synuclein, IL-1α, and TNF-α in brain tissue. Moreover, histopathological analysis indicated that neurofibrillary tangles and plaques were noticeably decreased in a dose-dependent manner in PD rats treated with R. moschata extract. Conclusions: R. moschata extract alleviates haloperidol-induced PD in rats by reducing oxidative stress and neurodegeneration. It may be used for management and treatment of PD. However, additional studies are required to confirm its efficacy and molecular mechanisms.

Objective: To investigate the effects of Alpiniae oxyphyllae Fructus (AOF) on renal lipid deposition in diabetic kidney disease (DKD) and elucidate its molecular mechanisms. Methods: The mechanism of AOF in treating DKD was explored by network pharmacological enrichment analysis, molecular docking, and molecular dynamics simulation. The effects of AOF on renal function and lipid deposition were assessed in a mouse model of DKD and high glucose-stressed HK-2 cells. Cell viability and lipid accumulation were detected by CCK8 and oil red O staining. The expressions of PPARα and fatty acid oxidation-related genes (ACOX1 and CPT1A) were detected by quantitative RT-PCR, Western blot, and immunofluorescence. Furthermore, PPARα knockdown was performed to examine the molecular mechanism of AOF in treating DKD. Results: Network pharmacological enrichment analysis, molecular docking, and molecular dynamics simulation showed that the active compounds in AOF targeted PPARα and thus transcriptionally regulated ACOX1 and CPT1A. AOF lowered blood glucose, improved dyslipidemia, and attenuated renal injury in DKD mice. AOF-containing serum accentuated high glucose-induced decrease in cell viability and ameliorated lipid accumulation. Additionally, it significantly upregulated the expression of PPARα, ACOX1, and CPT1A in both in vivo and in vitro experiments, which was reversed by PPARα knockdown. Conclusions: AOF may promote fatty acid oxidation via PPARα to ameliorate renal lipid deposition in DKD.

The Clp/Hsp100 family, part of the ATPase associated with various cellular activities (AAA+) superfamily, includes caseinolytic peptidase B (ClpB), a highly conserved protein found in bacteria, fungi, protozoa, and plants. Notably, ClpB is present in all ESKAPE pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. ClpB plays a crucial role in reactivating and disaggregating proteins, enabling pathogens to survive under host-induced stress and conferring thermotolerance to bacterial cells. Infections caused by ESKAPE pathogens are particularly challenging due to their resistance to broad-spectrum antibiotics and biofilm formation, posing a significant global health threat as they are often multidrug-resistant, extensively drug-resistant, and pan-drug-resistant. Given its absence in human cells and its essential role in bacterial survival under stress, ClpB is a promising target for antimicrobial therapy. Targeting Hsp100 family proteins could lead to the development of novel antifungal and antiprotozoal treatments. This review explores the function of ClpB in the survival of ESKAPE pathogens and the protozoan Plasmodium falciparum. Relevant research findings were compiled using academic databases, and data analysis was performed using Clustal Omega Multiple Sequence Alignment and Boxshade tools.

Objective: To characterize mosquito larval habitats and the influence of meteorological factors on their prevalence, and to suggest alternatives for vector control in Makkah Al-Mukarramah. Methods: A mosquito survey was conducted within the 16 municipalities of Makkah Al-Mukarramah, from November 2022 to October 2023. The characteristics of larval habitats used by all reported species as oviposition sites were determined. Seasonal house, container, and breteau indices were used to determine larval abundance. Results: 16 Species belonging to five genera [Aedes (3 spp.), Anopheles (3 spp.), Culex (8 spp.), Culiseta (1 sp.), and Lutzia (1 sp.)] were collected. A total of 185 608 potential mosquito larval habitats were surveyed. Of these, 95 853 (67.4%) were Aedes, 45 522 (32%) were Culex, 718 (0.5%) were Anopheles, and 38 (0.03%) were other species; 154 726 (83.4%) were water sources for mosquito larvae, and among these sources, 7 663 (5.0%) were positive for larvae, with 45.9% indoors and 54.1% outdoors. Most of the positive larval habitats were recorded in Al-Shawqiya (1 093, 14.3%), Al-Sharayia (1 003, 13.1%) and Al-Umrah (984, 12.8%). A total of 142131 mosquito larvae and pupae were collected. The majority number of positive residences for all mosquito larvae was observed in January 2023 (1 658, 21.6%). Conclusions: New appropriate alternatives for vector control are proposed, such as mechanical, biological, and environmental control.

Objective: To investigate the prevalence, mechanisms, and trends of knockdown resistance (kdr) in Anopheles (An.) culicifacies and its impact on the efficacy of organochlorine and other insecticides. Methods: A systematic review was conducted based on PRISMA guidelines, extracting data from biooan.org, Embase, ProQuest, PubMed, Scopus, and Web of Science without a time limit until the end of 2022. Articles meeting the inclusion criteria were assessed using the STROBE checklist. Data on kdr mutations, insecticide resistance, and effectiveness were analyzed across eight selected studies from various regions. Results: The review revealed widespread kdr-mediated resistance in An. culicifacies, primarily against dichloro-diphenyl-trichloroethane (DDT), persisting even decades after discontinued use. Key kdr mutations, including L1014F and L1014S, were identified. Resistance to deltamethrin was less stable, with increased sensitivity observed after short-term discontinuation. The findings underscore the vector's sustained resistance to organochlorine insecticides and relative sensitivity to pyrethroids. Conclusions: Stable kdr resistance in An. culicifacies to organochlorine insecticides highlights the need for periodic susceptibility assessments and strategic rotation or combination of insecticides to combat malaria effectively and prevent the development of resistance.

Objective: To ascertain the prevalence and distribution of malaria parasites among the three monkeys species from three provinces in Sumatra Island, Indonesia. Methods: Infections with Plasmodium spp. were determined morphologically from the blood smears which were stained with Giemsa solution and molecularly through nested polymerase chain reaction (PCR) in DNA samples from 68 primates, which were captured at three locations: Jambi (Bungo district), Bengkulu (Muko-Muko district), and Riau Islands (Lingga district). Results: Out of 68 samples analyzed, 46 were positive for various Plasmodium species, including Plasmodium knowlesi, Plasmodium cynamolgi, Plasmodium inui, and Plasmodium coatneyi. Over one-third of the population exhibited multiple infections, with Plasmodium inui being the most predominant strain. Conclusions: The high prevalence of multiple malaria infections in monkeys, coupled with the rising reports of primate malaria cases in human raises questions about the potential for human transmission. These findings emphasize the necessity for ongoing monitoring and endeavors to comprehend and alleviate the risk of zoonotic malaria transmission, particularly in areas experiencing environmental changes.

Objective: To assess the protective effects of trigonelline against spinal cord injury (SCI) in rats. Methods: Rats (Sprague-Dawley, male) were randomly assigned to seven groups (n=15 per group): normal, sham, SCI control (1% DMSO), methylprednisolone (30 mg/kg), and trigonelline (50, 100, and 200 mg/kg). Rats received respective treatment daily for 28 days. SCI was induced by using a temporary aneurysm clip. Behavioral, biochemical, and histological analyses were performed to investigate the neuroprotective effect of trigonelline. Results: Trigonelline (100 and 200 mg/kg) treatment effectively (P

Objective: To determine the incidence, risk factors, antibiotic resistance patterns, and outcomes of various nosocomial infections in Intensive Care Unit (ICU) patients. Methods: The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months. Incidence, risk factors, and outcome parameters were calculated using Mann Whitney U test, Chi-square test, and stepwise univariate and multivariate logistic regression analysis. Results: The overall incidence of nosocomial infections was 23.5% (74/314). Ventilator-associated pneumonia was the most common infection (54.1%, 52/96), followed by catheter-related bloodstream infections (22.9%, 22/96). Stress ulcer prophylaxis (aOR 7.691, 95% CI 2.202-26.860, P=0.001), endotracheal intubation (aOR 3.251, 95% CI 1.251-8.420, P=0.015), Foley’s catheter (aOR 11.917, 95% CI 1.335-106.410, P=0.027), and ICU stay > 7 days (aOR 30.915, 95% CI 10.062-94.980, P=0.001) were statistically significant risk factors associated with nosocomial infection in ICU patients. Gram­negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline. Infected group's mortality was significantly greater than the uninfected group (21.62% vs. 5.83% P

Abstract Background Despite significant distribution of insecticide-treated net (ITNs) by the Government of Uganda to refugees, malaria is major cause of mortality and morbidity among children under five years in refugee settlements. This highlights the persistent challenges and complexities surrounding malaria control and prevention efforts in these settings. Studies that focus on the determinants of ITN utilization among children under five years in refugee settlements in Uganda are not available. Using the 2018–2019 Uganda’s Malaria Indicator Survey (UMIS) data, analysis of the individual and household factors associated with utilization of ITN among children under five in refugee settlements of Uganda was conducted. Methods This study focused on 589 children under five staying in refugee settlements located in Uganda. The extracted variables from the UMIS included social-economic factors associated with ITN utilization. Descriptive analysis was performed to generate summarized statistics, while inferential statistics by way of bivariate analysis were performed to assess the association between the outcome and the independent variables using the chi-square test, and multivariable logistic regression modelling to assess the magnitude of the associations after controlling for other covariates. All analyses considered the survey sampling design and sampling weights, and are conducted in Stata version 18. Results The odds of children sleeping under ITN were higher if their mothers had secondary and higher education (8.1 times) as well as primary education (1.5 times). The odds of children sleeping under ITN reduced by 50% if their mothers were pregnant. Interestingly, the odds of children sleeping under ITN were 70% lower if their mothers knew that ‘not sleeping in nets’ caused malaria. Mothers who were exposed to malaria messages had lower odds of their children sleeping under ITNs. Conclusions The results highlight areas of intervention that can increase ITN use in refugee settlements of Uganda. Improving access to education for mothers, providing targeted health education on the importance of ITN, dispelling misconceptions about malaria transmission, facilitating the proper installation of ITNs among others, can all contribute to increased ITN utilization among children under five.

Abstract Background Malaria remains a leading cause of death worldwide, claiming over 600,000 lives each year. Over 90% of these deaths, mostly among children under 5 years, occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The merozoites stage of the parasite, crucial for asexual development invade erythrocytes through ligand-receptor interactions. Erythrocyte binding antigen (EBA)-175 is one of the key ligands facilitating invasion via interaction with glycoprotein A (GpA) receptors on the erythrocytes. EBA-175 is known to exist in two dimorphic allelic (F and C) forms with each found to infer different virulence. There is paucity of data on the prevalence of these alleles and their epidemiology in the Ghanaian malaria landscape and hence this study. Methods Parasite gDNA was extracted from archived Dried Blood Spots (DBS) prepared from 700 confirmed malaria-infected individuals and analysed for P. falciparum EBA-175 dimorphism. Selective eba-175 gene amplification via nested PCR and allele scoring using agarose gel electrophoresis for F, C and F/C alleles. Results Of the total 632 successfully genotyped samples, prevalence of F, C, and F/C allelic forms were 61.2% (n = 387), 20.7% (n = 131), and 18.0% (n = 114), respectively. Seasonality analysis did not reveal a statistically significant difference in the prevalence of dimorphic forms between the wet (n = 475) and dry (n = 157) seasons (p = 0.051). The prevalence ratio (wet/dry) for C, F and F/C were determined to be 1.0, 1.1 and 1.4, respectively. Between 2019 and 2022, the prevalence of the alleles changed significantly (χ2 = 6.5427, p = 0.03). Geometric mean parasite density for the C, F, and F/C alleles were 21,477.1 [95%CI 15,749.2 − 29,288.1], 18,308.0 [95%CI 15,149.9–22,124.5] and 22,690.4[95% CI 16,891.9–30,479.2], respectively. Conclusion The F-allele was the most prevalent form across all age groups, followed by the C allele and mixed F/C alleles. No significant difference in allele prevalence was observed between the high malaria season (wet) and low malaria season (dry). However, a statistically significant difference in the temporal prevalence of pure alleles (F & C) between two time points was observed. The current study adds to the existing body of knowledge on eba-175 allelic dimorphism and highlights the co-circulation of alleles in high malaria endemic areas in Ghana.

Abstract Background Informal Healthcare Providers (IHCPs), including Proprietary Patent Medicine Vendors (PPMVs), drug peddlers, traditional healers, and herbal drug sellers are often the first choice for malaria treatment, especially in urban slums. Unplanned urbanization significantly impacts malaria transmission by creating cities with inadequate safety nets and healthcare access, increasing reliance on IHCPs. While the World Health Organization recognizes IHCP’s crucial role and emphasizes integrating them into formal healthcare for improved malaria care, they lack requisite training in malaria management and operate outside official regulations, raising concerns about the quality of care they provide. Understanding IHCPs' perceptions and practices is essential for their proper integration. This study explored the perceived malaria burden, IHCPs’ competence in malaria treatment, and reasons for visiting IHCPs in various urban settlements from both community member and provider perspectives. Methods This qualitative cross-sectional study was carried out in Ibadan and Kano metropolises. Eighteen Focus Group Discussions among 157 adult community members and twelve Key-Informant Interviews among PPMVs, drug peddlers, traditional healers and herbal drug sellers were conducted in these cities. Participants were drawn purposively from settlements—designated as formal, informal, and slum based on local definitions—in selected wards within the cities. Data were collected using pre-tested guides and analysed thematically. Results This study reveals that malaria remains a significant health problem in these Nigerian cities. Patronage of IHCPs generally is driven by affordable treatment, perceived mildness of illness, and access to credit facilities. However, cultural belief was key to patronage of traditional healers and herbal drug sellers, largely among informal and slum residents. Furthermore, while IHCPs had a strong perceived competence in managing malaria cases, inadequate diagnosis and treatment were standard practices. Conclusions IHCPs remain consistently patronized across urban settlements. IHCPs are continuously patronized in all urban settlement. Educating and equipping IHCPs with diagnostic tools, enhancing access to affordable healthcare, and raising public awareness is crucial for proper malaria management and promoting collaborations with formal healthcare providers.

Abstract Background Low malaria parasitaemia is a diagnostic challenge in pregnancy, leading to false negative microscopy and rapid diagnostic test (RDT) results. However, these submicroscopic or subpatent infections could cause adverse pregnancy outcomes. Thus, evaluating the diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy is vital for informed decisions. Methods A total of 835 peripheral blood and 372 placental blood samples were collected from 835 pregnant women attending first antenatal care or admitted for delivery at selected health facilities in northwest Ethiopia between November 2021 and July 2022. In multiplex qPCR, all microscopy and/or RDT positive samples were extracted and amplified individually, whereas all samples negative by both RDT and microscopy were extracted after pooling ten samples together and tested for Plasmodium genus. The diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy was compared and evaluated against each other. Results Using multiplex qPCR as a reference test, microscopy had a sensitivity of 73.8% (95% confidence interval (CI): 65.9–80.7) and 62.2% (95% CI: 46.5–76.2) to detect Plasmodium parasites in peripheral and placental blood samples, respectively, with a 100% (95% CI: 98.9–100) specificity in both samples. Similarly, the RDT had a sensitivity of 67.6% (95% CI: 59.3–75.1) and a specificity of 96.5% (95% CI: 94.9–97.8) for Plasmodium infection diagnosis in peripheral blood and a sensitivity of 62.2% (95% CI: 46.5–76.2) and a specificity of 98.8% (95% CI: 96.9–99.7) in placental blood samples. Considering microscopy as a reference test, multiplex qPCR showed a sensitivity of 100% (95% CI: 96.6–100) and a specificity of 94.8% (95% CI: 93.0–96.3) to diagnose Plasmodium infections in both peripheral and placental blood samples. Pooled multiplex qPCR detected 34 peripheral and 12 placental blood Plasmodium infections from microscopy and RDT negative samples. The pooled assay obviated about half of the reactions and its testing costs. Microscopy showed almost perfect agreement (κ = 0.823) with multiplex qPCR for detecting malaria parasites in pregnancy, whereas the RDT showed a substantial agreement (κ = 0.684). Conclusion Multiplex qPCR had a better performance for Plasmodium infection diagnosis in pregnancy compared to microscopy and RDT. Pooled multiplex qPCR could be a sensitive and resource-efficient strategy for epidemiological surveillance of Plasmodium infections in pregnancy.

Abstract Background Synergists reduce insecticide metabolism in mosquitoes by competing with insecticides for the active sites of metabolic enzymes, such as cytochrome P450s (CYPs). This increases the availability of the insecticide at its specific target site. The combination of both insecticides and synergists increases the toxicity of the mixture. Given the demonstrated resistance to the classical insecticides in numerous Anopheles spp., the use of synergists is becoming increasingly pertinent. Tropical plants synthesize diverse phytochemicals, presenting a repository of potential synergists. Methods Extracts prepared from medicinal plants found in Jamaica were screened against recombinant Anopheles gambiae CYP6M2 and CYP6P3, and Anopheles funestus CYP6P9a, CYPs associated with anopheline resistance to pyrethroids and several other insecticide classes. The toxicity of these extracts alone or as synergists, was evaluated using bottle bioassays with the insecticide permethrin. RNA sequencing and in silico modelling were used to determine the mode of action of the extracts. Results Aqueous extracts of Piper amalago var. amalago inhibited CYP6P9a, CYP6M2, and CYP6P3 with IC50s of 2.61 ± 0.17, 4.3 ± 0.42, and 5.84 ± 0.42 μg/ml, respectively, while extracts of Kalanchoe pinnata, inhibited CYP6M2 with an IC50 of 3.52 ± 0.68 μg/ml. Ethanol extracts of P. amalago var. amalago and K. pinnata displayed dose-dependent insecticidal activity against An. gambiae, with LD50s of 368.42 and 282.37 ng/mosquito, respectively. Additionally, An. gambiae pretreated with K. pinnata (dose: 1.43 μg/mosquito) demonstrated increased susceptibility (83.19 ± 6.14%) to permethrin in a bottle bioassay at 30 min compared to the permethrin only treatment (0% mortality). RNA sequencing demonstrated gene modulation for CYP genes in anopheline mosquitoes exposed to 715 ng of ethanolic plant extract at 24 h. In silico modelling showed good binding affinity between CYPs and the plants’ secondary metabolites. Conclusion This study demonstrates that extracts from P. amalago var. amalago and K. pinnata, with inhibitory properties, IC50

Abstract Background The World Health Organization conditionally recommends reactive drug administration to reduce malaria transmission in settings approaching elimination. However, few studies have evaluated the impact of reactive focal drug administration (rFDA) in sub-Saharan Africa, and none have evaluated it under programmatic conditions. In 2016, Senegal’s national malaria control programme introduced rFDA, the presumptive treatment of compound members of a person with confirmed malaria, and reactive mass focal drug administration (rMFDA), an expanded effort including neighbouring compounds during an outbreak, in 10 low transmission districts in the north of the country. This evaluation sought to measure the impact of rFDA and rMFDA on malaria incidence. Methods An interrupted time series analysis was conducted with routine surveillance data on health post-level monthly confirmed malaria case counts from the District Health Information Software (DHIS2). The study evaluated the change in incidence following rFDA and rMFDA rollout (level change), which ranged from August 2016 to November 2019, and monthly thereafter (trend change), using an adjusted negative binomial regression model with data from January 2015 through January 2020. The model was used to estimate the number of cases averted via a counterfactual simulation. Results No incidence rate reductions were estimated immediately following rollout (level change: incidence rate ratio (IRR) = 1.00, 95% credible interval (CI) = 0.76, 1.33). However, rFDA and rMFDA were associated with a 4% monthly decline in incidence relative to the baseline trend (trend change: IRR = 0.96, 95% CI = 0.95, 0.98). Over the study period, RFDA and rMFDA were estimated to avert 2,070 (95% CI = 577, 4,367) of 4,108 (95% CI = 2,620, 6,425) malaria cases. Conclusions RFDA and rMFDA were associated with reduced malaria incidence in northern Senegal, supporting their use in malaria control in very low transmission areas. However, additional strategies are likely needed to achieve elimination in this setting.

Abstract Background Foreign migrant workers from malaria-endemic regions play a critical factor in the transmission of malaria to non-endemic areas, mainly due to their mobility while seeking employment opportunities. This risk is particularly heightened in areas where malaria vectors are present. Methods This study aimed to investigate the malaria vectors in two sub-districts in Khon Kaen Province, known for their factory areas and the significant presence of Myanmar migrant worker communities. The collection was carried out from June 2020 to May 2021. The black light traps (BLT) operated continuously from 6:00 pm to 6:00 am (12 h) and Kelambu trap (KT) were set up from 6:00 pm to 9:00 pm, with both traps set up once a month. A total of 679 female Anopheles mosquitoes were collected near the workplaces and dormitories of these workers. Subsequently, the collected female mosquitoes underwent morphological identification using Standard Thailand keys and polymerase chain reaction analysis with rDNA ITS2 primers. Results Morphological identification revealed that 201 (29.6%) belonged to the Barbirostris complex. The remaining Anopheles mosquitoes are in the subgroup Cellia, comprised 437 (64.4%) Anopheles vagus, 39 (5.7%) Anopheles subpictus, and 2 (0.3%) Anopheles annularis. To distinguish the Barbirostris complex, multiplex PCR based on ITS-2 sequences was conducted. Out of the 201 specimens examined, 153 (76.1%) as Anopheles campestris, 36 (17.9%) as Anopheles wejchoochotei, and 12 (6%) as Anopheles dissidens. Additionally, the subgroup Anopheles Cellia was confirmed using specific primers based on ITS-2 sequences. Conclusions From the obtained results, An. campestris, An. wejchoochotei, An. vagus and An. annularis are reported as the malaria vectors in Thailand. The findings emphasized the important of addressing the presence of Anopheles malaria vectors, especially in the substantial migrant worker population originating from endemic areas. This situation raises concerns regarding the potential transmission of malaria infections to regions not traditionally affected by the disease. Epidemiological studies on malaria vectors should not solely concentrate on endemic regions but also extend to non-endemic areas because of the mobility of migrant workers throughout the country. This broader approach is crucial for implementing an effective malaria surveillance strategy. Graphical Abstract

Abstract Background Congenital malaria remains a significant public health challenge in Nigeria, particularly in regions with high malaria endemicity. The increased vertical transmission of malaria is partly associated with the high susceptibility of women to malaria during pregnancy. This systematic review aimed to assess the prevalence, characteristics, and treatment outcomes of congenital malaria in Nigeria. Methods Twelve studies were included in this review. Studies were retrieved from multiple electronic databases such as PubMed, EMBASE, Google Scholar, Scopus, Web of Science, African Journals Online (AJOL), and Cochrane Library and subjected to a multistage screening per established eligibility criteria. The study was registered with PROSPERO and was conducted per PRSIMA-established guidelines. Quality assessment of included studies was done using the Critical Appraisal Skills Programme (CASP) framework, while a narrative synthesis synthesized and summarized extracted data. Results The prevalence of congenital malaria in Nigeria ranged from as low as 5.1% to as high as 96.3%. Clinical manifestations were often non-specific, with fever being the most common symptom. Treatment regimens included a variety of antimalarial drugs, such as chloroquine, sulfadoxine-pyrimethamine, amodiaquine, quinine, and artemisinin-based combination therapy. While treatment outcomes were generally positive, some studies reported complications and deaths. Conclusions The findings highlight the need for improved diagnostic tools, standardized treatment protocols, and targeted interventions in high-burden areas. Further research is required to investigate the long-term health outcomes of neonates with congenital malaria and to evaluate the effectiveness of different treatment strategies. By addressing these gaps, effective prevention and management strategies can be developed to reduce the burden of congenital malaria in Nigeria.

Abstract Background Imported malaria from southern Mozambique drives low levels of disease transmission in KwaZulu-Natal, South Africa. Therefore, the South African Department of Health funded implementation of indoor residual spraying (IRS) in Mozambiquan districts identified as sources of malaria infection for border communities in KwaZulu-Natal. IRS was initiated in districts of Guija, Inharrime, Panda and Zavala. To determine impact of spraying on malaria transmission in these districts, data relating to incidence and prevalence was collected before spraying (2018) and before the second round of spraying was completed (2023). Implementation of IRS was also monitored to ensure optimal spray coverage was achieved. Methods The study was a cross-sectional survey conducted in 6 sentinel sites in each of the four afore-mentioned districts, focusing on children 6 months to 95%) resulted in greater population protection. Conclusion The study revealed that IRS implementation decreased malaria prevalence in Inharrime and Panda but not in Guija and Zavala. To ensure that cross-border movement of people does not result in increased malaria transmission, targeting areas identified as source of infection in travelers is paramount to reaching elimination.

Abstract Background The Plasmodium proteasome emerges as a promising target for anti-malarial drug development due to its potential activity against multiple life cycle stages. Methods In this investigation, a comparative analysis was conducted on the structural features of the β5 subunit in the 20S proteasomes of both Plasmodium and humans. Results The findings underscore the structural diversity inherent in both proteasomes. The human proteasome β5 subunit reveals a composition rich in β-sheets and adopts a more compact conformation. This structural arrangement limits the ligand binding pocket's capacity to accommodate only small compounds effectively. In contrast, the Plasmodium β5 subunit exhibits a higher prevalence of loop structures, creating a more open and flexible binding pocket. This unique structural characteristic enables the binding of a larger and more diverse array of compounds. Conclusion The discernible structural contrast between the human and Plasmodium proteasome β5 subunits holds promise for the identification of Plasmodium-selective compounds. The ability of the Plasmodium proteasome to accommodate a broader range of compounds due to its distinctive structural features opens avenues for drug screening to intending to develop selective anti-malarial agents. This study contributes valuable insights into the structural basis for targeting the Plasmodium proteasome and paves the way for the rational design of compounds with enhanced specificity and efficacy against malaria.

Abstract Background The negative impact of COVID-19 pandemic on healthcare service utilization has been reported in several countries. In Gabon, data on the preparedness for future pandemic are lacking. The aim of the present study was to assess the trends of hospital attendance, malaria and self-medication prevalences as well as ITN use before and during Covid-19 first epidemic waves in a paediatric wards of a sentinel site for malaria surveillance, in Libreville, Gabon. Methods This was a retrospective descriptive and hospital-based survey which was conducted at the Regional Hospital of Melen Estuaire (RHME). Census of files of patients below 18 years of age attending for fever management with a result of malaria biological diagnosis from January 2018 to December 2022 was conducted. Comparison of the prevalence of microscopic malaria, ITN use, self-medication and the fever duration prior the screening before and after year 2020 was performed using bivariate and multivariate analysis. Results Overall, 14428 febrile participants were screened for malaria. A 15% increase in the number of febrile patients was observed between 2019 and 2020 while this rate was above 100% in 2021 and 2022. The frequency of self-medication significantly doubled in 2020 and 2021 compared to the pre-COVID-19 period (p

Abstract Background While antimicrobial use (AMU) in human healthcare has received significant attention as a key driver of antimicrobial resistance (AMR), less emphasis has been placed on AMU practices and attitudes in animal husbandry. To address this gap, this study examines the patterns and underlying drivers of AMU on animal farms. Methods A survey instrument was distributed to farm staff in 150 animal farms across 15 Egyptian governorates. Farms were selected from a list curated by a private platform specialized in Egypt’s poultry and cattle industry. An online search was conducted to identify additional farms not included in the list or when the contact information was unavailable. The instrument covered key items related to AMU including types of antimicrobials used, indications, their perceived benefits, and the feed conversion ratio (FCR). Using the theory of reasoned action (TRA) as a guiding theoretical framework, this study assesses key factors influencing the AMU behavior of farm personnel. Results Out of 150 farm personnel invited to fill out the survey forms, 111 (74%) responded and agreed to participate. All surveyed personnel reported using antimicrobials, and almost two-thirds (65%) reported using them for non-therapeutic purposes. Non-therapeutic use of antimicrobials, however, had no impact on FCR across all farm types (poultry, cattle, and mixed). The most used antimicrobials were penicillins (81%), followed by macrolides (78%) and tetracyclines (72%). Half of the studied farms reported using colistin, with more than half of this segment (55%) reporting using it for non-therapeutic purposes. Farm personnel’s AMU behavior was associated with the TRA constructs: perceived benefits of antimicrobials (attitude) and perceived AMU behavior in other farms (subjective norm). Conclusions Antimicrobials are unanimously used in animal farms in Egypt, including those classified as last-resort options, such as colistin. Using antimicrobials for disease prevention or growth promotion did not decrease the FCR. Interventions that target the farm personnel’s attitude and the subjective norm should be carried out to change their behavior regarding the use of antimicrobials. Egyptian guidelines for AMU in livestock are urgently needed, along with training to raise awareness of AMR and safer practices. The use of last-resort drugs like colistin should be banned in animal farming, and national surveillance systems should monitor AMU and AMR trends.

Abstract Introduction Flaviviruses such as dengue virus (DENV), Zika virus (ZIKV), Japanese encephalitis virus (JEV), and Yellow fever virus (YFV) are mosquito-borne RNA viruses causing major public health threats in major parts of the world. While DENV and ZIKV have been detected in urine samples, data on the presence and stability of flaviviruses in the water environment are limited. Methods In this study, we determined the stability and infectivity of flavivirus in different water environments by utilizing RT-qPCR and plaque assay to explore the feasibility of environmental detection and surveillance of flaviviruses. Results Viral RNA could be detected for up to 49-days, at 4 °C, 25 °C and 37 °C temperatures, and infectious particles could be detected for up to 7 days. While our findings showed that flaviviral RNA has higher stability and better detection rates at lower temperatures, the infectious capacity of flaviviruses was comparatively short at 7 days. Conclusions Our results indicate that flaviviruses retains limited infectivity in general water environments and highlight the feasibility of detection and surveillance in various epidemiologic and environmental settings.

Abstract Background Childhood is a crucial period that shapes a person’s growth and development. For orphans, a lack of familial support affects their upbringing, making orphanages crucial for care. Children living in orphanage centers are vulnerable to several conditions, including dermatological disorders, due to factors such as malnutrition, overcrowding, and poor hygiene. The current study was carried to determine the prevalence and patterns of skin disorders among orphan children in Egypt, and to identify associated risk factors among orphans in Egypt. Methods A cross-sectional study was conducted among 415 children aged 1–18 years living in orphanage centers in Fayoum and Giza governorates, Egypt. Results Among the children, 77.1% had at least one skin disorder, with noninfectious conditions being more prevalent than infectious conditions (67.4 vs. 24.3%). The most common noninfectious conditions were dermatitis/eczema, pigmentary disorders, skin appendage disorders, and psycho-cutaneous issues. Fungal infections were the most common infectious condition. There was a significant relationship between hygiene and the type of skin disorder. Conclusion The prevalence of skin diseases in orphanages in Egypt is relatively high and is dominated by noninfectious skin diseases, and the prevalence of psycho-cutaneous disorders is high among these children. Comprehensive care strategies focusing on improving hygiene and emotional support and preventing abuse are essential for reducing the incidence of skin disorders and enhancing the overall health of orphaned children.

Romaric Nzoumbou-Boko,1,2 Mireille Cornelia Ingrid Denissio Morissi Nalingbo,1,3 Brice Martial Yambiyo,4 Roger Detol,5 Ermeland Rock Feller Moussa,1 Didita Nalinga,1 Lydie Joella-Venus de la Grace Namsenei-Dankpea,4 Alexandre Manirakiza,4 Lawrence Ayong,6 Yap Boum II1,7 1Parasitology Laboratory, Pasteur Institute of Bangui, Bangui, Central Africa Republic; 2Faculty of Science, University of Bangui, Bangui, Central Africa Republic; 3Faculty of Health Sciences, University of Bangui, Bangui, Central Africa Republic; 4Epidemiology Department, Pasteur Institute of Bangui, Bangui, Central Africa Republic; 5Medical Entomology Department, Pasteur Institute of Bangui, Bangui, Central Africa Republic; 6Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon; 7Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CamerounCorrespondence: Romaric Nzoumbou-Boko, Parasitology Laboratory, Pasteur Institute of Bangui, P.O. Box 923, Bangui, Central Africa Republic, Tel +236 75692448, Email romaric.nzoumbou-boko@pasteur-bangui.cfBackground: Malaria is a major public health problem in the Central African Republic (CAR). Data on malaria epidemiology are often derived from confirmed cases of symptomatic malaria using passive detection approaches, with very limited knowledge of the extent of subclinical and submicroscopic infections.Methods: A community-based cross-sectional study was conducted in Bangui, the capital of the CAR, to assess the prevalence of subclinical malaria parasitaemia. Proportions of positive tests for malaria parasites were determined by combining the results of antigen-based malaria rapid diagnostic test (mRDT), thick blood smear microscopy, and polymerase chain reaction (PCR).Results: A total of 638 participants (mean age, 26.44 years (range, [1– 75] years) with a sex ratio (M/F) of 1.22) were tested for malaria using all three detection methods. Proportions of positives were 32.45% by PCR, 27.59% by mRDT, and 23.51% by Giemsa-based thick blood smear microscopy, representing the burden of subclinical malaria. In addition, a 9.56% prevalence of submicroscopic infections was observed. Subclinical malaria was more common in individuals aged 15– 49 years, and microspatial heterogeneity in positivity was observed, with the majority of cases occurring in semi-urban areas by mRDT and microscopy, respectively. Approximately, 80% of microscopy-positive subjects had a low parasite density (< 1000 parasites/μL whole blood). Although P. falciparum was the most common species (98.55%), the transmission of P. ovale appears to be well-established in the area, occurring either as mono-infection (1.45%) or co-infection (1.93%) with P. falciparum.Conclusion: This study of community malaria in Bangui highlights the high burden of subclinical malaria in the community and provides essential baseline data to guide future research on malaria parasites in the CAR, particularly regarding the circulating parasite species. The high prevalence of community malaria demonstrates its persistence as a major public health challenge in the country, highlighting the need to intensify its ongoing control using new tools such as the upcoming malaria vaccine.Plain Language Summary: Malaria is widespread in the Central African Republic, with prevalence data based mainly on highly flawed medical records. Moreover, little is known about the extent of, and factors associated with subclinical Plasmodium infections, which are essential for guiding ongoing antimalarial interventions in the community. Subclinical infection is defined as an infection with no noticeable clinical symptoms.This study demonstrated that one out of three people living in Bangui is carrying malaria parasite without showing any symptoms. This high prevalence of low-density Plasmodium infections in the Bangui community, especially in 15– 49 age group, raises concerns about the persistence of malaria in the community and the opportunity for its elimination in CAR.The current findings underscore the need to intensify community-based interventions, including vaccination, against malaria, particularly in CAR and Bangui.Keywords: malaria, subclinical parasitaemia, Bangui, Central African Republic

Objetivo. Validar la aplicabilidad de la prueba de rosa de bengala (RB), enzimoinmunoensayo (ELISA) indirecto IgG o IgM y la prueba Brucellacapt® al contexto local, determinar la seroprevalencia de brucelosis y evaluar el conocimiento sobre la enfermedad en personas a riesgo en una zona lechera de La Maica, Cochabamba (Estado Plurinacional de Bolivia). Métodos. La validación de las pruebas se realizó inicialmente en un grupo de 76 personas, la población de estudio final fue de 330 personas, que además participaron en una encuesta socioepidemiológica. Resultados. De 330 muestras analizadas, 12,7 % fueron positivas, ya sea por la prueba de rosa de bengala (RB) o por Brucellacapt®. El ELISA indirecto IgG dio resultados falsos positivos, lo que indica que se debe adaptar el punto de corte a la situación epidemiológica local. Casi la totalidad de casos positivos por RB fueron asintomáticos. La encuesta socioepidemiológica resalta la falta de información y de conciencia sobre la naturaleza zoonótica, el modo de transmisión y los síntomas de la brucelosis. Conclusión. Este estudio reveló una seroprevalencia elevada de brucelosis en la zona lechera La Maica en Cochabamba (Estado Plurinacional de Bolivia), con muchos casos asintomáticos y un número elevado de falsos positivos con ELISA indirecto IgG. Se recomienda realizar campañas de concientización sobre los riesgos de esta enfermedad y desalentar el consumo de leche cruda.

Objective. To conduct a point prevalence survey (PPS) of antibiotic use in the main pediatric tertiary-level hospital in Panama City to establish antibiotic prevalence and identify key areas for addressing antimicrobial resistance. Methods. This point prevalence survey (PPS) conducted in a tertiary-level hospital in Panama followed the Pan American Health Organization’s adaptation of the methodology proposed by the World Health Organization for PPSs on antibiotic use. Information obtained included patients’ demographic characteristics, antimicrobial prescriptions, indication for antimicrobial use, and prescription’s adherence to guidelines. Results. Of 298 patients surveyed from August to September 2023, 176 (59.0%) were treated with antibiotics. The pediatric ward (86.3%) and the neonatal intensive unit (80.0%) had the highest prevalence of antibiotic use. Hospital-acquired infections accounted for 32.6% of antibiotic prescriptions, with piperacillin/tazobactam (29.4%), meropenem (15.3%), amikacin (15.3%), and ampicillin/sulbactam (10.2%) being the most prescribed. Treatment for community-acquired infections represented 55.9% of antibiotic prescriptions, with ampicillin (24.6%), gentamicin (22.6%), and ampicillin/sulbactam (14.0%) being the most frequently used. Of the prescriptions considered in the analysis, 61.0% adhered to hospital guidelines. Conclusions. This PPS observed a high prevalence of antibiotic use. The findings suggest it is necessary to assess the need for ampicillin, gentamicin, and piperacillin-tazobactam use in patients admitted to pediatric critical care units, with special emphasis on children with pneumonia and sepsis diagnosis, the most common pathologies for which an antimicrobial was prescribed.

Objetivo. Describir el funcionamiento del sistema de vigilancia de los eventos supuestamente atribuibles a la vacunación o inmunización (ESAVI) en Colombia con las herramientas de evaluación propuestas por la Organización Mundial de la Salud (OMS). Métodos. Se realizó un estudio descriptivo sobre el funcionamiento del sistema de vigilancia de ESAVI por vacunas contra la COVID-19, entre el 17 de febrero del 2021 y el 30 de setiembre del 2023. Se adaptaron los indicadores de la OMS tipo estructura, proceso y resultados. La información cualitativa se obtuvo de documentos oficiales y consultas técnicas, mientras que los datos cuantitativos de VigiFlow® y del Sistema Integrado de Información de la Protección Social. Resultados. El Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA) colaboró como autoridad regulatoria con el Ministerio de Salud y Protección Social y el Instituto Nacional de Salud en la farmacovigilancia de vacunas contra la COVID-19. Se establecieron comités de expertos a nivel nacional y subnacional para evaluar los ESAVI. Se implementó VigiFlow® para notificar y gestionar los casos, se promovieron capacitaciones, así como la detección de señales y acciones regulatorias, con base en los protocolos de la OPS y la Organización Mundial de la Salud. La información sobre ESAVI se difundió a través de boletines y se fortaleció la cooperación técnica entre el INVIMA y la OPS. Conclusiones. Se cumplieron con los indicadores de vigilancia de los ESAVI contra la COVID-19. Las regulaciones y funciones de las autoridades sanitarias proporcionaron una base sólida para las actividades de farmacovigilancia de vacunas, lo que permitió un uso efectivo de recursos técnicos. Es necesario una estructura de requisitos legales para las vacunas no COVID-19, capacitación continua y un enfoque automatizado para mejorar la capacidad del programa de seguridad de vacunas.

Abstract Background Emodepside is an anthelmintic used in veterinary medicine that is currently under investigation in human clinical trials for the treatment of soil-transmitted helminths and possibly Onchocerca volvulus. Emodepside targets the calcium-activated voltage-gated potassium slowpoke 1 (SLO-1) channels of presynaptic nerves of pharynx and body wall muscle cells of nematodes leading to paralysis, reduced locomotion and egg laying, starvation, and death. Emodepside also has activity against Drosophila melanogaster SLO-1 channels. Orthologous SLO-1 genes are present in Anopheles gambiae and Aedes aegypti, suggesting that emodepside may have activity against mosquitoes. Methods Both Anopheles dirus and Ae. aegypti were blood-fed emodepside across a range of concentrations (1–10,000 nM) and mosquito survival was monitored for 10 days. Co-feeding experiments were also performed with An. dirus blood fed ivermectin at the concentrations that kills 25% (LC25) and 50% (LC50) of mosquitoes with and without emodepside at clinical peak concentration in humans (Cmax) and five times the Cmax, and mosquito survival was monitored for 10 days. Results Emodepside had weak mosquito-lethal effects in An. dirus but none observed in Ae. aegypti at the concentrations evaluated. The An. dirus emodepside LC50 was 4,623 [4,159–5,066] ng/ml which is > 100-fold greater than the peak concentrations seen in human. The ivermectin and emodepside co-feed experiment with An. dirus did not indicate any altered effect of ivermectin on mosquito survival when emodepside co-fed at human Cmax or five times that of the human Cmax. Conclusions Emodepside was not lethal to An. dirus at human-relevant concentrations and had no effect on Ae. aegypti survival. Thus, mass distribution of emodepside does not appear to be a potential tool for vector-borne disease control. Emodepside induced mortality in An. dirus does suggest that the SLO-1 channel could be a potential target for novel vector control and may warrant further investigation.

Abstract Background Under-5 children have been known to bear a significant burden of malaria in endemic countries. Though significant progress has been made towards malaria prevention and control in Nigeria, it is expected that the addition of new malaria prevention strategy, such as perennial malaria chemoprevention (PMC) can contribute to a more rapid decline in malaria cases. This study aimed to determine the prevalence and factors associated with malaria and anaemia among children aged 2–18 months in Osun State. Methods A cross-sectional household malariometric study was conducted in 80 communities across eight Local Government areas (LGAs) in Osun State. Ethical approval was obtained from Osun State Health Research Ethical Committee (OSHREC/PRS/569T312/ on the 22nd of May 2023. Malaria test positivity was determined by rapid diagnostic test (RDT) and microscopy. In addition, haemoglobin levels were measured using Haemocue® Hb 201. Caregivers were interviewed on malaria management practices using tools adapted from Nigeria Malaria Indicator Survey. Results A total of four hundred children aged 2–18 months were assessed in this study, which was conducted in July 2023. The caregivers were mostly the biological mothers of the children (n = 387, 96.8%). Female children were 51.8% and their male counterparts 48.2% respectively. Malaria positivity rate by RDT was 36.8% and this was higher in children aged 13–18 months (48.0%) and followed by those aged 7–12 months (44.0%). By microscopy, the positivity rate was 12.5% overall, with 15.0% positivity rate among children aged 7–12 months, about 13.5% among those 13–18 months and those aged 2–6 months had the least positivity rate whether by microscopy (8.5%) or RDT (18.5%). Overall, the prevalence of severe anaemia was 4.0%, moderate was 37.3%, mild was 18.3% and the normal was 40.4% respectively. However, higher proportion of moderate anaemia (7.0–9.9 haemoglobin (g/dL)) was reported in older children. Children from medium wealth households (aOR = 0.549; 95% CI 0.306–0.986) and those from rich households (aOR = 0.543; 95% CI 0.283–1.042) had 45.0% reduction in the odds of having malaria, when compared with their counterparts from poor households. In addition, children aged 7–12 months (aOR = 2.856; 95% CI 1.524–5.354) and those aged 13–18 months (aOR = 4.269; 95% CI 2.422–7.526) had higher odds of malaria infection, respectively, when compared with children aged 2–6 months. Conclusion Malaria infection and anaemia were found to be higher in older children. Household wealth and child’s age were significantly associated with malaria infection. These findings would inform the positioning of PMC intervention touch-points to reduce malaria burden in young children.

Abstract Monkeypox virus (MPXV) is an enclosed, double-stranded DNA virus from the Orthopoxvirus genus, which also contains variola, vaccinia, and cowpox. MPXV, which was once confined to West and Central Africa, has recently had a rebound, spreading beyond its original range since 2017. The virus is distinguished by its unique morphology, which includes an oval or brick-shaped structure and a complex lipid and protein makeup. The current multi-country outbreak designated a public health emergency in 2022, has highlighted MPXV’s shifting epidemiology and ability to spread rapidly over the globe. ‘No one is safe until everyone is safe’ is a slogan we often heard during the COVID-19 pandemic, which is now also required for the growing global and regional mpox outbreaks. The epidemic is divided into two clades: Clade I and Clade II, which have distinct pathogenic characteristics. Diagnostic approaches have developed with advances in molecular techniques, yet problems persist in resource-constrained situations. This overview summarizes the virus’s history, epidemiology, morphology, and clinical characteristics, offering insights into its recent comeback and current global response efforts.

Abstract Background In moderate-to-high malaria transmission regions, the World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) alongside insecticide-treated bed nets to reduce the adverse consequences of pregnancy-associated malaria. Due to high-grade Plasmodium falciparum resistance to SP, novel treatment regimens need to be evaluated for IPTp, but these increase pill burden and treatment days. The present qualitative study assessed the acceptability of IPTp-SP plus dihydroartemisinin-piperaquine (DP) in Papua New Guinea, where IPTp-SP was implemented in 2009. Methods Individual in-depth interviews (IDIs) and focus group discussions were conducted at health facilities where a clinical trial evaluated IPTp-SP plus DP (three-day regimen) versus IPTp-SP plus DP-placebo. IDIs were conducted with: (1) trial participants at different stages of engagement with ANC and IPTp, e.g. first antenatal clinic visit, subsequent antenatal clinic visits and postpartum; (2) local health workers (nurses, community health workers, midwives, health extension officers, doctors); and (3) representatives of district, provincial and national health authorities involved in programming ANC and IPTp. Focus group discussions comprised pregnant women only, including those engaged in the clinical trial and those receiving routine ANC outside of the trial. All interviews were audio recorded and transcribed. Transcripts were analysed using inductive and deductive thematic analysis applying a framework assessing: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. Results Women expressed positive feelings and attitudes towards SP plus DP/DP-placebo; reported limited side effects; and found the size, number, colour, and taste of study medicines acceptable. Health workers and policymakers were concerned that, compared to SP alone, additional tablets, frequency (three-day regimen), and tablet size might be barriers to acceptability for users outside a non-trial setting. There was a high perceived effectiveness of SP plus DP; most women reported that they did not get malaria or felt sick during pregnancy. Broader healthcare benefits received through trial participation and the involvement of health workers, relatives and community members in the clinical trial enabled antenatal clinic attendance and perceived acceptability of this IPTp regimen. Conclusions In the trial context, IPTp-SP plus DP was acceptable to both users and providers. Healthcare providers were concerned about the realities of acceptability and adherence to SP plus DP outside a clinical trial setting.

Abstract Background Acceptability of malaria chemoprevention interventions by caregivers is crucial for overall programme success. This study assessed coverage and acceptability of Seasonal Malaria Chemoprevention (SMC) in selected communities in the Northern part of Ghana. Methods An analytical cross-sectional design was conducted from “July 23rd to August 4th, 2020—a 12-day period that covered 5 days of the first SMC implementation cycle and 7 days post-implementation. Using a stratified multi-stage sampling technique, a total of 495 caregivers providing care for 569 eligible children aged 3–59 months from randomly selected households in the study communities were enrolled into the study. Acceptability of SMC was assessed on a set of 19 questionnaire items-8 of the items measured caregivers’ perceptions and 11 items measured children’s reaction to administered medicines. Univariable and stepwise multivariable logistic regression analyses were performed to assess the predictors of acceptability of SMC at a 95% confidence interval and a p-value of 0.05. Results SMC coverage was 95.1% (541/569). Caregivers had a good level of knowledge of SMC (n = 475; 96.0%; 95% CI 94.2—97.7%) and a good perception of SMC (n = 471; 95.2%; 95% CI 93.3–97.0). Seven out of ten caregivers (70.9%; 95% CI 66.9–74.9%) had good acceptability of SMC. For 7 out of 28 children who did not receive the SMC intervention, their caregivers intentionally refused them the intervention. Of those that received the treatment, 17.2% (n = 85; 95%CI 13.8–20.5%) of caregivers had at least one leftover amodiaquine tablet after the third day of treatment. Caregivers who practice Christianity or Islam had better acceptability than caregivers who practice African traditional religion (p

Abstract Background Global progress toward malaria elimination and eradication goals has stagnated in recent years, with many African countries reporting increases in malaria morbidity and mortality. Insecticide-treated nets and indoor residual spraying are effective, but the emergence and increased intensity of insecticide resistance and the challenge of outdoor transmission are undermining their impact. New tools are needed to get back on track towards global targets. This Perspective explores the major challenges hindering wider-scale implementation of larviciding in Africa and identifies potential solutions and opportunities to overcome these barriers. Larviciding in Africa: overview, challenges, and solutions Larviciding is a valuable vector control tool with strong potential for regional scale-up. There is considerable evidence of its effectiveness, and the World Health Organization (WHO) recommends it as a supplemental intervention. However, malaria programmes hoping to implement larviciding face significant barriers, including (1) poor global technical, policy, and funding support; (2) fragmented implementation and experience; (3) high complexity of delivery and impact evaluation; and (4) limited access to the full range of WHO prequalified larvicide products. Strategic barriers related to global policy and donor hesitancy can be overcome through a coordinated demonstration of cost-effectiveness. Technological advancements and strengthened operational capacity have already overcome technical barriers related to larvicide delivery, targeting, coverage, and evaluation. Developing a Community of Practice platform for larviciding has strong potential to consolidate efforts, addressing the challenge of fragmented implementation and experience. Such a platform can serve as a resource center for African malaria programmes, collating and disseminating technical guidance, facilitating the exchange of best practices, and aiding malaria programmes and partners in designing and evaluating larviciding projects. Conclusion The global shift toward targeted and adaptive interventions enables the incorporation of larviciding into an expanded vector control toolbox. As more African countries implement larvicide programmes, establishing a regional Community of Practice platform for exchanging experiences and best practices is necessary to strengthen the evidence base for cost-effective implementation, advocate for support, and inform policy recommendations, thus supporting Africa’s progress toward malaria elimination.