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Introduction: In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia's health system. Methods: This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points. Results: Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector. Conclusion: This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system. [ABSTRACT FROM AUTHOR]

Accurate assessment of water resources at the watershed level is crucial for effective integrated watershed management. While semi-distributed/distributed models require complex structures and large amounts of input data, conceptual models have gained attention as an alternative to watershed modeling. In this paper, the performance of the GR4J conceptual model for runoff simulation in the Gambia watershed at Simenti station is analyzed over the calibration (1981–1990) and validation period (1991–2000 and 2001–2010). The main inputs to conceptual models like GR4J are daily precipitation data and potential evapotranspiration (PET) measured from the same catchment or a nearby location. Calibration of these models is typically performed using the Nash–Sutcliffe daily efficiency with a bias penalty as the objective function. In this case, the GR4J model is calibrated using four optimization parameters. To evaluate the effectiveness of the model's runoff predictions, various statistical measures such as Nash–Sutcliffe efficiency, coefficient of determination, bias, and linear correlation coefficient are calculated. The results obtained in the Gambia watershed at Simenti station indicate satisfactory performance of the GR4J model in terms of forecast accuracy and computational efficiency. The Nash–Sutcliffe (Q) values are 0.623 and 0.711 during the calibration period (1981–1990) and the validation period (1991–2000), respectively. The average annual flow observed during the calibration period is 0.385 mm while it increases with a value of 0.603 mm during the validation period. As for the average flow simulated by the model, it is 0.142 mm during the calibration period (i.e., a delay of 0.142 mm compared to the observed flow), 0.626 mm in the validation period (i.e., an excess of 0.023 mm compared to the observed flow). However, this study is significant because it shows significant changes in all metrics in the watershed sample under different scenarios, especially the SSP245 and SSP585 scenarios over the period 2021–2100. These changes suggest a downward trend in flows, which would pose significant challenges for water management. Therefore, it is clear that sustainable water management would require substantial adaptation measures to cope with these changes. [ABSTRACT FROM AUTHOR]

Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: − 0.26, 95% CI − 0.31 to − 0.20], and Cameroon [C: − 0.19, 95% CI − 0.22 to − 0.17], and relatively it was less concentrated among the poor in Liberia [C: − 0.07, 95% CI − 0.11 to − 0.04], and Gambia [C: − 0.07, 95% CI − 0.11 to − 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity. [ABSTRACT FROM AUTHOR]

Background: A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. Methods: A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019–2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05. Results: The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30–34 [aOR = 1.79, 95% CI = 1.30–2.47], those who were married [aOR = 2.69, 95% CI = 1.85–3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas. Conclusion: Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia. [ABSTRACT FROM AUTHOR]

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

The recent experimental results illustrate that adding ivermectin to artemisinin-based combination therapy can target malaria parasite and its vector, which may be a new treatment option. In this paper, we present a new malaria transmission model, which incorporates spatial heterogeneity, general incidence rate and treatment plan with ivermectin. The basic reproduction number R 0 is introduced as a threshold parameter to determine whether malaria will eventually die out or not. Further, we propose and analyze the regional optimal control problem to minimize mosquito population, exposed and infectious humans as well as cost. Numerically, we investigate the transmission and control of malaria in The Gambia. Results show that the treatment plans with ivermectin and without ivermectin have the same contribution to R 0 , but have different effects on the epidemic level of malaria. This conclusion also holds for different incidence rates with some assumptions. Moreover, by comparing the cost and benefit of different strategies, the most cost-effective strategy is found. • A malaria model includes spatial heterogeneity, general incidence rate and ivermectin therapy. • Regional optimal control problem with terminal state in objective is investigated. • The transmission and control of malaria in The Gambia are discussed. • The effects of mosquito species distribution and incidence rate are explored. • The most cost-effective strategy is determined by comparing cost and benefit of eleven strategies. [ABSTRACT FROM AUTHOR]

Ocean governance is constituted by a range of institutions and actors across nation-states, markets, civil society and communities. As government-led management of commercial wild capture fisheries came under increased scrutiny following the rise of neo-liberalism and overfishing in the late 20th century, many non-governmental organizations and businesses turned to market and consumer-oriented approaches such as eco-labels and certification systems to define and reward sustainable fisheries and to incentivize change in others. However, our understanding of how small-scale fisheries in the Global South engage with these systems over time remains limited, particularly in the African context. This paper seeks to improve understanding by examining the interactions between diverse actors working to achieve Marine Stewardship Council certification for a small-scale fishery in The Gambia, West Africa, one of the earliest in Africa to engage the program. Situating the study within social science research on inequities and power imbalances in Southern engagements with Northern-led sustainability certifications, the case study analyzes qualitative data from documents and from 16 key-informant interviews. The data was organized using a social science approach which enables the analysis of factors promoting or hindering governance interactions and of who and what drives outcomes. Taking multiple factors into account, this paper argues that Southern interest in, and accessibility to, certification is dynamic, and influenced by the uneven distribution of regulatory resources, capacity, power and benefits. Promised but nebulous benefits clashed with arduous and recurring appraisals, exacerbating institutional factors leading the fishery to repeatedly fall short of certification. While important improvements can be gained from the pursuit of certification, Southern producers, managers and policy makers should have opportunities to be better informed about the diverse factors impacting: i) governance interactions and capacity building, ii) paths towards, and barriers to, improvements, and ii) the likelihood, or not, for achieving equitable access and social development benefits, especially for marginalized producers. The role and significance of sustainability certification in future ocean governance will be shaped fundamentally by such knowledge. • Sustainability certification remains an influential form of fisheries governance. • Responses to MSC certification in the Global South remain understudied. • Few studies have examined fisheries certification failures in African contexts. • Studying governance interactions can identify key capacities for change. [ABSTRACT FROM AUTHOR]

Musca sorbens (Diptera: Muscidae) flies are thought to be vectors of the blinding eye disease trachoma, carrying the bacterium Chlamydia trachomatis (Ct) between the eyes of individuals. While their role as vectors has been convincingly demonstrated via randomised controlled trials in The Gambia, studies of fly-borne trachoma transmission remain scant and as such our understanding of their ability to transmit Ct remains poor. We examined fly-eye contact and caught eye-seeking flies from 494 individuals (79% aged ≤9 years) in Oromia, Ethiopia. Ct-carrying flies (harbouring Ct DNA) were found to cluster spatially in and nearby to households in which at least one resident had Ct infection. Fly-eye contact was positively associated with the presence of trachoma (disease), lower human body weight and increased human body temperature. Studies of laboratory-reared M. sorbens indicated that Ct is found both externally and internally following feeds to Ct culture, with scanning electron microscopy revealing how Ct bodies can cling to fly hairs (setae). Testing for Ct on field-caught M. sorbens found fly 'bodies' (thorax, wings and abdomen) to consistently test positive for Ct while legs and heads were infrequently Ct-positive. These studies strongly support the role of M. sorbens as vectors of trachoma and highlight the need for improved understanding of fly-borne trachoma transmission dynamics and vector competence. Author summary: Trachoma is a blinding eye disease caused by an infection of the eye by the bacterium Chlamydia trachomatis (Ct). Trachoma is responsible for vision impairment or blindness in 1.8 million people and is the leading infectious cause of blindness worldwide. The presence of flies around the eyes of young children is a common feature of life in trachoma endemic communities worldwide. This fly is most often Musca sorbens, an understudied species thought to transmit Ct. In order to understand more about Musca sorbens flies and their relationship with Ct, the researchers studied 247 households in the Oromia region of Ethiopia, where there is known to be a lot of trachoma. The authors found evidence of Ct on flies and that flies in households containing children with Ct infection were much more likely themselves to be carrying Ct, adding to evidence that M. sorbens flies contribute to transmission of the bacterium. They also found that children who weigh less and currently have trachoma were more likely to have flies land on their face. Should further studies clearly elucidate a role for M. sorbens as vectors of trachoma, controlling fly populations or preventing fly-eye contact may become an important aspect of trachoma disease control. [ABSTRACT FROM AUTHOR]

In recent years, accessing rainfall data from ground observation networks maintained by national meteorological services in West Africa has become increasingly challenging. This is primarily due to high acquisition costs and the often sparse distribution of rainfall gauges across the region, which limits their use in hydrological studies and related research. At the same time, the rising availability of precipitation products derived from satellite/earth observations, reanalysis datasets, and in situ measurements presents exciting prospects for hydrological applications. Nonetheless, these datasets constitute indirect measurements, necessitating rigorous validation against ground-based rainfall data. This study comprehensively assesses twenty-three gridded rainfall products, including sixteen from satellites, six from reanalysis data, and one from in situ measurements, across the Senegal, Gambia, and Casamance River basins. Performance evaluation is conducted across distinct climatic zones, both pre- and post-resampling against observed rainfall data gathered from forty-nine rainfall stations over a six-year period (2003–2008). Evaluation criteria include the Kling–Gupta Efficiency (KGE) and Percentage of Bias (PBIAS) metrics, assessed at daily, monthly, and seasonal time steps. The results reveal distinct performance levels among the evaluated rainfall products. RFE, ARC2, and CPC notably yield the highest KGE scores at the daily time step, while GPCP, CHIRP, CHIRPS, RFE, MSWEP, ARC2, CPC, TAMSAT, and CMORPHCRT demonstrate superior performance at the monthly time step. During the rainy season, these products generally exhibit robustness. However, rainfall estimates derived from reanalysis datasets (ERA5, EWEMBI, MERRA2, PGF, WFDEICRU, and WFDEIGPCC) perform poorly in the studied basins. Based on the PBIAS metric, most products tend to underestimate precipitation values, while only PERSIANN and PERSIANNCCS lead to significant overestimations. Spatially, optimal performance of the products is observed in the Casamance basin and the Sudanian and Sahelian climatic zones within the Gambia and Senegal basins. Conversely, in the Guinean zone of the Gambia and Senegal Rivers, the rainfall products displayed the poorest performance. [ABSTRACT FROM AUTHOR]

Malaria is the most common cause of death among the parasitic diseases. Malaria continues to pose a growing threat to the public health and economic growth of nations in the tropical and subtropical parts of the world. This study aims to address this challenge by developing a predictive model for malaria outbreaks in each district of The Gambia, leveraging historical meteorological data. To achieve this objective, we employ and compare the performance of eight machine learning algorithms, including C5.0 decision trees, artificial neural networks, k-nearest neighbors, support vector machines with linear and radial kernels, logistic regression, extreme gradient boosting, and random forests. The models are evaluated using 10-fold cross-validation during the training phase, repeated five times to ensure robust validation. Our findings reveal that extreme gradient boosting and decision trees exhibit the highest prediction accuracy on the testing set, achieving 93.3% accuracy, followed closely by random forests with 91.5% accuracy. In contrast, the support vector machine with a linear kernel performs less favorably, showing a prediction accuracy of 84.8% and underperforming in specificity analysis. Notably, the integration of both climatic and non-climatic features proves to be a crucial factor in accurately predicting malaria outbreaks in The Gambia. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia. Methods: Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence. Conclusion: This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population. [ABSTRACT FROM AUTHOR]

Background: Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. Methods: We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. Results: Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. Conclusions: Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Globally, there are 37.7 million people living with human immunodeficiency virus (HIV). So far, there is no study done in Gambia which assessed comprehensive HIV knowledge and its associated factors. Therefore, this study aims to assess comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia. Objective: To assess the prevalence of comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia. Methods: The study used the Gambian Demographic and Health Survey, which was conducted from 21 November 2019 to 30 March 2020 in Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Logistic regression analysis was used to identify factors associated with HIV comprehensive knowledge. Statistical significance was declared at a P value of less than 0.05 with a 95% confidence interval (CI). Results: The overall prevalence of comprehensive HIV knowledge was 27.1% (25.1–36.2%). Older age [adjusted odds ratio (AOR) of 1.20 (95% CI 1.16–1.26)], using contraceptive [AOR of 1.15 (95% CI 1.01–1.31)], higher education [AOR of 4.73 (95% CI 3.86–5.81)], rich wealth quintile [AOR of 1.61 (95% CI 1.37–1.87)], media exposure [AOR of 1.76 (95% CI 1.39–2.23)], ever tested for HIV [AOR of 1.55 (95% CI 1.42–1.74)], visited health facility within the last 12 months [AOR of 1.26 (95% CI 1.12–1.41)] and decision-making autonomy [AOR of 1.42 (95% CI 1.27–1.60)] were positively associated with comprehensive HIV knowledge. However, being married [AOR of 0.72 (95% CI 0.62–0.82)] was negatively associated with comprehensive HIV knowledge. Conclusions: The prevalence of comprehensive HIV knowledge was low in Gambia. Educational interventions that focused mainly on awareness creation about HIV/AIDS should be designed especially for married women and lower socio-economic status. An effort has to be made to address those disparities at the national level. [ABSTRACT FROM AUTHOR]

Background: Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. Case Report: The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. Results: The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. Conclusion: This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management. [ABSTRACT FROM AUTHOR]

This study examines how the Point News Media portrayed the ECOWAS military intervention in The Gambia. ECOWAS intervened when former President Yahya Jammeh refused to step down after losing the 2016 election. Scholars and the media world wide discussed the intervention's legality and legitimacy in promoting the democratic transfer of power in the region. Initially, the intervention was praised for successfully promoting democratic change in a region that is prone to coups. However, the public later requested the withdrawal of the intervention force. The study analyzed 64 news articles published between 2017 and 2023. Ten frames were identified: dissatisfaction, ECOMIG mandate, ECOMIG success, instability, legitimacy, reassurance, social service, support, uncertainty, and confrontation. The Point news media portrayed the intervention negatively, characterized by dissatisfaction and confrontation in implementing the intervention's mandate. This negative depiction may have contributed to the shift in public discourse towards requesting the ECOWAS military withdrawal. The study used qualitative content analysis as a data gathering and analysis method to explore the portrayal of the intervention. This method allowed the researchers to identify the different frames used to depict the intervention. By presenting the findings in simple language, the study increases accessibility and understanding of the topic. [ABSTRACT FROM AUTHOR]

There is substantial diversity within and between contexts globally in caregiving practices and family composition, which may have implications for the early interaction's infants engage in. We draw on data from the Brain Imaging for Global Health (BRIGHT, www.globalfnirs.org/the-bright-project) project, which longitudinally examined infants in the UK and in rural Gambia, West Africa. In The Gambia, households are commonly characterized by multigenerational, frequently polygamous family structures, which, in part, is reflected in the diversity of caregivers a child spends time with. In this paper, we aim to 1) evaluate and validate the Language Environment Analysis (LENA) for use in the Mandinka speaking families in The Gambia, 2) examine the nature (i.e., prevalence of turn taking) and amount (i.e., adult and child vocalizations) of conversation that infants are exposed to from 12 to 24 months of age and 3) investigate the link between caregiver diversity and child language outcomes, examining the mediating role of contingent turn taking. We obtained naturalistic seven-hour-long LENA recordings at 12, 18 and 24 months of age from a cohort of N = 204 infants from Mandinka speaking households in The Gambia and N = 61 infants in the UK. We examined developmental changes and site differences in LENA counts of adult word counts (AWC), contingent turn taking (CTT) and child vocalizations (CVC). In the larger and more heterogenous Gambian sample, we also investigated caregiver predictors of turn taking frequency. We hereby examined the number of caregivers present over the recording day and the consistency of caregivers across two subsequent days per age point. We controlled for children's cognitive development via the Mullen Scales of Early Learning (MSEL). Our LENA validation showed high internal consistency between the human coders and automated LENA outputs (Cronbach's alpha's all >.8). All LENA counts were higher in the UK compared to the Gambian cohort. In The Gambia, controlling for overall neurodevelopment via the MSEL, CTT at 12 and 18 months predicted CVC at 18 and 24 months. Caregiver consistency was associated with CTT counts at 18 and 24 months. The number of caregivers and CTT counts showed an inverted u-shape relationship at 18 and 24 months, with an intermediate number of caregivers being associated with the highest CTT frequencies. Mediation analyses showed a partial mediation by number of caregivers and CTT and 24-month CVC. The LENA provided reliable estimates for the Mandinka language in the home recording context. We showed that turn taking is associated with subsequent child vocalizations and explored contextual caregiving factors contributing to turn taking in the Gambian cohort. • It is unclear how caregiver diversity affect language development. • LENA measures were used at 12, 18 and 24 months in the UK and The Gambia (GM). • Turn taking & child vocalizations were associated in GM and, less clearly, in UK cohort. • Caregiver consistency was associated with turn taking at 18 & 24 m in GM. • Number of caregivers mediated the turn taking & child vocalizations link in GM. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium tuberculosis culturing remains the gold standard for laboratory diagnosis of tuberculosis. Tuberculosis remains a great public health problem in developing countries like The Gambia, as most of the methods currently used for bacterial isolation are either time-consuming or costly. Objective: To evaluate the Kudoh swab method in a West African setting in Gambia, with a particular focus on the method's performance when culturing Mycobacterium africanum West Africa 2 (MAF2) isolates. Method: 75 sputum samples were collected in the Greater Banjul Area and decontaminated in parallel with both the standard N-acetyl-L-Cysteine-NaOH (NALC-NaOH) and the Kudoh swab method in the TB diagnostics laboratory in the Medical Research Council Unit The Gambia between 30th December 2017 and 25th February 2018. These samples were subsequently cultured on standard Löwenstein-Jensen and Modified Ogawa media respectively and incubated at 37°C for mycobacterial growth. Spoligotyping was done to determine if the decontamination and culture methods compared could equally detect Mycobacterium tuberculosis, Mycobacterium africanum West Africa 1 and Mycobacterium africanum West Africa 2. Result: Among the 50 smear positives, 35 (70%) were culture-positive with Kudoh and 32 (64%) were culture positive with NALC-NaOH, whilst 7(28%) of the 25 smear negative samples were culture positive with both methods (Table 2). There was no significant difference in recovery between both methods (McNemar's test, p-value = 0.7003), suggesting that the overall positivity rate between the two methods is comparable. There were no differences in time-to-positivity or contamination rate between the methods. However, Kudoh yielded positive cultures that were negative on LJ and vice versa. All findings were irrespective of mycobacterial lineages. Conclusion: The Kudoh method has comparable sensitivity to the NALC-NaOH method for detecting Mycobacterium tuberculosis complex isolates. It is easy to perform and could be an add on option for mycobacterial culture in the field in The Gambia, since it requires less biosafety equipment. [ABSTRACT FROM AUTHOR]

The Gambia has experienced three significant political crises in its history: the attempted coup of 1981, the successful coup of 1994, and the latest events in 2016–2017 when President Yahya Jammeh, having exercised semi-authoritarian power since 1994, was defeated at the ballot box but refused to step down until he was finally forced to do so. Using academic, media, social media and interview material, this article examines all three processes and their aftermaths, in particular the latter, through the lens of 'small state' politics. The article demonstrates that the small size of the population, elite, and landmass indeed matters in driving Gambian political processes. In 2023, several post-2017 processes, including constitutional change, transitional justice and elections, are playing out within the confines of the small state. This article then assesses to what extent a 'New Gambia', to use current President Adama Barrow's phrase, has emerged. [ABSTRACT FROM AUTHOR]

Although African regional interventions have tangible effects on politics and order in African states, we know little about how people living in the countries concerned experience and evaluate these interventions. The assumption in the literature is that African interventions are generally perceived as legitimate due to the interveners' cultural proximity to the contexts of intervention. Based on interview and focus group research, we present firsthand and systematically generated empirical data on local perceptions of AU and ECOWAS interventions in two African states: Burkina Faso (2014/15) and The Gambia (2016/17). Contrary to the assumption in the literature, we demonstrate that (1) AU and ECOWAS interventions are locally more contested than often assumed, but that (2) local perceptions are at the same time multiplex. In both countries, we find (3) a marked difference between elite perceptions on the one hand and those of 'everyday citizens' on the other, which reflects variegated experiences with and exposures to the regional interventions resulting from different social, political, and spatial positionalities. These findings extend existing research on local perceptions of interventions by a perspective on non-Western interveners; and they have important implications for understanding both the legitimacy and effectiveness of African regional interventions. [ABSTRACT FROM AUTHOR]

Background: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. Methods: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. Results: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. Conclusion: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders. [ABSTRACT FROM AUTHOR]

Background: Chronic carriage of asymptomatic low-density Plasmodium falciparum parasitaemia in the dry season may support maintenance of acquired immunity that protects against clinical malaria. However, the relationship between chronic low-density infections and subsequent risk of clinical malaria episodes remains unclear. Methods: In a 2-years study (December 2014 to December 2016) in eastern Gambia, nine cross-sectional surveys using molecular parasite detection were performed in the dry and wet season. During the 2016 malaria transmission season, passive case detection identified episodes of clinical malaria. Results: Among the 5256 samples collected, 444 (8.4%) were positive for P. falciparum. A multivariate model identified village of residence, male sex, age ≥ 5 years old, anaemia, and fever as independent factors associated with P. falciparum parasite carriage. Infections did not cluster over time within the same households or recurred among neighbouring households. Asymptomatic parasite carriage at the end of dry season was associated with a higher risk of infection (Hazard Ratio, HR = 3.0, p < 0.0001) and clinical malaria (HR = 1.561, p = 0.057) during the following transmission season. Age and village of residence were additional predictors of infection and clinical malaria during the transmission season. Conclusion: Chronic parasite carriage during the dry season is associated with an increased risk of malaria infection and clinical malaria. It is unclear whether this is due to environmental exposure or to other factors. [ABSTRACT FROM AUTHOR]

This quantitative study investigates the perceptions of accountants in explaining budget-related fraud behaviour of public servants in developing economies using the elements of the fraud triangle theory. Fraud triangle elements constitute the Pressure, opportunity and rationalization dimensions that cause fraud. This study seeks to extend this theory to budget slack fraud investigation in the public sector to fill an existing gap. It therefore aims to test if indications of fraud based on the concept of fraud triangle can be used to detect public servants' budget slack fraud behaviour in developing countries like The Gambia. The population in this study constituted all accountants in the public and private sector. Convenience sampling technique was used to collect primary data via an online questionnaire instrument containing Likert-style questions with 51% response rate. The Likert-style questions drawn on the concept of fraud triangle analysis helped to realize the study's objectives. The result showed that components of Fraud Triangle analysis, Pressure, Opportunity and Rationalization variables have significant combined linear/predictive effect on BSFB, with the greatest influence coming from Opportunity variable. Moreover, the predictors in a multiple regression model generated 73% variance/prediction strength in budget-related fraud behaviour of which 27% are accounted for by residuals. These findings align with literature and have implication for policy and further research. [ABSTRACT FROM AUTHOR]

For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6–18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and immunogenic doses for children, and the possible benefit of a mucosal adjuvant, double mutant labile toxin (dmLT). Considering the promising but still underexplored potential of inactivated whole cells in oral vaccination, we present a perspective compiling key observations from past ETVAX® trials that informed The Gambian trial design. This report will update the trial's status and explore future directions for ETEC vaccine trials. Our aim is to provide not only an update on the most advanced ETEC vaccine candidate but also to offer insights beneficial for the development of other much-needed oral whole-cell vaccines against enteric and other pathogens. [ABSTRACT FROM AUTHOR]

This paper studies the association between caregiver--child interactions and early childhood development in literacy and numeracy in West and Central Africa. Data comes from Multiple Cluster Indicator Surveys (MICS) conducted in Central African Republic, Chad, Democratic Republic of the Congo, Gambia, Ghana, Guinea-Bissau, Sierra Leone, and Togo between 2017 and 2020. A multilevel logistic regression is used to estimate the likelihood of being developmentally on track for 35,752 children aged 3-4 years. The results indicate that cognitively stimulating interactions with caregivers such as reading and telling stories are correlated with a higher likelihood of being developmentally on track. Interactions with mothers are associated with significantly higher odds of being developmentally on track but not interactions with fathers.

Background: Despite Africa's significant infectious disease burden, it is underrepresented in global vaccine clinical trials. While this trend is slowly reversing, it is important to recognize and mitigate the challenges that arise when conducting vaccine clinical trials in this environment. These challenges stem from a variety of factors peculiar to the population and may negatively impact adverse event collection and reporting if not properly addressed., Methods: As a team of clinical researchers working within the MRCG (Medical Research Council Unit The Gambia), we have conducted 12 phase 1 to 3 vaccine trials over the past 10 years. In this article, we discuss the challenges we face and the strategies we have developed to improve the collection and reporting of adverse events in low-income settings., Outcome: Healthcare-seeking behaviors in the Gambia are influenced by spiritual and cultural beliefs as well as barriers to accessing orthodox healthcare; participants in trials may resort to non-orthodox care, reducing the accuracy of reported adverse events. To address this, trial eligibility criteria prohibit self-treatment and herbal product use during trials. Instead, round-the-clock care is provided to trial participants, facilitating safety follow-up. Constraints in the healthcare system in the Gambia such as limitations in diagnostic tools limit the specificity of diagnosis when reporting adverse events. To overcome these challenges, the Medical Research Council Unit maintains a Clinical Services Department, offering medical care and diagnostic services to study participants. Sociocultural factors, including low literacy rates and social influences, impact adverse event collection. Solicited adverse events are collected during home visits on paper-based or electronic report forms. Community engagement meetings are held before each study starts to inform community stakeholders about the study and answer any questions they may have. These meetings ensure that influential members of the community understand the purpose of the study and the risks and benefits of participating in the trial. This understanding makes them more likely to support participation within their communities., Conclusion: Conducting ethical vaccine clinical trials in resource-limited settings requires strategies to accurately collect and report adverse events. Our experiences from the Gambia offer insights into adverse event collection in these settings., (© 2024. The Author(s).)

Background: The introduction of pneumococcal conjugate vaccines (PCV) has reduced carriage of vaccine-type (VT) pneumococci in many settings. We determined the impact of The Gambia's national PCV programme on carriage of VT pneumococci in the population., Methods: Seven-valent PCV (PCV7) was introduced in August 2009 without catch-up and with doses scheduled at 2, 3, 4 months of age; it was replaced by PCV13 in May 2011. We did cross-sectional carriage surveys in 2009, 2015, and 2017 in age-stratified, population-based samples. Nasopharyngeal specimens were collected and processed according to WHO guidelines. We calculated observed and adjusted prevalence ratios (PR) of VT carriage before and after PCV introduction., Findings: We enrolled 2988, 3162, and 2709 participants in 2009, 2015, and 2017 respectively. The baseline (2009) prevalence of VT pneumococcal carriage among children aged 0-4 years was 42.6 %, which declined to 14.9 % and 17.5 % in 2015 and 2017 respectively (adjPR 0.32 [95 % CI 0.27, 0.38] and 0.38 [0.31, 0.46] respectively). VT prevalence among children aged 5-14 years was 16.6 %, 15.1 %, and 15.8 % in the three surveys (2017 vs 2009, adjPR 0.70 [0.58, 0.83]). VT prevalence among 15-44 year-olds was 6.4 %, 5.7 %, and 7.1 % in the three surveys (2017 vs 2009, adjPR 0.59 [0.46, 0.75]), while in those aged ≥ 45 years it was 4.5 %, 6.5 %, and 4.5 % respectively. Non-VT carriage increased in all age-groups. Prevalent residual serotypes were 34 and 15B (age 0-4 years), 3 and 34 (age 5-14 years), and 3 and 16F (age ≥ 15 years)., Conclusions: Introduction of PCV was associated with reduced VT pneumococcal carriage in young, and older children, although with substantial residual prevalence. Persisting VT, and non-VT, carriage indicate significant, persistent transmission of pneumococci in the population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)