Introduction: Culex pipiens complex, vectors of filaria worms and emerging arboviruses are widely distributed in Cameroon. However, information on their infectivity, diversity and insecticide resistance profile across ecozones in the country remains limited. Understanding the pattern of resistance to pyrethroids and carbamates insecticide subclasses, as well as their eco-diversity and dynamic will support effective vector control intervention strategies. Method: This was a cross-sectional study conducted over 5 years (2020-2025) in the humid Savannah and forest ecological zones of Cameroon. Culex mosquitoes were collected by larva breeding (LB) and human landing catch (HLC) and identified morphologically. Sensitivity of Cx. pipiens complex to deltamethrin, permethrin and propoxur was assessed using the WHO insecticide susceptibility assay and its sibling species detected by multiplex diagnostic PCR. Kdr-west genotyping and the presence of Wuchereria bancrofti and Brugia malayi was assessed by PCR. Results: A total of 4749 Culex mosquitoes were collected, mainly by HLC (62.1%), with significantly (p<0.001) more trapped in the Forest Ecological Zone (FEZ). Cx. quinquefasciatus was exophagic in the FEZ and endophagic in the humid Savannah Ecological Zone (hSEZ), with peak biting period between 02:00-03:59 in both zones. Cx. quinquefasciatus were susceptible to 1X propoxur, exhibiting concentration-dependent mortality rates (31.1-94.0%) in the FEZ but resistant to all insecticide types and concentrations in the hSEZ. In both ecozones, there was an association (p<0.001) between phenotypic resistance and Kdr-west . Wuchereria bancrofti and B. malayi were not detected in the sample. Conclusion: The diversity of Culex mosquito species, insecticide resistant profiles and biting dynamics vary across ecozones. The presence of insecticide resistance necessitates continuous monitoring while implementing next generation insecticides for better vector management in Cameroon.
Research on health system capacity to manage non-communicable diseases (NCDs) has largely focused on 'system hardware' such as infrastructure, workforce, and commodities. However, this overlooks the critical role of 'system software' elements, such as relationships, norms, and power, and the complex adaptive nature of health systems. This study aimed to explore how health system hardware and software elements interact to shape the capacity of the health system to deliver hypertension care in Kilifi County in the coastal region of Kenya. We conducted a cross-sectional qualitative study and collected data using document reviews (n = 13) and in-depth interviews with purposively selected front-line health workers (FLHWs) at five health facilities and health managers at county and national levels (n = 37). We applied a framework approach to data analysis, utilizing complex adaptive systems (CAS) theory as our analytic framework. Complex interactions of system hardware and software elements constrained the provision of hypertension care. Frequent medicines stockouts (hardware) stemmed from budgetary gaps, procurement delays, regulatory restrictions, and weak quantification practices (software). To mitigate medicines shortages, facilities employed adaptive responses such as inter-facility borrowing and sourcing from alternative suppliers (software). Access and continuity of care were enabled by organizational norms like dedicated hypertension clinic days (software) but undermined by inadequate consultation rooms, staff shortages (hardware) and limited training and support supervision (software). FLHWs' ideas to improve medication adherence were undermined by staff shortages (hardware) and inadequate support from facility managers (software), weakening service delivery. The application of CAS theory unpacked the hitherto underexplored aspects of health system capacity. System 'software' plays a central role in shaping health system capacity for hypertension care. Therefore, strengthening health system capacity for NCDs requires coordinated investment in both system hardware and software elements. Importantly, system strengthening interventions should consider the CAS nature of health systems to foster conditions for productive emergence.
Abstract Background Advanced HIV disease (AHD) remains a major contributor to hospitalization and inpatient mortality across sub-Saharan Africa. In resource-limited settings, restricted access to diagnostics for opportunistic infections (OIs) often results in delayed or empirical treatment, impacting outcomes. Despite a reported lower national HIV prevalence compared to neighboring countries, evidence on the clinical burden and management of hospitalized people living with HIV (PLWHIV) in The Gambia is scarce. Methods We conducted a retrospective cohort study of adults and children with confirmed HIV admitted to the Clinical Services Department of the MRC Unit The Gambia between February 2020 and April 2025. The study was undertaken within the context of a quality improvement project to quantify the burden of AHD, including opportunistic infections, diagnostic capacity, treatment practices, disease severity (assessed using adult MEWS), and inpatient outcomes, using anonymised electronic medical record data. Results Among 258 patients (214 adults, 44 children), adults had a mean age of 43.5 years and 65% were female; 97.3% had advanced HIV disease (27.9% WHO stage III, 69.4% stage IV), and with high clinical burden: 46.3% of adults had MEWS ≥7 at admission. OIs and severe bacterial infections (BIs) were common and mostly diagnosed clinically. Tuberculosis (TB) investigations (GeneXpert or sputum microscopy) were performed in 147 patients (57.0%), with treatment initiated in 87 (33.7%): 53 empirically and 34 microbiologically confirmed. Cryptococcal disease evaluation was limited, with antigen testing in 26 patients (10.1%) and lumbar puncture in 30 (11.6%). Blood cultures were obtained in 77.0% of patients at admission (85.1% among those with MEWS ≥7), yielding 24 clinically significant isolates, most commonly Salmonella spp., Escherichia coli, Streptococcus spp./S.pneumoniae, and Staphylococcus aureus. Empirical antibiotics were prescribed to 203 patients, with ceftriaxone being the most frequently used agent (49%). Inpatient mortality was 12.0%, higher among those with elevated MEWS and those receiving TB treatment, particularly empirically. Conclusions Hospitalized PLWHIV with AHD at MRCG present with severe illness and a high burden of BIs and OIs, managed largely empirically due to limited diagnostic resources. Strengthening access to essential diagnostics and promoting earlier HIV diagnosis may enable targeted therapy, reduce disease severity at admission, and potentially improve inpatient outcomes.
A growing ageing population in Africa underscores the need to reorient health systems to provide care for non-communicable conditions impacting older populations such as hip fractures. In The Gambia, the number of hip fractures are expected to quadruple for both men and women in the next 30 years. This is comparable to hip fracture incidence rates in other South and West African countries. Moreover, mortality rates post-hip fracture are 2-3 fold higher in populations from the African Region than for those in other high-income countries. Globally, in many countries including in The Gambia, musculoskeletal conditions are treated in a pluralistic medical system by both biomedical healthcare professionals and traditional bone setters (TBS). Further research is required to understand the interactions between these different therapeutic modalities in the treatment of fractures, including hip fractures - a life changing injury. Such evidence is important for developing collaborative initiatives between traditional and biomedical practitioners. This study sought to describe the practices and procedures used by TBS to treat hip fractures and their interactions between with biomedical care in The Gambia. In-depth interviews were conducted with 16 TBS and 38 healthcare professionals involved in hip fracture care provision in both rural and urban regions of the country. Data were analysed using an inductive thematic analysis. TBS used different modalities to identify a hip fracture. Most TBS misidentified and treated hip fractures as dislocations. On account of this, treatment consisted of pulling, massaging, and kneading the limb back into the hip socket. During this process, TBS applied concoctions of herbs and butters followed by splinting and tying the limb. Few TBS provided pain relief medication during treatment and most advised an extensive period of immobilisation of the limb. Follow up visits reviewed recovery. The narratives of both TBS and healthcare professionals further highlighted the informal referral of hip fracture patients from TBS to biomedical care to receive radiographs, analgesia, and for other ailments. While some biomedical healthcare professionals maintained that TBS should have no role in hip fracture care, others noted the importance of regulation of TBS practices and training initiatives. Considering these findings, we propose short-, medium- and long-term recommendations for the integration of traditional and biomedical sectors in the treatment of hip fractures in The Gambia. This includes the need to establish regulatory mechanisms for TBS practices and patient referral pathways between biomedical and TBS care.
Antimicrobial resistance (AMR) represents a major global health threat, heightened by extensive and often indiscriminate use of antibiotics in livestock production. In Nigeria, pig farming constitutes a significant yet underexamined pathway for the emergence and spread of AMR. This review aimed to examine the role of pig farming in the development and spread of AMR, evaluate the associated public health and economic risks, and propose evidence-based strategies to curb its spread. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL) for studies published between January 2000 to May 2025 and in English language. Relevant publications were screened, and data were extracted on antimicrobial use patterns, resistance prevalence, and associated risk factors. Studies were synthesized narratively and comparatively to identify key trends and policy gaps. The routine administration of antibiotics for therapeutic, prophylactic, and growth-promoting purposes, coupled with insufficient veterinary oversight, inadequate biosecurity measures, and limited regulatory enforcement, has facilitated the proliferation of multidrug-resistant bacteria including Escherichia coli, Salmonella spp., Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus), and Enterococcus spp. The persistence of antibiotic residues in pork products further increases public health risks by increasing the incidence of treatment failures and prolonging infections in humans. Beyond the health implications, AMR in pig farming has profound economic consequences, including reduced livestock productivity, increased production costs, and potential trade restrictions. Addressing this multifaceted challenge requires stringent antibiotic regulations, enhanced veterinary regulation, improved farm hygiene, and targeted farmer education on antimicrobial stewardship. A comprehensive One Health approach integrating veterinary, environment, and public health professionals is imperative to reduce the impact of AMR locally and globally.
