Background Whether a macroscopically normal appendix identified during surgery for suspected acute appendicitis should be removed or left in situ remains controversial. Although unnecessary appendectomy may expose patients to avoidable operative risks and healthcare costs, failure to remove an appendix with occult inflammation may lead to delayed diagnosis, disease progression, and subsequent complications. This systematic review and meta-analysis aimed to determine the incidence of histologically confirmed appendicitis and other clinically significant pathology in macroscopically normal appendices removed during surgery for suspected appendicitis. Methods A systematic review was conducted in accordance with the PRISMA 2020 statement and prospectively registered in PROSPERO (CRD42023397449). PubMed, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library, the WHO International Clinical Trials Registry Platform, and Google Scholar were systematically searched for eligible studies published up to 1 March 2023. Experimental and observational studies reporting histopathological findings in macroscopically normal appendices removed during surgery for suspected appendicitis were included. Random-effects meta-analysis was performed to estimate the pooled incidence of histologically confirmed appendicitis and overall clinically significant pathology. Results Eighteen studies involving 1,780 patients with macroscopically normal appendices removed during diagnostic laparoscopy or open surgery for suspected appendicitis met the inclusion criteria. The pooled incidence of histologically confirmed acute appendicitis was 25% (95% CI 0.15–0.33), while the pooled incidence of overall clinically significant pathology was 28% (95% CI 0.20–0.37). Although appendicitis accounted for the vast majority of abnormal histological findings, other important pathologies, including neuroendocrine tumours and appendiceal neoplasms, were also identified. Considerable between-study heterogeneity was observed. Conclusions Macroscopic assessment alone does not reliably exclude appendiceal pathology, with approximately one in four macroscopically normal appendices showing histologically confirmed appendicitis. Appendectomy may therefore be considered when no alternative cause of symptoms is identified, although decisions should be individualised given the heterogeneity and observational nature of the evidence. Clinical guidelines should also consider healthcare capacity, access to follow-up, and the potential resource consequences of both unnecessary surgery and missed disease. Prospective studies incorporating patient-centred outcomes, healthcare utilisation, and economic evaluation are needed to inform context-specific surgical policy. Registration : PROSPERO CRD42023397449
Background Despite the widely acknowledged impacts of climate change, the effect of climate change on women’s health remains underexplored in quantitative scientific research. This study investigates how climate hazards, and specifically landslides, influence intimate partner violence (IPV) and explores the broader implications of these findings for future research and understanding of IPV risk. Methods Drawing on nationally representative data from 1993 to 2019 from 156 different countries, this study used a two-way fixed effects model to predict IPV based on climate shocks, gender inequality indices (GII), and national economic indicators. Using this model, this study assesses the role of climate, economic, and social factors on IPV estimates while adjusting for skewed distributions and weighted effects. Results The final model revealed a significant relationship between landslides and IPV, where an increase in landslide risk is associated with an increase in IPV (β = 0.136, p = 0.0424). In addition, gender inequality had a significant positive association with IPV (β = 22.876, p = 0.00016). Conclusions Landslides, although not typically the focus of climate and IPV-related studies, have significant economic consequences for agricultural output and property damage, and therefore may serve as an important measure of climate change’s impact on household instability. With climate change worsening and directly impacting landslides, as well as indirectly impacting factors like GDP, these results demonstrate the need for research and policy decisions to reflect the increasing economic consequences of climate change through landslides and its implications for IPV and women’s health.
Background The financial performance of public hospitals remains a major challenge in sub-Saharan Africa, where health care financing largely relies on out-of-pocket payments. In Benin, where recent reforms aim to strengthen hospital economic performance, this study analyses the efficiency and performance of the financial resource mobilisation system of a reference teaching hospital. Methods An evaluative cross-sectional study was conducted using the structure–process–outcome framework. Financial, administrative and organisational data from Centre Hospitalier Universitaire de la Mère et de l’Enfant-Lagune in Cotonou, 2021-2023 were collected through interviews, observations, document review and user surveys, and triangulated. The analysis focused on collection rates, financial losses, revenue trends by service type, and structural and operational factors influencing performance. Results Overall revenue collection was 0.795, below the expected level for an autonomous hospital. Internally generated resources were inefficient (≈0.70), with particularly low performance in laboratory services (≈0.59) and a marked decline in ultrasound revenue collection (from 1.15 to 0.65). Financial losses due to unpaid bills and revenue leakage exceeded USD 18,300. The system showed strong dependence on irregular public subsidies, sometimes disbursed after more than 300 days, alongside weakly formalised processes, limited digitalisation and insufficient professionalisation of revenue collection. Low household solvency further increased the risk of non-payment in a predominantly out-of-pocket financing context. Conclusions The revenue mobilisation system is fragile, with significant technical and organisational inefficiencies undermining economic performance and financial sustainability. Strengthening financial governance, expanding digitalisation and professionalising revenue collection, together with extending financial protection mechanisms for users, are essential to improve hospital efficiency and support progress towards universal health coverage.
Background Ethiopia has expanded immunisation coverage significantly over the past two decades through strengthened primary healthcare services. However, the quality of immunisation services remains a concern, and their overall quality status has not been thoroughly investigated. This study assesses the immunisation service quality using technical aspects, such as pre-, intra-, and post-administration session quality, as well as perceived quality (client satisfaction), in Ethiopia. Methods This study was part of the national immunisation program evaluation survey. Vaccinators’ practices were observed, and exit interviews were conducted with mothers and caregivers. The study was conducted in all regions and city administrations, except for the Tigray region. A total of 2,971 session observations and 2,955 exit interviews were included. A structured checklist assessed vaccinators’ competency, while satisfaction was measured using a Likert scale questionnaire. Results The study revealed sub-optimal immunisation session quality and client dissatisfaction. Only 4% of vaccinators conducted a complete infant assessment, 11% used educational materials, and 7% delivered key immunisation messages. Nearly half of the sessions were handled by a single vaccinator. Incorrect vaccine administration was noted, with 9% and 11% missing the correct route and site for BCG, 8% and 9% for measles, and 7% administering incorrect doses of the Rota vaccine. Only 55% of mothers/caregivers reported satisfaction with the service. Conclusions The study highlights poor communication regarding immunisation, vaccine administration, and post-administration safety practices, as well as caregivers’ dissatisfaction. Strengthening immunisation service quality through standardised guidelines, ongoing capacity-building, and accountability measures is essential to improve immunisation service uptake, quality, and health outcomes.
Background Household hunger remains a major public health challenge globally and is particularly severe in Kinshasa. This study aimed to estimate the prevalence of household hunger and identify its associated factors in the Mont Ngafula II health zone. Methods A cross-sectional survey was conducted between November and December 2024 among 583 households with at least one child aged 6–59 months, selected using multistage probability sampling. Household hunger was assessed using the Household Hunger Scale. Multivariable logistic regression was applied to identify factors associated with household hunger. Results Overall, 32.4% of households experienced moderate hunger and 3.8% experienced severe hunger. After adjustment, children with inadequate dietary diversity were more likely to experience household hunger (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI]: 1.03–2.44). Children from food-insecure households had a higher risk of wasting (aOR = 2.6; 95% CI: 1.65–8.24) and were more likely to be underweight (aOR = 7.1; 95% CI: 2.4–22.0). Household hunger was also significantly associated with unemployment of the household head, poverty, food expenditure below US$1 per person per day, consumption of fewer than three meals per day, and larger household size. Conclusions Household hunger remains highly prevalent in this urban setting and is strongly associated with poor child nutritional outcomes and socioeconomic deprivation. The findings underscore the need for integrated policies addressing poverty reduction, social protection, equitable resource allocation, and nutrition-specific and nutrition-sensitive interventions, including urban agriculture and nutrition education.
Background Cardiovascular disease is the leading cause of death and disability worldwide, yet its burden in early adulthood remains poorly characterised. Although recent global analyses report declining mortality alongside rising prevalence among individuals aged 15-39 years, aggregating this broad age range may obscure important life-stage differences. Young adulthood (ages 20-24 years) represents a critical transitional period marked by changes in lifestyle and metabolic risk factors that shape long-term cardiovascular risk trajectories, with potentially greater impact in low- and middle-income countries. Methods We analyzed Global Burden of Disease 2021 estimates for 204 countries, stratified by Sociodemographic Index quintiles. Outcomes included age-standardized prevalence, death, and disability-adjusted life year rates, as well as disability-adjusted life years attributable to behavioral, metabolic, and environmental or occupational risks. Age-standardized rates were calculated using the Global Burden of Disease 2021 standard population. Results The number of individuals aged 20-24 years living with cardiovascular disease increased from 7.0 to 9.6 million (+37%), with prevalence rising by approximately 13% (95% uncertainty interval=9.7-15.5%). The proportion of cases occurring in low- and low-middle-Sociodemographic Index regions increased from 38% to 60%. Globally, disability-adjusted life year and death rates declined by 21% and 25%, respectively, driven primarily by reductions in high-Sociodemographic Index countries. Metabolic risks accounted for the largest share of burden, with disability-adjusted life years attributable to high body-mass index increasing by approximately 90%. Conclusions Despite declines in mortality, the global burden of cardiovascular disease among young adults aged 20-24 years is increasing, particularly in low-Sociodemographic Index regions, underscoring the need for early and targeted prevention strategies.
Background The sustainability of community-managed boreholes remains a major challenge in rural areas of the Democratic Republic of the Congo (DRC). Frequent breakdowns and inadequate maintenance limit access to safe drinking water and increase exposure to water-related health risks. Methods A cross-sectional analytical study was conducted in six villages within the Bolobo Health Zone. Data were collected through guided interviews with 367 household heads and members of water management committees using a semi-structured questionnaire. Variables with a p-value < 0.20 in bivariate analysis were included in a multivariable logistic regression model, and those with p < 0.05 were considered statistically significant. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were used to assess associations. Results Low household income (aOR = 1.011; 95% CI: 1.001–1.059; p = 0.021) and non-contribution to water user fees (aOR = 3.21; 95% CI: 1.54–6.68; p = 0.002) were significantly associated with reduced borehole sustainability. Technical factors were particularly influential, including the absence of trained repair artisans (aOR = 124.5; 95% CI: 13.2–981.4; p < 0.001) and limited availability of spare parts. Institutional weaknesses also played a key role, with lack of trained management committees (aOR = 14.22; 95% CI: 2.45–82.1; p = 0.003) significantly compromising sustainability. Conclusions The sustainability of boreholes in Bolobo is shaped by socio-economic capacity, availability of technical support, and the strength of local governance structures. Strengthening financial contributions, building local technical expertise, and improving community-based management systems are critical to ensuring sustained access to safe drinking water in rural DRC.
Background Postnatal care (PNC) is a critical intervention for reducing maternal and neonatal morbidity and mortality. Despite its importance, utilisation of PNC services remains low in Ethiopia, particularly in the Oromia region. This study aimed to identify determinants of PNC utilisation among postpartum women and develop expert-validated strategies to improve service uptake. Methods A facility-based cross-sectional study was conducted among 156 postpartum women aged 18–49 years who had delivered within the preceding six weeks and attended Ambo General Hospital in Oromia, Ethiopia. PNC utilisation was defined as receipt of at least one postnatal care visit within six weeks after delivery. Data were collected using a structured, pretested questionnaire and analysed using descriptive statistics and multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify factors associated with PNC utilisation. Determinants were interpreted using the Andersen Health Services Utilisation Model and the Three Delays Model. Evidence-informed strategies to improve PNC utilisation were subsequently developed and refined through a two-round Delphi consensus process involving maternal and child health experts. Results Overall, 31% of women reported utilising PNC services within six weeks following childbirth. Factors independently associated with PNC utilisation included higher maternal education (AOR=2.1; 95% CI: 1.1–9.1), urban residence (AOR=2.6; 95% CI: 1.29–5.17), higher household income (AOR=1.05; 95% CI: 1.01–1.10), facility-based delivery (AOR=5.1; 95% CI: 2.38–10.92), and access to free maternal health services (AOR=2.0; 95% CI: 1.20–3.30). The Delphi process achieved expert consensus on a range of community-, facility-, and policy-level strategies to strengthen awareness, accessibility, affordability, and continuity of postnatal care services. Conclusions Postnatal care utilisation in Oromia remains suboptimal and is shaped by socioeconomic, geographic, and health system factors. The expert-validated strategies developed in this study provide a practical, evidence-informed framework for improving PNC uptake. Future implementation studies are needed to assess the feasibility, acceptability, and effectiveness of these strategies in routine practice.
Background Though Ethiopia has achieved remarkable progress in immunisation services, there is limited evidence on comprehensive national immunisation coverage. Therefore, this national study evaluated the performance of life-course immunisation services. Methods This study was conducted in all Ethiopian regions and city administrations from March to July 2023. Two-stage stratified cluster sampling was used. About 13666 children aged 12-35 months, 5338 adolescent girls (15–18) and 13843 adults aged 12 years or more were included in the study. Child vaccination status was assessed through reviewing immunisation cards/health facility registration books/caregivers’ recall. A descriptive analysis was done with an adjusted sampling weight. Results Three-fourths of children aged 12-23 months received the first dose of the pentavalent vaccine, and two-thirds received the third dose of the Pentavalent Vaccine. About two-thirds and half of the children received the first and second doses of the Measles vaccine, respectively. The dropout rates for Pentavalent was 14.1% and for Measles, was 19.9%. Full immunisation coverage was 43.9%, and zero-dose children accounted for 24.7%. About 85% of mothers received the first dose of the Tetanus-Diphtheria vaccine. Half of adolescent girls received their first vaccination, and a quarter of them received a second dose of the HPV vaccine. Conclusions Although Ethiopia has made strides in child immunisation, coverage remains below national and global targets. Tetanus-diphtheria vaccine uptake was initially high but dropped significantly by the fourth and fifth doses. HPV vaccine coverage was suboptimal, with most not receiving the second or booster doses. Strengthening national efforts to address both demand and supply barriers is vital for increasing vaccine uptake.
Background Mpox, known before like monkeypox and caused by the Mpox virus, represents an emerging zoonosis of significant magnitude for international public health. There is no publication regarding the preparedness of the military against Mpox in the Kokolo Military Health Zone. The objective of this research was to examine the knowledge, attitudes, and practices (KAP) related to Mpox within the military community in Kinshasa. Methods Between April and September 2025, an analytical study was conducted across 27 Health Areas located in the Kokolo Health Zone, which are spread throughout the city of Kinshasa. A structured and approved questionnaire on KoboCollect was used to collect sociodemographic data as well as information on knowledge, attitudes, and practices (KAP) regarding Mpox. We performed descriptive analyses, chi-square tests, as well as logistic regressions. Analysis done with the significant level of 5%; Results Among the 1170 respondents, 50.4% demonstrated sufficient knowledge, 45.0% had a positive attitude, and 9.5% showed good practices related to Mpox. Significant gaps in knowledge were observed, including in awareness. Additionally, 25.9% of the military personnel expressed their support for mandatory Mpox vaccination. Discharged military personnel (adjusted odds ratio, aOR = 0.13; 95% confidence interval, CI: 0.003–0.80; p-value = 0.026 and aOR = 0.15; 95% CI: 0.05–0.81; p-value = 0.023), graduates (aOR = 0.05; 95% CI: 0.011–0.44; p-value = 0.004 and aOR = 0.08; 95% CI: 0.012–0.40; p-value = 0.008), state diploma holders (aOR = 0.09; 95% CI: 0.005–0.79; p-value = 0.029 and aOR = 0.10; 95% CI: 0.005–0.84; p-value = 0.029), and those with a primary school certificate or no formal education (aOR = 0.13; 95% CI: 0.06–0.49; p-value = 0.022 and a OR = 0.14; 95% CI: 0.009–0.51; p-value = 0.028) were significantly less likely to exhibit positive attitudes and report good practices related to Mpox compared to those holding a postgraduate degree. The higher-ranking personnel reported positive attitudes. Conclusions The research highlights a lack of knowledge, a rather low attitude, and poor habits related to Mpox among military personnel in the Kokolo Health Zone in Kinshasa. The gaps identified underscore the crucial need for specific education and skill development actions to optimize preparedness and response to Mpox.
Background Adverse Events Following Immunization (AEFI) surveillance remains underdeveloped in Ethiopia, impeding efforts to promote vaccine uptake and reduce vaccine preventable diseases. This study aims to comprehensively evaluate the effectiveness of AEFI surveillance system in Ethiopia and assess the magnitude of AEFI cases in the community. Methods All health system levels including the ministry of health, Ethiopian Food and Drug Authority (EFDA), and health facilities were studied. AEFI data were collected from children aged 12-35 months who received routine vaccinations, individuals who received COVID-19, and adolescent girls who were vaccinated for HPV. Key informant interviews were conducted with key actors of the program. Data were analyzed categorizing AEFI cases by region, facility type and location. Quantitative data were triangulated with qualitative findings. Results A significant majority (88%) of facilities reported no AEFI cases within the year preceding the survey, with only 4% reporting more than 10 cases. Reported AEFI cases varied across different groups, with household surveys (59.1%), exit interviews (46.6%), COVID-19 vaccine recipients (44.9%), and HPV recipients (36.2%) experiencing adverse events. About 51 vaccinated individuals experienced serious AEFI. Lack of collaboration among the various stakeholders involved in immunization activities, and ambiguity in roles in the response to adverse events were the major challenges reported. Conclusions Significant majority of the health facilities do not report AEFI cases and have suboptimal surveillance system. The absence of a robust AEFI surveillance system coupled with insufficient measures to counter AEFI-related misinformation poses a challenge to the immunization program. The different actors should work together including the EFDA and ministry of health to effectively identify adverse events and improve the AEFI surveillance system.
Background The supply of health products is a key determinant of both care continuity and the economic efficiency of health systems. In low- and middle-income countries (LMICs), supply chain failures remain major obstacles to accessing essential medicines. In Benin, empirical data on the economic viability of supply systems at the peripheral level remain limited. Methods A cross-sectional evaluative study was conducted from March to July 2025 in 17 public health facilities (50% of the total), selected by simple random sampling, including the district hospital and the zonal distribution depot. Economic viability was assessed according to three components (structure, process, and outcome) using the six fundamental criteria of economic performance, enriched by four original composite indicators: the Composite Logistics Efficiency Index (CLEI), the Six Rights Compliance Index (SRCI), the Economic Vulnerability Index (EVI), and the Storage Failure Opportunity Cost (SFOC). Results Sixteen out of 17 facilities (94.12%) were classified as economically viable. The process component reached the 80% threshold in all facilities (100%). The mean CLEI was 80.66% (6 facilities below threshold) and the mean SRCI was 86.51%. The EVI revealed moderate economic vulnerability in 82.35% of facilities, primarily due to the universal absence of a financial dashboard and inadequate transport means. The SFOC was estimated at FCFA 11.37 million per year for the 8 facilities at risk of storage deficiencies. Conclusions The Allada-Toffo-Zè health district shows overall satisfactory economic viability according to normative criteria, with performance comparing favourably to regional benchmarks. However, cross-cutting structural vulnerabilities, in transport, financial management, and storage conditions, identified by composite economic indicators underscore that this viability remains fragile and contingent on targeted and sustained investments
Background The Diagnosis-Related Groups (DRGs) and Diagnosis-Intervention Packet (DIP) payment models aim to enhance healthcare efficiency, yet primary hospitals struggle with rational drug use under cost-control pressures. Pharmaceutical information management systems (PIMS) offer a potential solution, yet evidence from resource-limited settings remains limited. We evaluated whether a multifaceted intervention incorporating PIMS can improve drug use rationality and financial performance under DRGs/DIP in a primary hospital setting. Methods A quasi-experimental study with historical controls compared pre-intervention (January-December 2022) and post-intervention (January-December 2023) data from a primary hospital in Sichuan Province, China. The intervention comprised multidisciplinary team coordination, real-time clinical decision support, pharmacist-led ward rounds, training programs, and clinical pathway optimization. Outcomes included drug costs, antimicrobial use intensity (defined daily doses [DDD]/100 bed-days), prescription rationality rates, and DRG financial balance. Due to data aggregation at the hospital level, segmented regression analysis was not feasible; independent t-tests were used for pre-post comparisons. Results Post-intervention, average outpatient drug costs decreased significantly (33.48±3.67 vs. 39.29±5.52 yuan, p=0.006), and inpatient antimicrobial use intensity declined from 48.97±6.02 to 43.71±3.06 DDD/100 bed-days (p=0.013). Prescription review compliance improved from 93.67% to 97.50% (p<0.001). DRG settlement shifted from a loss of ¥394,800 to a surplus of ¥198,700. However, without adjustment for case-mix changes, seasonal variation, or concurrent policy reforms, causal attribution remains uncertain. Conclusions The multifaceted intervention was associated with improved drug use indicators and financial performance. These findings suggest potential benefits of integrating PIMS with pharmacist-led interventions in primary care, though methodological limitations preclude strong causal inference. Further research employing rigorous quasi-experimental methods across multiple sites is warranted.
Background Tuberculosis, the second deadliest infectious disease in the world after COVID-19, is caused by Mycobacterium tuberculosis. This bacterium most commonly affects the lungs. Economic and financial barriers can hinder access to healthcare services for the diagnosis and management of this disease. The objective of this study was to determine the cost of managing drug-sensitive tuberculosis in the Selembao Health Zone, specifically at the Diagnostic and Treatment Center (CSDT) of Makala General Referral Hospital. Methods A descriptive cross-sectional study was conducted from February 24 to March 17, 2024, involving 122 tuberculosis patients who were diagnosed, treated, and declared cured at the tuberculosis screening and treatment center (CSDT) Makala, in the Selembao Health Zone. A simple random probability sampling method was used. Descriptive analyses were performed to determine the costs (direct, indirect, and total) associated with tuberculosis management. Results The direct cost of managing drug-sensitive tuberculosis per patient in our study area (Selembao) ranged from 139,150 to 787,150 CDF (50.6 to 286.2 USD), with a median of 214,150 CDF (77.9 USD), based on the exchange rate of 2,750 CDF for 1 USD during the study period. The indirect cost per patient was estimated at 6,000 to 7,860,000 CDF (2.2 to 2,858.2 USD), with a median of 796,000 CDF (289.5 USD). The total cost of care ranged from 172,150 to 8,040,000 CDF (62.6 to 2,923.6 USD), with a median of 1,026,650 CDF (373.3 USD). The share of the DRC government in supporting the management of this disease was estimated at 12.1% of the total cost. Conclusions The management of drug-sensitive tuberculosis remains a significant financial burden not only for patients but also for their families and households. We therefore recommend substantial government support to enhance the coverage of this condition.
Background The need for obstetric care is defined by health conditions that require appropriate medical management. Limited literature in the Democratic Republic of Congo (DRC) using the unmet obstetric needs (UON) approach prompted this study. We aimed to assess the coverage of UON in the city of Lubumbashi, estimate the magnitude of unmet obstetric needs, identify factors associated with maternal mortality, and explore stakeholders’ awareness of the UON approach. Methods We conducted a mixed-methods cross-sectional analytical and phenomenological study in 12 health facilities in Lubumbashi. A total of 444 women were included in the quantitative analysis, and 30 semi-structured interviews were conducted with key stakeholders. Results An overall deficit of 88% in major obstetric interventions (MOIs) was observed. The deficit was markedly lower at the university clinics (1.1%) and Sendwe Hospital (33%) compared with an average deficit of 93.1% across the 10 secondary-level hospitals. Caesarean section was associated with higher odds of maternal death aOR=1.42(95% CI:1.21-1.72), whereas blood transfusion and referral to a higher level of care appeared to be protective factors. Qualitative findings revealed limited awareness among healthcare providers regarding the UON approach. Conclusions This study highlights a substantial burden of unmet obstetric needs in Lubumbashi, particularly in secondary-level facilities, alongside persistent maternal mortality largely driven by haemorrhagic complications. Strengthening emergency obstetric care capacity at secondary-level facilities, improving referral systems, and integrating UON indicators into routine health information systems should be prioritised to reduce preventable maternal deaths.
Background Countries in the Middle East and North Africa (MENA) face increasing pressure to optimise healthcare spending through evidence-based decision making. Economic evaluation guidelines (EEGs) are key policy tools that standardise the conduct and reporting of health economic analyses and inform reimbursement decisions. This study systematically compares national EEGs across MENA countries using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) framework. Methods A systematic search was conducted to identify national EEGs in the MENA region. Primary sources included the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) repository and the Guide to Economic Analysis and Research (GEAR), supplemented by searches of bibliographic databases and grey literature. Extracted data were mapped against CHEERS checklist domains and supplemented with information on guideline scope, methodological requirements, and implementation status. Results Four national EEGs were identified for Saudi Arabia, Egypt, Lebanon, and Tunisia, published between 2015 and 2025. Three were mandatory, while the Egyptian guideline was advisory. All guidelines required clear definition of target populations, comparator selection, appropriate time horizons, and evidence on effectiveness. However, substantial variation was observed in model structure, handling of uncertainty, perspective, costing approaches, and decision thresholds. The Saudi and Tunisian guidelines showed closer alignment with CHEERS domains, particularly in model transparency and sensitivity analysis requirements. Conclusions EEGs in the MENA region differ considerably in methodological detail, enforcement, and institutional maturity, reflecting uneven development of health technology assessment systems. Harmonisation efforts should focus on core methodological standards while allowing contextual adaptation to national health system priorities.
Background The rapid adoption of artificial intelligence (AI) in African healthcare presents both transformative opportunities and structural risks. While AI-enabled diagnostic technologies may expand clinical capacity and improve service delivery, their deployment also raises questions of data sovereignty, infrastructural dependency, regulatory auditability, and unequal value capture. Methods This exploratory multi-case analysis examines four African health technology firms: Helium Health, Ubenwa, Neural Labs Africa, and Envisionit Deep AI. The study draws on publicly available secondary sources published between 2017 and 2025, comprising 26 peer-reviewed or academic sources, 6 policy and regulatory documents, and 4 firm-level sources. A thematic analysis was conducted through a political-economy framework using deductive and inductive coding. Results Publicly available documentation suggests three recurring structural patterns. First, the selected firms rely on AWS or Google Cloud for key infrastructure functions, creating potential limits on domestic regulatory oversight of diagnostic data pipelines and model updates. Second, the absence of publicly documented locally governed datasets and systematic local retraining points to data sovereignty and clinical validation gaps. Third, fragmented data protection regimes across Nigeria, Kenya, and South Africa create governance asymmetry that may constrain the cross-border data pooling needed for African AI model development. Conclusions Diagnostic equity in African health AI requires governance over data, infrastructure, models, and validation systems. The study proposes tiered data sovereignty frameworks, regionally coordinated health data trusts, and staged AI validation sandboxes as practical pathways for reducing dependency while preserving innovation capacity. Findings are exploratory and should be interpreted in light of reliance on publicly available evidence.
Background The supply chain plays a central role in ensuring continuity and quality of healthcare services. In response to recent supply chain failures, Benin has initiated a shift in its health commodity logistics model, moving from a fragmented PULL system to an integrated PUSH approach. This study was conducted to assess the contribution of the new model to supply chain performance. Methods A descriptive cross-sectional study with evaluative and analytical components was carried out among 176 participants from two health zones in the Couffo Department, including health facilities, district warehouses, logistics professionals, and patients. Data were collected through observation, interviews, and document review. Data were analysed using the Varkevisser scoring scale, statistical tests, and odds ratio estimation at a 5% significance level. Results Overall performance was higher under the PUSH model, particularly in the Klouékanmè-Toviklin-Lalo (KTL) health zone compared with the Aplahoué-Djakotomey-Dogbo (ADD) health zone (86.13% vs 71.00%; p=0.000001). Significant improvements were observed in product availability (odds ratio, OR=2.00; p=0.002), reduction in stock-outs (OR=0.21; p=0.001), shorter delivery lead times (β=−12.65; p=0.001), lower logistics costs (OR=8.56; p=0.008), and higher stakeholder satisfaction (OR=4.40; p=0.044). Some indicators (patient satisfaction and reduction in spoilage) were not statistically significant. Conclusions Improved logistical and economic performance of the supply chain is associated with the implementation of the PUSH model. Its scale-up, supported by a longitudinal study examining the determinants of its sustainability, represents a relevant strategic perspective for health procurement policies.
Background With a high maternal mortality rate of 1047 deaths per 100,000 live births as of 2020 in Nigeria, it is important to understand the underlying factors contributing to the disparities in maternal healthcare access. This study used the latest Multiple Indicator Cluster Survey (MICS) 2021 to examine regional disparities in Antenatal Care utilization in Nigeria. Methods Data for this study was obtained from the Nigeria MICS 2021, a nationally representative household survey that employed a multistage, stratified cluster sampling design. Information on 6998 women of reproductive age between the ages of 15 - 49 was used. The outcome variable was adequate ANC visits defined by at least four visits while the independent variables were the socioeconomic and demographic factors of the mother. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 27. Descriptive analyses were done and a multivariable binary logistic model determined the adjusted effect of independent variables on adequate ANC visits at a significance level of 0.05. Results The majority of the respondents were between 15-34 years of age. Inadequate utilization of antenatal care was highest in the North West (35.5%) and generally higher in the Northern region when compared to the Southern region. Women from the North West, North East and North Central regions had an inadequate ANC coverage rate of 35.5%, 31.6%, and 27.3% respectively, while for women from the South-South, South East, and South West it was 14.9%, 10.3% and 10.0% respectively. The regional disparities varied by education, income, parity, and access to internet and health insurance. Women with primary, secondary, and tertiary education from the South-South were 2.2, 1.6, and 6.7 times respectively, more likely to adequately use ANC than those with no formal education. Conclusions We found persisting regional disparities in antenatal care utilization in Nigeria. Hence, a need for evidence-based interventions tailored to address the unique challenges faced by each region to ensure equitable access to maternal healthcare services.
