Introduction Maintaining measles surveillance in fragile, conflict-affected settings remains challenging due to insecurity, limited laboratory access and epidemic surges. Borno State, Nigeria, operates a dual-intensity surveillance framework combining laboratory-confirmed case-based surveillance (CBS-Lab) with epidemiologically linked outbreak reporting (CBS-Epi). We evaluated system performance, spatiotemporal surveillance patterns and operational constraints from 2020 to 2024.Methods We conducted a programmatic surveillance system evaluation using the US Centers for Disease Control and Prevention updated guidelines, assessing system attributes against WHO AFRO benchmarks. The evaluation used retrospective measles surveillance data (28 370 suspected cases) and a cross-sectional survey of surveillance officers assessing perceptual and operational domains (31/58; 53% response), supplemented by a contextual policy document review. Spatiotemporal alignment between surveillance streams was analysed using Spearman’s rank correlation.Results CBS-Lab represented 6.1% (n=1725) of notifications, functioning as a sentinel subset with ≥98% completeness, a 47.8% positive predictive value and 88.4% specimen collection within 48 hours, though only 5% of cases met the <10-day turnaround standard.CBS-Epi (93.9%; n=26 645) maintained ≥99.8% completeness and captured epidemic peaks in 2021 and 2023, though representativeness was constrained by geographic inaccessibility in conflict-affected local government areas. No case-record overlap occurred between streams due to protocol design. Aggregate temporal (ρ=0.69) and geographic (ρ=0.65) co-variations were strong (p<0.001). Laboratory sampling intensity was inversely correlated with district case burden (ρ=−0.64; p<0.001), indicating risk-based prioritisation. Acceptability remained high despite insecurity, transport and funding constraints.Conclusion Within the specific operational context of Borno State, dual-intensity surveillance enabled operationally useful epidemic intelligence and maintained mortality-reduction phase performance despite protracted conflict. These findings suggest that the pragmatic combination of simplified outbreak reporting and targeted laboratory confirmation may represent a feasible surveillance approach in comparable fragile settings, though contextual adaptation would be required.
Introduction Reliable estimates of effective coverage of health interventions are essential for tracking progress towards health goals and informing policy decisions. In settings where routine health information systems are limited, population-based household surveys are frequently used as reference standards.Objective This study compared national and sub-national childhood vaccination coverage estimates from Kenya’s facility-based Health Information System (KHIS) and the 2022 Kenya Demographic Health Survey (KDHS) to assess concordance between the two data sources and to evaluate the suitability of routine data for programmatic decision-making.Methods We analysed BCG, pentavalent 1, pentavalent 3 and measles-rubella 1 (MR 1) vaccination data reported by 8178 health facilities to KHIS between March 2020 and March 2022 alongside KDHS 2022 data from 3679 children aged 12–23 months. Coverage estimates were compared at national and county levels using a two-proportion z-test. Absolute differences in coverage were categorised as minimal (<5%), moderate (5–10%) and high (10+%), thresholds previously used in immunisation monitoring as reported by WHO and United Nations International Children’s Emergency Fund coverage comparison.Results Nationally, KDHS coverage estimates were higher than KHIS estimates for BCG, pentavalent 1 and MR 1; the absolute differences were all <5% and statistically significant. For pentavalent 3, no significant difference was detected (0.38 percentage points; 95% CI −0.54 to 1.42). Sub-national discrepancies were substantially larger: minimal differences (<5%) were observed in only 15–21 of 47 counties depending on antigen, while high discrepancies (>10%) occurred in 9–14 counties. Only three counties showed absolute differences <5% across all four antigens; several counties showed persistent divergence across antigens.Conclusion KHIS yields reasonably concordant national-level estimates of childhood vaccination coverage, but substantial and uneven county-level discrepancies limit its reliability for sub-national decision-making. A differentiated approach is warranted: KHIS can support national trend monitoring and may be usable in counties with demonstrated concordance, whereas counties with persistent divergence require continued survey-based validation and targeted strengthening of routine data systems. The two data sources should not be treated as interchangeable at county level.
Introduction The USA has two types of medical schools: allopathic and osteopathic schools. End-of-life (EOL) care requires shared decision-making between patients and physicians and is potentially influenced by physician factors. However, little is known about whether allopathic and osteopathic physicians show different practice patterns in EOL settings. Therefore, this study aimed to compare EOL care processes and outcomes for beneficiaries treated by allopathic and osteopathic physicians.Methods We used cross-sectional data of a 20% random sample of fee-for-service Medicare beneficiaries aged ≥66 years who died in 2016–2019. Each beneficiary was attributed to a physician responsible for the largest number of evaluation and management visits in the last 6 months of life. Our outcomes were eight EOL care-related measures categorised into (1) advance care planning (ACP) and palliative care and (2) high-intensity care at the EOL. We estimated differences in these measures for beneficiaries treated by allopathic and osteopathic physicians, adjusting for physician and beneficiary characteristics.Results Among 306 335 decedents, 240 907 (78.6%) were treated primarily by allopathic physicians and 65 428 (21.4%) by osteopathic physicians. We observed no differences in the eight measured indicators: billed ACP (adjusted rate, 14.1% vs 14.5%; p>0.99), palliative care counselling or hospice use in the last 180 days of life (62.4% vs 62.2%; p>0.99), emergency department visits (57.0% vs 56.9%; p>0.99), hospital admissions (50.9% vs 50.4%; p=0.31), intensive care unit admissions (27.3% vs 27.2%; p>0.99), mechanical ventilation or cardiopulmonary resuscitation (14.5% vs 14.4%; p>0.99), placement of feeding tubes (1.4% vs 1.4%; p>0.99) in the last 30 days of life, and death in acute care hospital (20.9% vs 20.4%; p=0.13).Conclusions We found no evidence of differences in the eight measured EOL care indicators between beneficiaries treated by allopathic versus osteopathic physicians, although differences in unmeasured aspects of care cannot be excluded.
Introduction Physical activity (PA) is central to public health strategies, but policies often assume that active children become active adults and remain active throughout life. However, evidence supporting these assumptions is limited and inconclusive. This meta-analysis aimed to examine the trajectory and stability of PA across the lifespan, specifically focusing on total PA, moderate-to-vigorous PA (MVPA) and daily steps.Methods A systematic review of five databases (Web of Science, PubMed, MEDLINE, SCOPUS and SPORTDiscus) was searched for studies published up to September 2026 that measured PA at least two times over a minimum 1-year interval and reported PA in min/day or provided correlation coefficients. Two authors independently screened studies, extracted data and assessed risk of bias. All meta-analytical statistics were performed in R. Absolute changes in PA were calculated using weighted mean differences and stability using correlation coefficients.Results A total of 151 studies involving 145 274 participants were included in the meta-analysis. Total PA showed moderate tracking across the lifespan, with r values ranging from 0.32 to 0.40 and a significant annual decline of −7.8 min/day (95% CI −15.1 to −0.5). The weakest association in tracking was observed between childhood and adulthood (r=0.32). MVPA tracking was weaker, particularly from childhood to adulthood (r=0.21), with an annual average decrease of −2.0 min/day (95% CI −3.2 to −0.8). Step-count data revealed weak tracking from youth to adulthood (r=−0.01), but moderate tracking in adulthood (r=0.52). No significant sex differences were observed for any PA behaviour.Conclusions With poor-to-moderate tracking from youth to adulthood and consistent declines in PA and MVPA, these findings challenge the efficacy of interventions focused solely on early-life PA promotion. They underscore the need for sustained age-spanning strategies to effectively promote PA across the lifespan.PROSPERO registration number CRD42024495292.
