Background Sexually transmitted infections (STIs) infect 374 million people annually, with sub-Saharan Africa bearing the highest burden. Community behavioural resilience remains poorly understood in low-income settings, creating a critical gap in STI pandemic preparedness. This study identifies predictors of willingness to adopt protective behaviours during a hypothetical STI outbreak in rural Cameroon. Methods We conducted a community-based survey in 2022 among residents of three riverine health areas in the Bafia Health District, Cameroon. Participants (N=372; 202 females [54.3%], 170 males [45.7%]) >= 18 y of age were enrolled; 336 with complete data were included in regression analyses. All participants were assessed for STI knowledge (awareness of 10 pathogens), self-reported STI history, current symptoms, willingness to undertake STI screening and willingness to abstain from sexual intercourse in a hypothetical STI pandemic scenario. Multivariable logistic regression identified independent predictors of willingness to abstain. Results Among 336 participants, 247 (73.5%) reported a willingness to abstain from sexual intercourse during a hypothetical STI pandemic. The strongest independent predictors of protective intention were willingness to undertake STI screening (adjusted odds ratio [aOR] 10.3 [95% confidence interval {CI} 4.55 to 24.2], p<0.001) and self-reported history of an STI (aOR 4.88 [95% CI 2.16 to 11.5], p<0.001). Knowledge of Chlamydia trachomatis (aOR 3.91 [95% CI 1.16 to 13.0], p=0.026) and hepatitis B (aOR 3.50 [95% CI 1.55 to 8.02], p=0.003), as well as age 30-39 y (aOR 5.94 [95% CI 1.51 to 28.3], p=0.016), were also significant predictors. In this study, a low overall STI knowledge score was paradoxically associated with higher odds of protective intention (aOR 10.7 [95% CI 1.57 to 76.7], p=0.016). The wide CI reflects statistical instability from small cell counts, thus the estimates should be regarded as exploratory. Conclusions Community behavioural intentions during a hypothetical STI pandemic are driven more by experiential factors (personal STI history and willingness to seek testing) than by general STI knowledge. These findings are based on stated behavioural intentions in a hypothetical scenario, not observed behaviour. Still, the implication is clear. Pandemic preparedness policies must therefore integrate experiential drivers, including routine asymptomatic screening and accessible diagnostic services, to strengthen community behavioural resilience. This experience-aware model offers scalable insights for low- and middle-income countries and global health security planning.
Abstract Background Tuberculosis (TB) remains a major public health challenge in Sierra Leone, contributing to high morbidity and mortality. Understanding trends in its prevalence and identifying sex-based disparities are crucial for designing targeted, evidence-based interventions. This study explored the trends in the age-standardized prevalence of TB in Sierra Leone from 2000 to 2019, with a focus on sex-based inequalities. Methods A cross-sectional analysis was conducted using age-standardized prevalence data (per 100 000 population) from the World Health Organization’s Health Equity Assessment Toolkit (HEAT). Data were analysed at five time points (2000, 2005, 2010, 2015 and 2019). Inequality measures, including difference (D), ratio (R), population attributable fraction (PAF) and population attributable risk (PAR) were calculated to assess absolute and relative disparities between males and females. Confidence intervals (CIs) were reported for all estimates to ensure the precision of findings. Results The age-standardized prevalence of TB in Sierra Leone declined from 38 741.6 per 100 000 population in 2000 to 23 797.1 in 2019, a relative reduction of 38.6%. However, sex-disaggregated analysis revealed disparities, with males experiencing higher prevalence rates than females. In 2019, the prevalence for males was 24 968.0 per 100 000 population (95% CI 22 051.1 to 28 307.9) compared with 22 651.8 for females (95% CI 20 053.2 to 25 784.3). The absolute difference (D) widened in magnitude over time, from 1130.7 in 2000 to 2316.2 in 2019 (reported as negative values because female prevalence was lower). The inequality ratio (R) remained close to 1.0 throughout the study period, indicating modest relative disparities. The PAF increased from 1.5% in 2000 to 4.8% in 2019, and the PAR increased from 564.1 to 1145.3 per 100 000 population, indicating a small but growing share of the overall TB burden attributable to the higher prevalence among males. Conclusions Despite a marked decline in the overall prevalence of TB in Sierra Leone from 2000 to 2019, males consistently faced a higher burden compared with females. These findings underscore the need for targeted strategies to address the sex-based disparities. Strengthening health systems, promoting equitable access to care, and implementing tailored prevention programs are critical to reducing the overall burden of TB and achieving health equity in Sierra Leone.
Abstract Objectives Somaliland has recurrent measles transmission, but outbreak-specific evidence on modifiable child, household, and health-service factors is limited. We examined factors associated with measles case status during the 2025–6 Burao outbreak. Methods We conducted a community-based unmatched case-control study among children aged <15 years from 14 June to 8 July 2026. Cases were enrolled consecutively and controls sampled systematically from households using a random start and every fourth household. Cluster-robust logistic regression estimated adjusted ORs (aORs), with indeterminate responses modeled separately. Results Among 804 children (290 cases, 514 controls), case status was associated with non-vaccination (aOR 2.12, 95% CI 1.02–4.42), close contact (3.00, 1.72–5.25), reported health-facility attendance (2.79, 1.91–4.06), vaccine unavailability (2.62, 1.17–5.85), and trucked/vendor water (2.98, 2.03–4.36). Prior malnutrition, large-gathering attendance, household vaccination-refusal history, and poor ventilation were also associated. Health-facility attendance referred to the 21 days before rash onset/reference date, but exact visit dates were not collected. Conclusion Measles case status was associated with immunity gaps, contact, household conditions, and service-related factors. Response priorities include reliable vaccine availability, catch-up vaccination, and contact-based action. The health-facility attendance association is temporally ambiguous and does not establish healthcare-associated transmission.
