Objectives To evaluate the effectiveness of 18 different host biomarkers in differentiating bacterial from non-bacterial acute febrile illness (AFI) in resource-limited settings, specifically in Brazil, Malawi and Gabon.Design Multinational, cross-sectional study.Setting The study was carried out across multiple primary healthcare facilities, including urban and rural settings, with a total of three participating centres. Recruitment took place from October 2018 to July 2019 in Brazil, May to November 2019 in Gabon and April 2017 to April 2018 in Malawi.Participants A total of 1915 participants, including children and adults aged 21–65 years with a fever of≤7 days, were recruited through convenience sampling from outpatient clinics in Brazil, Gabon and Malawi. Individuals with signs of severe illness were excluded. Written consent was obtained from all participants or their guardians.Intervention This is not applicable as the study primarily focused on biomarker evaluation without specific therapeutic interventions.Primary and secondary outcome measures The primary outcome measure was the ability of each host biomarker to differentiate between bacterial and non-bacterial AFI, as evaluated by area under the receiver operating characteristic (AUROC) curves. Secondary outcomes included the performance of individual biomarkers across the different study sites and in a multivariable setting.Results A Kruskal-Wallis test, adjusted by Benjamini-Hochberg, was performed for each biomarker to identify covariates with a significant difference in the distribution of biomarker values. The analysis revealed that country of origin (Brazil, Gabon, Malawi), age, sex and malaria status significantly impacted biomarker distribution (p≤0.001). The most widely known biomarkers, such as white blood cell (WBC) count and C-reactive protein (CRP), demonstrated the best performance in distinguishing between bacterial and non-bacterial infections, with AUROCs reaching up to 0.83 (0.77–0.88) for WBC count and 0.71 (0.59–0.82) for CRP. However, none of the evaluated novel host biomarkers exhibited high performance (AUROC<0.70 in most cases) and variations in biomarker performance were observed across the three settings. Multivariable analyses demonstrated that while the best combination of biomarkers achieved higher AUROCs, the increase was modest (1–13%), suggesting that the interaction of biomarkers contributed minimally to predictive accuracy.Conclusions There is a continued need for innovation in the host-biomarker space as the available markers do not meet the needs of diverse populations around the globe. This highlights the importance of targeted evaluations in non-severe patients in multiple settings to understand the true potential for real-life use. The findings highlight that not one-marker fits all settings and novel innovations remain urgently needed.Trial registration number Clinical trial number: NCT03047642.

Background More than 20 million people are infected with L. loa, and around 40 million live in high or intermediate-risk areas in West- and Central Africa. Although loiasis is associated with significant morbidity and excess mortality, little is known about the perception of loiasis by affected communities. This study assessed the knowledge, attitudes, and practices in the rural population of Sindara, Gabon, a region characterized by high loiasis prevalence. Methods A community-based cross-sectional survey was conducted in Gabon between January and June 2022. During systematic door-to-door visits, randomly selected inhabitants were invited to participate in this questionnaire based survey. Venous blood was collected at midday from all participants for microscopic detection of filarial infection and clinical signs of loiasis were assessed. Results A total of 150 participants were recruited, of which 66% were infected by L. loa. While almost everyone had some knowledge about L. loa, 72% of the participants understood that L. loa is a parasitic worm. The transmission of L. loa via the deer fly was known to only 21% of participants. The most frequently mentioned clinical symptoms attributed to loiasis were itching (84%), eye worm migration (59%), and conjunctivitis-like symptoms (53%). Participants who experienced migratory loiasis had better knowledge of loiasis and considered it as more serious. Traditional and herbal medicine was reported most often as an available treatment option (72%). While the formal healthcare sector was mentioned as the preferred treatment provider, 60% of the reported infections were treated by traditional medical practitioners. Conclusion Loiasis is in general well known by this community residing in a region of high L. loa transmission. Important gaps in knowledge were discovered foremost regarding the mode of transmission. The available healthcare system does not seem to provide adequate management for loiasis.

The consequent use of malaria rapid diagnostic tests (RDTs) preceding a treatment decision has improved the global management of malaria. A combination RDT, including an inflammation marker to potentially guide antibiotic prescription, could improve the management of acute febrile illness (AFI). We performed a prospective, cross-sectional study in Gabon evaluating the STANDARD Malaria/CRP DUO (S-DUO) RDT. Participants aged 2 to 17 years with fever at presentation and/or a history of fever < 7 days were enrolled. Expert microscopy, SD Bioline Malaria Ag P.f/Pan test for malaria detection, and NycoCard CRP device for CRP were used as comparators. AFI cases were classified on a spectrum encompassing bacterial vs. non-bacterial infection. 415 participants with AFI were enrolled. S-DUO RDT sensitivity and specificity for malaria detection vs. microscopy were 99·1

Introduction: To date, 38.4 million people live with the Human Immunodeficiency virus (HIV) amongst whom 1.7 million are children below fourteen years of age. The highest burden of HIV is in sub-Saharan Africa. Children living with HIV acquired the infection mostly by mother-to-child transmission (MTCT), however the diagnosis is often delayed.In malaria-endemic countries, fever is one of the most frequent symptoms for seeking medical care and it is often primarily suspected as the onset of malaria or respiratory bacterial infections. Here, we report a case of late-onset undiagnosed AIDS in a 13-year-old boy living in rural Gabon in the Gabonese tropical rainforest in the province of Ngounié. Case: A 13-year-old orphan child presented at our routine consultation for fever screening at the Institut de Santé de Sindara (ISSA) in 2021 due to remittent fever episodes, paleness, chronic fatigue and cough. His medical history documented repeated consultations and hospitalisations over the past years, establishing various diagnoses and treatments without significantly improving his condition. Serologic testing established the diagnosis of HIV-1 infection, classifying it as CDC stage 3 AIDS. Given the family history, late-onset symptomatic HIV infection 13 years after mother-to-child transmission was the most likely transmission mode. Discussion: HIV infection may occur in older children and young adolescents and should be considered as an important differential diagnosis of reappearing fevers in regions of malaria transmission. Early diagnosis of HIV, particularly in children and adolescents, improves health outcomes. highlighting the need for HIV testing in children and adolescents.

Background and Objectives:Point-of-care testing using nonsputum samples like serum or plasma proteins can improve tuberculosis (TB) patients access to a definitive diagnosis, especially in resource-constrained and remote areas. Recently, approximately 400 proteins were identified as playing a role in the pathogenesis of TB, offering a translational clinical research repository for TB. In a previous manuscript, we proved the potential use of these proteins for point-of-care testing for active TB diagnosis. The present work aims to confirm the performance of single and combination proteins to select the best candidate biomarkers for further development as a diagnostic testing tool for active TB. Methods:Seventy-four participants were assessed on the diagnostic performance of 17 single proteins and combinations of 2 to 4 proteins to diagnose active TB. The selection criteria included differential expression of the proteins between active TB and community-acquired pneumonia (CAP) and a performance rate ≥70% for active TB. Results:SULT4A1, WASPF3, SPTLC1, FAM107B, SORCS2, and CYTOb561 were differentially expressed in TB compared to CAP patients. Two single proteins, SULT4A1 and WASPF3, performed ≥70% to discriminate active TB from CAP patients. The diagnostic performance of 3 protein-based combinations of active TB was 81% after leave-one-out cross-validation. Conclusion:Single proteins and 3 protein-based combinations are candidate biomarkers for diagnosing active TB disease. A large and prospective study will confirm their performance as complementary diagnostic tools to rapid diagnostic methods for detecting active TB.

Background Nutritional imbalance is an underlying cause of 2.6million death annually and a third of child’s death globally. This study assessed and compared the nutritional status of primary school children and their caregiver’s knowledge on malnutrition in rural and urban communities of Ekiti State. Methods This is a cross-sectional comparative study carried out among 983 urban and rural primary school children in Ekiti State (495 in urban and 488 in rural) using interviewer-administered semi-structured questionnaire. A multi-stage sampling technique was used and data collected was analyzed using SPSS 23 with level of statistical significance set at p < 0.05. Results Underweight and stunting were relatively higher in rural (6.5% and 22.7% respectively) than in urban (6.3% and 19.4% respectively) and these differences are not statistically significant (p = 0.898, p = 0.197). However, wasting, overweight and obesity were higher in urban (12.7%, 6.1% and 7.7% respectively) than rural (11.5%, 3.7% and 7.5% respectively) but the difference is not statistically significant. (p = 0.242). Majority of the caregivers in both settings had good knowledge of malnutrition though higher in urban mothers (89.5%) with statistical significance than their rural counterparts (71.5%). However, there is no significant association between caregiver’s knowledge and malnutrition in this study. Being in lower primary school class, relationship with caregiver, educational status of caregiver and occupation of caregiver were the common predictors of malnutrition among the school children in both community settings. Conclusion Generally, the prevalence of malnutrition was high in both urban and rural primary school children in this study. However, while underweight and stunting were more prevalent among the children in the rural communities, wasting, overweight and obesity were more prevalent in the urban. The caregivers in both communities had good knowledge of malnutrition (better in the urban) but this is not good enough to bring a significant relationship with the occurrence of malnutrition in the children. Common predictors of malnutrition in both community settings are being in lower primary school class, relationship with caregiver, educational status of caregiver and occupation of caregiver. It is therefore recommended that regular continuous public enlightenment, nutritional education programmes and other programmes targeted at improving the economic power of the caregivers are measures that will improve the nutritional status of the primary school children.

Background: Research on breast cancer risk factors and mortality is gaining recognition and attention globally; there is need to add more information on its determinants among patients admitted in hospital. Some studies on risk factors and mortality of breast cancer in Nigeria hospitals conducted in the urban and suburban areas have been documented. Therefore, an addition of a study conducted in the setting of a rural health institution is necessary. This study assessed the risk factors and determinants of mortality among patients admitted for breast cancer in rural Southwestern Nigeria. Methods: A retrospective observational study was conducted on 260 patients who were admitted for breast cancer between January 2010 and December 2023 using a data form and a standardized information form. The data were analyzed using SPSS version 22.0. The risk factors and the determinants of mortality of patients with breast cancer were identified using multivariate regression model. Results: The breast cancer risk factors were old age, family history, tobacco smoking, combined oral contraceptives, and hormonal therapy use. The case fatality rate was 38.1%, and its determinants of mortality were patients who were older (adjusted odds ratio [AOR], 1.956; 95% confidence interval [CI]:1.341-4.333), obese (AOR, 2.635; 95% CI: 1.485-6.778), stage IV (AOR, 1.895; 95% CI: 1.146-8.9742), mastectomy (AOR, 2.512; 95% CI: 1.003-6.569), discontinued adjuvant chemotherapy (AOR, 1.785; 95% CI: 1.092-4.6311), and yet to commence adjuvant chemotherapy (AOR, 2.568; 95% CI: 1.367-5.002). Conclusion: The study revealed that patients with breast cancer were associated with high mortality. Sustained health education to promote early diagnosis, managed co-morbidities, and access to treatment may contribute to reduction in breast cancer mortality in rural Nigeria.

Objectives We aimed to identify the prevalence, bacterial isolates, antimicrobial susceptibility profile, and factors associated with asymptomatic bacteriuria (ASB) in patients with type 2 diabetes mellitus (T2DM) in rural southwestern Nigeria.Methods We performed a hospital-based cross-sectional study of patients with T2DM and ASB. Demographic and clinical data were collected using questionnaires. Urine samples were cultured using standard laboratory procedures, and bacterial colonies were isolated and antimicrobial sensitivity was performed using the disc diffusion technique. Relationships between variables were assessed using adjusted odds ratios (AORs) and 95% confidence intervals (CIs).Results Of the 280 participants, 73 (26.1%) had ASB (95% CI: 20.9%-31.2%). The most commonly identified isolate was E. coli (45/73; 61.7%), 100.0% of which were sensitive to cefuroxime but resistant to ciprofloxacin. Female sex (AOR, 6.132; 95% CI: 2.327-16.157), living below the poverty line (AOR, 2.066; 95% CI: 1.059-4.029), uncontrolled blood glucose (AOR, 2.097; 95% CI: 1.000-4.404), and a history of indwelling urethral catheterization (AOR, 14.521; 95% CI: 4.914-42.908) were associated with ASB.Conclusion The findings suggest that cefuroxime should be used as an empirical treatment, pending urine culture and sensitivity, and that efforts should be made to prevent ASB in rural southwestern Nigeria.

Background: Unlike adults, children experienced stronger and longer vector replication in plasma and shedding in saliva following rVSVAG-ZEBOV-GP vaccination. The resulting risks of immunosuppression or immune hyperactivation leading to increased Adverse Events (AEs) and altered antibody responses are concerns that have been addressed in the present manuscript. Methods: Children aged 1-12 years living in Gabon received either rVSVAG-ZEBOV-GP (ERVEBO (R)) vaccine or the varicella-zoster virus (VZV) vaccine (VZV). The concentration of rVSVAG vector in blood and saliva, the occurrence of AEs up to day 28; the anti-rVSVAG-ZEBOV-GP and anti-VZV IgG antibody titres, neutralising and avidity functions of anti-rVSVAG-ZEBOV-GP by day 365; were assessed in serum. (PACTR202005733552021) Findings: In the rVSVAG-ZEBOV-GP group, 70% and 7% of children had > 0 copies/ml of rVSVAG respectively in plasma by day 3 and in saliva by day 14 after vaccination, with no detection on day 28. Significantly higher but transient AEs occurred in the rVSVAG-ZEBOV-GP group. Both vaccines induced seroconversion on day 28 and sustainable IgG antibody titres by day 365. Avidity and neutralisation functions of the antirVSVAG-ZEBOV-GP antibodies peaked at day 28 and were maintained by day 365. Interpretation: The replication and shedding do not affect the favourable risk-benefit balance of the rVSVAG-ZEBOV-GP in children. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objectives To examine family planning through the community’s perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.Design A descriptive exploratory study.Setting Three communities were selected from three local government areas, each in the three senatorial districts in Ekiti State.Participants The study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active.Main outcome measures Eight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed.Results The majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake—intrapersonal, interpersonal and health system factors.Conclusion The study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.

Aim: This work was conducted between the period of April 2022 and March 2023 to investigate the prevalence and predisposing factors of enteric parasites among children accessing medical healthcare at the Federal Medical Center keffi, Nasarawa State. Study Design: The study was a cross-sectional study. Methodology: Fresh stool specimens were collected into sterile bottles from children aged 1-15 (246 males and 194 females) who accessed medical healthcare at the Federal Medical Center keffi, Nasarawa State between the period of April 2022 and March 2023. Information such as age, gender, and drinking water sources were obtained from the subjects through a structured questionnaire. The stool specimens were observed visually for colour, consistency, and presence of blood, pus, and adult worms while the concentration of the eggs, cysts, and larvae of the intestinal parasites was carried out using the formol ether method and viewed with X10 and X40 magnifications of the binocular microscope. Data obtained from this study were analyzed using the chi-square test by the use of Statistical Package for Social Sciences (SPSS) version (21.0). Values obtained were considered significant at 95% probability. Results: An overall prevalence of 27.26% was obtained in the study participants with a total of five species of intestinal parasites identified. The parasites include; Entamoeba coli, Entamoeba histolytica, Giardia lamblia, Strongyloides stercoralis, and Trichomonas hominis. Entamoeba. histolytica was the most prevalent (15.45%) while S. stercoralis was the least prevalent (1.36%). In this study, males recorded a higher prevalence of Entamoeba. histolytica (16.49%) than females (14.63%) likewise for E. coli (5.14%) and (4.07%), Strongyloides stercoralis (1.55%) and (1.22%) respectively. In contrast, females recorded a higher prevalence of Giardia lamblia (2.85%) than males (2.58%) and Trichomonas hominis (3.25%) and (1.03%) respectively. The prevalence of intestinal parasites varied significantly among the age groups, with the age group 1-5 years being the most susceptible to E. histolytica (45.71%). Children who drank river water had the highest prevalence of parasitic infection (57.14%) while those who drank borehole water had the lowest majority (14.29%). Conclusion: The high prevalence of intestinal parasites observed in this study in relation to the sources of drinking water of the subjects suggests a major predisposing factor to intestinal parasitic infections. Therefore, the provision of potable drinking water and public enlightenment on proper hygiene practices in the study area is of great importance.

Background Live attenuated, including viral vector, vaccines may be transmitted to others. Benefits of secondary transmission include increased vaccine coverage and accelerated achievement of herd immunity. In contrast, risks include vaccine evolution to wild-type pathogens e.g., oral polio vaccine and risks of adverse events in vulnerable populations. Recently, we reported the shedding of the rVSVΔG-ZEBOV-GP vaccine in children’s saliva, suggesting potential secondary transmission to relatives. In this phase 2 vaccine trial, we investigate the secondary transmission of the rVSVΔG-ZEBOV-GP vaccine to the vaccinees’ relatives in Gabon. Methods One hundred sixty-three relatives of our study vaccinees (Gabonese children aged 1–12 years old) were enrolled to assess the transmission of the rVSVΔG-ZEBOV-GP vaccine, compared to another live attenuated vaccine containing the Oka strain of the varicella-zoster virus. They were followed up on days 0, 2 or 3, 7, 14, 21, 28, and 56 post-vaccination. Clinical symptoms and signs were observed, and samples were collected during the study visits. Relative plasma and saliva were tested by RT-PCR for presence of rVSV RNA, alongside antibody titers’ determination. Results Quantifiable rVSV RNA was detected in plasma in a low proportion of relatives on days 2 or 3; there was no detection in the saliva of relatives at any visit. These data will be aligned with titers of anti -ZEBOV-GP and further interpreted. No adverse event was observed in the relatives. Conclusion rVSVΔG-ZEBOV-GP vaccine virus is transmissible to relatives or close contacts of vaccinees, based on the RT-PCR Ct values, favoured by virus shedding in vaccinated individuals. The implications of this finding require further consideration. Funding: IMI, VSV-EBOPLUS consortium

Background: Globally, acute febrile illness (AFI) is one of the main reasons individuals present to primary healthcare facilities, particularly children. Particularly, in resource-limited settings, it is often difficult to distinguish bacterial from non-bacterial AFI, which can lead to the unnecessary use of antibiotics and increase the spread of antimicrobial resistance. Host biomarkers have the potential to inform the aetiology of AFI, but which biomarkers are most appropriate in resource-limited settings remains unclear.Methods: We conducted the Biomarker for Fever Diagnostic (BFF-Dx) study to evaluate 18 different host biomarkers, in a prospective study of 1915 patients with non-severe AFI in Brazil (n=500), Malawi (n=1000), and Gabon (n=415) using a standardized approach. Bacterial and non-bacterial classifications were made based on a 2-step process using laboratory testing and a clinical panel.Findings: The most widely known biomarkers, haematology biomarkers and C-reactive protein (CRP), remain the best-performing in this non-severely ill population with AUROCs of 0·8 (white blood cell count) or 0·71 (CRP) in the best cases, combinations not adding value. None of the evaluated novel host biomarkers exhibited high performances in distinguishing bacterial from non-bacterial infections in any of the settings (AUROC<0·70 in most cases).Interpretation: There is a continued need for innovation in the host-biomarker space as the available markers do not meet the needs of diverse populations. This highlights the importance of targeted evaluations in non-severe, intended-use settings for true assessments.Funding Information: Funding was provided to FIND, the global alliance for diagnostics, by the governments of the Netherlands, United Kingdom, and Australia.Declaration of Interests: SD, BLFC, CE, VH, SO, CH, AM, SL are or were employed by FIND, the global alliance for diagnostic during the study period. All others have nothing to declare. Ethical Approval: The study protocol was reviewed and approved by the relevant ethics committees of the three sites and countries. Only patients who met the eligibility criteria and who provided written consent (patient or guardian for children) were enrolled in the study.

Schistosomiasis impacts African populations most strongly. Despite Uganda's leading role in the Schistosomiasis Control Initiative for mass drug administration (MDA), about half the population remains at risk and a quarter infected. Prevalence and intensity remain high, and morbidity severe, in northwest Uganda around Lake Albert and the Albert Nile. An effective vaccine could combat repeated infection following MDA, and controlled human infection (CHI) studies could enable such vaccine development. Therefore, the Uganda Schistosomiasis Multidisciplinary Research Center and CHI-in-Africa Network hosted a symposium in Uganda bringing together local and international partners to discuss research on the drivers of schistosomal morbidity and the development of CHI studies for helminth vaccine development in Africa. In this TrendsTalk, we invited 10 early-to mid-career researchers to summarise the symposium proceedings.

Background: Haematological parameters including prothrombin time and activated partial thromboplastin time of HIV/AIDS patients on Anti Retroviral Therapy may be a manifestation of disease suppression and / or side effects of drugs. Objective: This study evaluated the haematological parameters including prothrombin time and activated partial thromboplastin time of adults HIV/AIDS patients on ART and compared with the negative control groups at Federal Medical Centre Keffi, Nasarawa State. Materials and Methods: This was a case - control study involving consented 73 tests on ART and 73 HIV negative individuals who were recruited through systematic random sampling technique. Semi- structured interviewer administered questionnaire was used to evaluate their socio demographic characteristics. Venous blood samples were collected and analyzed for the above haematological, PT and APTTK parameters using Sysmex KX21 automated analyze and manual method respectively. The data were analyzed using SPSS version 20.0. A p-value of less than 0.05 was taken as statistical significant. Results: The mean age and standard deviation of the tests and the control groups was 3.30± 10.40 years and 36.20 ± 11.70 years respectively. There were more females in both the tests (64.8%) and the control groups (56.2%) than male. The study showed a statistical significant higher leucopenia (17.8%) and neutropenia (20.5%) on the tests as compared with the control groups while anemia (45.1%) was the commonest haematological abnormalities observed in the tests on ART. The results of the clotting profile showed that thrombocytopenia (26.0%), APTT (53.4%) and PT (34.2%) were significantly more prevalent in the tests compared with the control group (P<0.05). There were Leucopenia, Neutropenia, Anemia, Thrombocytopenia and abnormalities in PT and APTT of the tests as compared to the control groups. Conclusion: The results showed that participants on ART had haematological abnormalities as compared to the control group. This may guide the stake holders on appropriate decision towards better management of the patients.

Background There is no recent epidemiological data on HIV infection in Gabon, particularly in pregnant women. To close this gap, an HIV-prevalence survey was conducted among Gabonese pregnant women, followed by a cross-sectional case–control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women. Methods Between 2018 and 2019, data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres (ANCs). Subsequently, for the prospective co-infection study, all HIV-positive pregnant women were recruited who frequented the ANC in Lambaréné and a comparator sub-sample of HIV-negative pregnant women was recruited; these activities were performed from February 2019 to February 2020. The mean number of co-infections was ascertained and compared between HIV-positive and HIV-negative women. Additionally, the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women. Results HIV-positivity was 3.9% (646/16,417) among pregnant women. 183 pregnant women were recruited in the co-infection study. 63% of HIV-positive and 75% of HIV-negative pregnant women had at least one co-infection. There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections (STIs) than HIV-positive women [mean (standard deviation, SD ): 2.59 (1.04) vs 2.16 (1.35), respectively; P = 0.056]; this was not the case for vector-borne infections [mean ( SD ): 0.47 (0.72) vs 0.43 (0.63), respectively; P = 0.59]. Conclusions Counterintuitively, the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women. The change of magnitude from the crude to adjusted OR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population. This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme, while no such similar overall service exists for HIV-negative women. This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status.

BACKGROUND:There is increasing evidence suggesting that adolescents are contributing to the populations at risk of malaria. This study determined the prevalence of malaria infection among the adolescents and examined the associated determinants considering socio-demographic, Long Lasting Insecticide Nets (LLINs) usage, and hematological factors in rural Southwestern Nigeria.METHODS:A hospital-based cross-sectional study was conducted between July 2021 and September 2022 among 180 adolescents who were recruited at a tertiary health facility in rural Southwestern Nigeria. Interviewer administered questionnaire sought information on their socio-demographics and usage of LLINs. Venous blood samples were collected and processed for malaria parasite detection, ABO blood grouping, hemoglobin genotype, and packed cell volume. Data were analyzed using SPSS version 20. A p-value <0.05 was considered statistically significant.RESULTS:The prevalence of malaria infection was 71.1% (95% CI: 68.2%-73.8%). Lack of formal education (AOR = 2.094; 95% CI: 1.288-3.403), being a rural residence (AOR = 4.821; 95% CI: 2.805-8.287), not using LLINs (AOR = 1.950; 95% CI: 1.525-2.505), genotype AA (AOR = 3.420; 95% CI: 1.003-11.657), genotype AS (AOR = 3.574; 95%CI: 1.040-12.277), rhesus positive (AOR = 1.815; 95% CI:1.121-2.939), and severe anemia (AOR = 1.533; 95% CI: 1.273-1.846) were significantly associated with malaria infection.CONCLUSION:The study revealed the prevalence of malaria infection among the adolescents in rural Southwestern Nigeria. There may be need to pay greater attention to adolescent populations for malaria intervention and control programs.

Objective: To assess and compare the relationship between spousal communication, fertility preference, and other factors with contraceptive use among married couples in Ekiti State, Nigeria. Methods: This cross-sectional study was carried out in Ado- Ekiti Local Government Area of Ekiti State, Nigeria between the 12th of August 2017 and the 15th of February 2018. A pre-tested, semi-structured interviewer-administered questionnaire was used to collect data from 976 respondents by a multi-stage sampling technique. Data were analyzed (univariate, bivariate, and binary logistic regression analysis) using SPSS version 24.0. Factors that showed statistical significance (P<0.05) were included in a binary logistic regression to determine significant predictors of contraceptive use. Results: The proportion of respondents currently using contraceptives was 56.9%. The education status of the respondents revealed that those with primary education were more likely to use contraceptives than those without formal education [adjusted odds ratio (aOR) 8.4, 95% confidence interval (CI) 1.97-36.2, P<0.001]. Respondents with fair spousal communication were more likely to use contraceptive than those with poor communication (aOR 4.9, 95% CI 2.80-8.71, P<0.001). In addition, fertility preference of 4 or less children was found to be significantly associated with contraceptive use (aOR 3.0, 95% CI 1.67-5.50, P<0.001) compared to a preference of more than 4 children. Finally, the urban respondents were more likely to use contraceptives than those in the rural setting (aOR 1.7, 95% CI 1.16-2.41, P=0.047). Conclusions: Educational status, residential site, spousal communication, and fertility preference significantly influence the level of contraceptive use among married couples. Couples should endeavor to discuss more on issues bordering on their fertility preference and contraceptive issue. Government should formulate policies to improve the rural uptake of contraceptives using identified target interventions.