Group antenatal care (G-ANC) is a model that brings pregnant women with similar estimated delivery dates together for clinical assessment and participatory learning in a supportive social context. A qualitative study was nested in a trial assessing the community impact of G-ANC on ANC retention and uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Atlantique Department, Benin. This nested qualitative study assessed women's experience of G-ANC, and ways participation could foster self-efficacy to perform a variety of prevention and care-seeking behaviors. Ten semi-structured focus group discussions were conducted with 129 women who attended G-ANC; deductive thematic codes were informed by Bandura's four sources of efficacy expectations. Recently pregnant women's experiences with individual ANC versus G-ANC were assessed via household surveys. G-ANC participation proffered three sources of self-efficacy expectations: performance accomplishments, verbal persuasion, and vicarious experience. Among household survey respondents, 96% (134/140) of women who participated in G-ANC would prefer it over individual ANC for future pregnancies. While a higher proportion of G-ANC participants felt that the provider answered all their questions in a way they could understand, most women reported that not all their questions were answered, even in G-ANC. G-ANC processes fostering self-efficacy to overcome barriers to ANC attendance may have facilitated women's participation in G-ANC meetings as well as taking more doses of IPTp. Self-efficacy of pregnant women participating in G-ANC could be strengthened by providers addressing all participants' questions in a more complete and understandable way, contributing to more effective verbal persuasion. Other parallel processes during G-ANC need to be maintained to provide multiple sources of self-efficacy for health behaviors like timely care-seeking, pregnancy management, pregnancy self-care, and facility birth.

Introduction:Understanding how Americans think about public health and the role of government institutions is crucial for informing effective health communication in a polarized political climate. Methods:We deployed an open-ended national survey of 1004 adults in October 2025 to assess public perceptions of these topics. Results:Respondents associated the term "public health" with health for everyone (44%) and health of everyone (23%), alongside healthcare (20%) and other themes. The most common perceived government benefit was facilitating access to healthcare (39%)-particularly by addressing cost (16%). Among perceived government harms, more Republicans than Democrats cited overregulation (16% vs 8%, P < 0.01), limiting personal freedoms (16% vs 6%, P < 0.001), and inefficiency (10% vs 4%, P < 0.01); more Democrats than Republicans mentioned dismissing science (7% vs 2%, P < 0.01) and defunding (7% vs 2%, P = 0.02). Weighted analyses yielded minimal substantive differences from unweighted findings. Conclusion:Findings reveal both cross-partisan common ground in term associations and divergent concerns regarding government action. Public health messaging should leverage shared priorities and acknowledge partisan concerns about government roles.

Backyard poultry raising is common in rural Bangladesh and many households keep their poultry inside their houses at night. Compared to keeping poultry outside in sheds at night, this practice likely elevates children’s exposure to poultry and poultry feces and associated enteric pathogens. We conducted a two-arm (subsidy and non-subsidy) pre-post pilot study. Households in both arms received the behavior change communication and counseling intervention. Households in the subsidy arm also received ~23 USD for the construction of an improved poultry shed for nighttime housing. We administered a household survey and spot-check at baseline (February 2020) and then after intervention implementation (January-February 2021) among 37 subsidy and 42 non-subsidy households to determine the impact of the intervention on 1) confining poultry in a shed outside of the house at night, 2) poultry feces management, and 3) hand washing with soap after contacting poultry and poultry feces. A secondary aim was to investigate the effectiveness of a monetary subsidy on encouraging poultry raisers to build an improved poultry night shed. At endline, 58% of all households had an improved poultry shed (87% of subsidy and 33% of non-subsidy households). The percentage of all households confining all of their poultry outside the house the previous night was significantly higher at endline (33%) compared to baseline (2.5%) (prevalence difference: 30 percentage points [pp]; 95% confidence interval: [19, 41]). More households (both arms) had no visible poultry feces piles inside the house compared to baseline (prevalence difference: 26pp [10, 41]). Our intervention effectively encouraged households to build poultry sheds, confine poultry outside of house at night, and maintain an indoor living space free of poultry feces. Future studies should assess if housing all poultry outside the house reduces children’s exposure to poultry feces enough to mitigate health risks associated with poultry ownership.

IntroductionThe absence of vaccination among children remains a significant public health challenge in Guinea. The objective of this study was to describe the trends and profiles of unvaccinated children in Guinea in 1999, 2012, and 2018.Methods and materialsThis was a descriptive cross-sectional study conducted from July to December 2024, focusing on children aged 12 to 24 months, as well as their mothers, using secondary data from the 1999, 2012, and 2018 Demographic and Health Surveys, DHIS2 databases, SAP (Excel), and measles laboratory registers (2012–2018). All databases were cleaned, merged, and validated to avoid duplicates or data entry errors, and the information was handled confidentially.ResultsBetween 1999 and 2018, unvaccinated children were mostly male (52 to 53%) and resided in rural areas (87 to 93%). Firstborn children (up to 90%) and mothers with low levels of education (88 to 96% had no schooling) were the most represented. Access to information was very limited, with 98 to 100% of mothers having no access to printed media, 47 to 58% never listening to the radio, and 78% never watching television. In 2018, 60% of mothers had not attended any prenatal consultations, and 80% of deliveries took place at home. The majority of confirmed measles cases affected unvaccinated children (85%), more than half of whom (52%) were aged 0 to 2 years. The geographic distribution mainly corresponded to certain regions with high non-vaccination rates, including Middle and Upper Guinea. Although the Nzérékoré region reported a lower number of unvaccinated children compared to other regions, it paradoxically had the highest number of measles cases in 2012, accounting for 67% of reported cases.ConclusionOur findings show that non-vaccination primarily affects children in rural areas, with uneducated, poorly informed mothers and limited access to healthcare. A targeted, community-based approach is essential to improve vaccination coverage and prevent epidemics.

Abstract Background Food hygiene is a critical but underemphasized link in fecal–oral disease transmission in dense informal settlements. A mesh-walled meatsafe, designed to exclude insects, animals, and young children while allowing ventilation, was distributed in a randomized controlled trial in Korail, Dhaka. Despite near-universal use (87.7–99.2% of intervention households storing cooked food across five spot-check rounds), the trial detected no reductions in food contamination or child diarrhoea. This qualitative substudy investigated what technological, psychosocial, and contextual factors limited the meatsafe’s protective potential despite high observed use. Methods Guided by the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH), we conducted 16 in-depth interviews with primary caregivers, purposively sampled to capture variation in meatsafe condition, maintenance, and food contamination profiles, and triangulated findings against spot-check records. Transcripts were thematically coded across IBM-WASH domains. Results Barriers preventing correct device use (fidelity barriers) included a steam-spoilage belief leading caregivers to cool food uncovered before meatsafe placement, rexine liner warping reinforcing cooling delays, and cumulative hardware friction from frame instability, latch weakness, and size constraints. Barriers that operated outside the scope of the intervention (beyond-fidelity barriers) included energy scarcity enforcing batch cooking with extended storage, monsoon flooding contaminating cooking spaces, seasonal displacement disrupting routines, and contested childcare authority limiting maternal protective behavior. The uncovered cooling period was invisible to spot-check monitoring yet represented the highest-risk contamination window. Conclusions Near-universal meatsafe use without contamination reductions is explained by a behavioral gap invisible to spot-check monitoring: households stored food only after an uncovered cooling period. The meatsafe addressed only one F-diagram pathway; other fecal–oral routes remained uncontrolled. Sustainable reduction of foodborne enteric disease requires co-designed hardware addressing the full causal pathway, behavior change communication directly confronting the steam-spoilage belief, and concurrent structural investment in energy access, drainage, and pest control.

Objective:The objective of this scoping review is to understand the knowledge and perspectives of African stakeholders regarding the use of gene drive mosquitoes in malaria control. Introduction:The prospect of using gene drive and genetically modified mosquitoes as tools for malaria control is generating considerable debate, particularly with regard to its acceptance and implications among key stakeholders, as well as the nature of governance established in its management. This study aims to fill the gaps in understanding the views of African stakeholders on the risks associated with these mosquitoes. Inclusion criteria:This review will include scientific articles and grey literature that explore the knowledge, perspectives, and risks perceptions of African stakeholders on the use of gene drive and genetically modified mosquitoes. Exclusions will apply to documents with restricted access, those addressing diseases other than malaria, and those involving stakeholders outside Africa. Methods:The search will be conducted across PubMed, Embase, Science Direct, Cochrane, and Google Scholar using index terms and keyword strategies tailored to each database. Documents will be selected in four stages: identification, duplicate removal, title and abstract screening, and full-text review for final inclusion. Screening will be conducted on Rayyan by two independent reviewers, with references managed in Zotero. Data extraction will include details on authorship, publication year, study objectives, design, methodology, sample size, findings, conclusions, and limitations. A thematic analysis of the extracted data will be conducted. Discussion:This scoping review will provide a clear understanding of the knowledge, perspectives, and risks perceived by African stakeholders regarding the use of gene drive and genetically modified mosquitoes in malaria control. The results will help to improve communities' engagement, which is crucial to the success of this technology. Registration:This protocol is registered on the Open Science Framework (OSF) (https://osf.io/4kz85).

Background:Street food is readily available food and beverages sold by vendors, frequently situated along streets or other public spaces. Street food is largely popular because it is low cost and readily available. However, unsafe food hygiene behaviors and conditions contribute to a substantial burden of foodborne illness. There is a gap in understanding what factors determine food hygiene behavior among street food vendors and consumers in low-income countries (LICs) and low- and middle-income countries (LMICs). Objective:This review aims to identify the determinants of safe food hygiene behavior and explore the effectiveness of food hygiene interventions for vendors and consumers in LICs and LMICs. Methods:We will search the PubMed, Cochrane Library, Web of Science, ProQuest, and Scopus databases for peer-reviewed articles and Google and Google Scholar for gray literature published in the English language from inception to October 31, 2023. We will apply the World Bank 2023 definition of LICs and LMICs to include studies from these countries in this review. Two independent reviewers will search, screen, and analyze the included literature. Data will be analyzed by narrative synthesis for all objectives. Results:This protocol outlines the methodology for conducting a scoping review. The findings will identify gaps in the existing literature and map the determinants of street food hygiene, as well as the interventions implemented for street food vendors and consumers. The project received funding in October 2022 and institutional review board approval in December 2022. Data analysis is currently underway, and the first results are expected to be submitted for publication in April 2026. Conclusions:To the best of our knowledge, this will be the first scoping review to investigate the determinants of street food hygiene behaviors and the effectiveness of interventions for vendors and consumers on street food hygiene in LICs and LMICs.

Weaning food contamination can occur through multiple environmental pathways, including contact with dirty hands, food, unsafe water, soil, flies, or domestic animals. This study assessed pathogen contamination in weaning foods, drinking water, and domestic surfaces in an urban informal settlement in Dhaka, Bangladesh to better understand household exposure risks. We conducted a mixed-method cross-sectional study in 32 households with children aged 6–24 months. Samples (n = 197) were collected to detect major foodborne pathogens using real-time qPCR. Structured observations and qualitative interviews (FGD, IDI, SSI) documented food preparation, storage, reheating, utensil cleaning, water use, and household hygiene practices. Overall, 44% of drinking water, 33% of food, and 80% of domestic surface swabs tested positive for at least one targeted pathogen. Vibrio cholerae , Bacillus cereus , and Staphylococcus aureus were the most frequently detected bacterial pathogens. Stored foods (54%) showed higher contamination than freshly cooked foods (19%), while domestic surfaces had the highest contamination prevalence. Rotavirus was detected in 34% of drinking water samples, indicating a possible viral exposure pathway. Qualitative findings suggested unsafe storage, inadequate reheating, untreated water, dirty utensils, and inconsistent handwashing as key drivers, highlighting that interventions should extend beyond hygiene education to include practical food safety packages.

Foodborne diseases are the major public health concerns in low- and middle-income countries, particularly during the complementary feeding period. Children become increasingly exposed to environmental pathogens at this age. Food hygiene during this period is critical to prevent such diseases. This formative study aimed to identify the behavioral determinants of complementary food hygiene practices among caregivers of complimentary aged children using the COM-B (Capability, Opportunity, Motivation Behaviour) framework to develop food hygiene interventions. The study was conducted in the Korail slum, Dhaka, between August 2023 and March 2024. Multiple qualitative methods were employed, including semi-structured household observations (8 h per household, n = 32), semi-structured interviews (n = 16), and focus group discussions (3 groups, n = 24). Participant selection varied by method, such as observation; households were purposively selected to ensure contextual diversity; interview participants were selected based on observed hygiene practices to explore behavioral drivers; and FGD participants were recruited to capture variation by caregiving experience. Data were analyzed iteratively using thematic analysis guided by the COM-B framework, with triangulation across methods to enhance credibility. Findings reveal that five key behaviors food reheating, food and water storage, utensil cleaning, surface cleaning, and hand hygiene are central to reducing microbial contamination and protecting children from enteric infections. Caregivers demonstrated strong psychological capability and reflective motivation, expressing awareness of recommended practices and concern for child health. However, physical opportunity constraints, including irregular fuel access, overcrowded shared kitchens, inadequate storage, distant communal washing areas, and the absence of designated handwashing facilities, consistently limited safe practice. Automatic motivation further shaped behavior, with reliance on visual cleanliness and sensory cues rather than microbial risk influencing routine decisions. Food hygiene behaviors in low-resource urban settings are constrained by inadequate technical knowledge, structural barriers, and habitual practices. Interventions should address these limitations by combining enabling environments with behaviorally informed strategies that target routine practices. Integrated approaches are essential to improve complementary food hygiene and reduce child exposure to contamination in informal settlements.

Microbial contamination of child feeding equipment (CFE) includes feeding bottles, teats, and breast pumps. This contamination is a recognized pathway for enteric pathogen exposure during early childhood, particularly during the complementary feeding period (6-24 months). Inadequate or inconsistent cleaning of CFE has been associated with increased diarrheal risk. Many cleaning approaches are practiced globally. However, comparative evidence on their effectiveness remains fragmented. This systematic review (CRD420251058230) aimed to evaluate the effectiveness and efficacy of commonly used CFE cleaning methods. We included studies that assessed microbial contamination on CFE. Each study compared at least one cleaning method with another method or a control. We included all epidemiological study designs conducted globally. PubMed, Web of Science, and Embase were searched from January 1970 to January 2025. Two reviewers independently screened 18,415 records and included 17 studies. Risk of bias was assessed by ROBINS-E and ROBINS-I. Feeding bottles and teats were the most frequently assessed equipment. Rinsing with water alone was consistently ineffective. Washing with soap and brushing achieved greater contamination reduction than washing without brushing. Chlorine-based disinfection substantially reduced contamination, with effectiveness varying by concentration and contact time. Sterilization by boiling or steaming, particularly when preceded by mechanical washing, achieved near-complete microbial elimination. The evidence base was limited by the small number of experimental studies. Study quality was variable, and outcomes were heterogeneous. These limitations emphasize the need for more rigorous and context-specific research to inform effective, scalable cleaning interventions.

Abstract Background Lead-acid batteries are widely used for their affordability, availability, and reusability. However, an increase in unregulated and informal recycling, especially of batteries used in electric three-wheelers, has led to widespread environmental contamination in low and middle-income countries. To address this contamination, soil remediation is a proven potential approach that has demonstrated its effectiveness in reducing blood lead levels, but its community responses have not been well documented. This study aimed to explore implementation challenges and achievements, and to assess community perceptions and responses to a soil remediation intervention in Bangladesh. Materials and methods A soil remediation intervention was developed and implemented from January through May 2022 in two abandoned lead-acid battery recycling facilities in Mirzapur, a subdistrict in Bangladesh. A qualitative investigation was undertaken in September 2023 to explore the perceptions and responses of residents living near the recycling site and intervention implementers. Respondents were selected using purposive sampling with variation in proximity to the site, exposure to the intervention, and community role. Data were collected through 30 in-depth interviews, 6 key informant interviews, and 2 gender-segregated focus group discussions ( n = 14). Thematic analysis was performed using an inductive approach. Results From the implementation perspective, key achievements included successful soil removal, local labor involvement, and visible environmental improvements, while challenges included limited community outreach, communication gaps, logistical constraints, and a lack of follow-up monitoring. Following remediation, participants reported perceived improvements in crop production, livestock health, and children’s well-being. Risk perceptions were greatly influenced by economic and livelihood concerns, with less emphasis on lead-related health risks. Participants expressed concerns about the safety of soil excavation near homes and the burial of contaminated soil. Key informants acknowledged the need for stronger community engagement, improved communication, and greater transparency to enhance acceptance. Conclusion The findings indicate that, although participants perceived environmental and health benefits, gaps in communication, engagement, and transparency in implementation affected overall acceptance. Future interventions should prioritize early community involvement, culturally appropriate communication, and safe waste management systems to improve effectiveness and scalability.

Diarrheal diseases remain a leading cause of under-five mortality globally, yet large-scale water, sanitation, and hygiene (WASH) interventions have shown limited effects on childhood diarrhea and growth, partly because foodborne transmission has been overlooked. In low-income urban settings, complementary foods for young children are often stored for several hours under unsafe conditions, increasing the risk of fecal contamination. This randomized controlled trial evaluated whether a low-cost wire-mesh food cabinet ("meatsafe"), paired with one-time behavior-change communication (BCC), could reduce microbial contamination and diarrhea among children aged 6-24 months in the Korail informal settlement of Dhaka, Bangladesh. A total of 290 households were randomly assigned 1:1 to receive a meatsafe plus food-hygiene handouts or no intervention. Over five biweekly post-intervention visits, we collected stored complementary food samples (≥4 h) for Escherichia coli testing and recorded 7-day caregiver-reported diarrhea. The primary outcome was the prevalence of high-level contamination (≥100 CFU E. coli/g). Prevalence ratios (PRs) were estimated using population-averaged modified Poisson regression adjusted for storage conditions. Across 1,545 food samples, contamination declined in both arms-from 49.6% to 25.2% in controls and 39.0% to 18.6% in the intervention arm-but the intervention had no effect on high-level contamination (adjusted PR = 0.83; 95% CI: 0.55-1.26) or caregiver-reported diarrhea (PR = 0.56; 95% CI: 0.24-1.31). Storing food for more than eight hours remained strongly associated with contamination (aPR = 1.49; 95% CI: 1.20-1.86). Although meatsafe adoption was high (88% at first visit, 99% at last), recall of general hygiene messages was limited. Providing a meatsafe with minimal BCC did not reduce food contamination or child diarrhea, despite excellent uptake. The findings underscore the limits of simple, passive technologies in resource-constrained settings and suggest that future strategies should integrate affordable storage innovations with more intensive and sustained hygiene promotion. TRIAL REGISTRATION:ClinicalTrials.gov, NCT07332078. Registered 12 January 2026 (retrospectively registered); https://clinicaltrials.gov/study/NCT07332078.

Objective:This study aimed to describe the evolution of resources and to identify the factors associated with the quality of care for epidemic-prone diseases in Guinea. Method:A descriptive cross-sectional study focused on the management systems for epidemic-prone diseases in Guinea. Data were collected using structured questionnaires. The analysis of factors associated with the quality of care was conducted using logistic regression. Results:The evolution of management systems varied across regions. Overall, at the national level, before the Ebola outbreak, the evolution of management systems was low, with an overall score of 12%. During the Ebola virus crisis, the evolution of the systems was average, reaching 73%, and after the outbreak, it remained average at 77%. The quality of care was predominantly rated as good, accounting for 62.5%. The main factors associated with better quality of care included the presence of a patient diagnostic mechanism (aOR = 8; 95% CI [2.02-19.45]; p = 0.000), the availability of treatment protocols (aOR = 9.44; 95% CI [1.02-12.02]; p = 0.000), the presence of isolation sites (aOR = 4.23; 95% CI [1.61-9.66]; p = 0.000), the coordination of care (aOR = 8.5; 95% CI [1.22-12.00]; p = 0.002), and the availability of care teams (aOR = 8.5; 95% CI [1.22-12.00]; p = 0.001). Conclusion:This study highlights significant progress in resources for the management of epidemic-prone diseases in Guinea during and after the Ebola crisis. Key factors such as diagnostic tools, treatment protocols, the availability of isolation sites, care coordination, and the presence of care teams were essential for success. The overall improvement reflects strengthened capacity and preparedness in Guinea, although challenges remain, particularly in terms of financial resources.

BACKGROUND:In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes. METHODS:We conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes. RESULTS:This study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices. CONCLUSION:Increasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment.

In the Democratic Republic of the Congo (DRC), a disparity exists in the fertility desires of men and women, with men often expressing a desire for more children than their partners. This disconnect can be attributed to social and gender norms that influence discussions and decision-making regarding birth spacing, birth limiting, and the adoption of modern contraceptive methods. This qualitative study, through semi-structured interviews and focus group discussions, explored the social norms shaping perceptions, attitudes, and decision-making around family planning among men in the DRC. The study protocol was adapted from the 5-step process set forth in the Social Norms Exploration Tool (SNET). Data collection took place in the three provinces of Kasai Central, Lualaba, and Sankuru. This process was divided into three phases: a reference-group identification phase incorporating a short, quantitative questionnaire, an exploration of norms and attitudes with the population of interest (N = 317) – here married and unmarried men – and further exploration of social norms among the reference groups (N = 144) cited by men. Social norms around family planning are contradictory and can be better understood by breaking down the concept of family planning into three categories of descriptive and injunctive norms: 1) the use of modern contraceptive methods, 2) birth spacing and family size, and 3) couple communication and decision-making. We found that while social norms oppose the use of modern contraceptive methods and advocate for larger family size, there is notable social support for birth spacing. Some men reported they would support their wives in learning about contraceptive methods if they were able to make the final decision. However, other men felt that allowing their wives to seek a method would undermine their authority or their virility. To increase modern contraceptive uptake, interventions should address the underlying issues that contribute to non-adherence, addressing the three categories and their associated norms individually and engaging reference groups important to each, including healthcare providers, religious leaders, and male peer groups, in family planning programming.

Objectives: This study aimed to evaluate the performance of response systems for epidemic-prone diseases (EPDs) in Guinea and identify their strengths and weaknesses to guide future improvements. Study design: A cross-sectional evaluation of epidemic-prone disease (EPD) management systems was performed through a sample of actors involved in the response. Method: ology: This descriptive cross-sectional evaluative study involved 356 response actors from Guinea's eight administrative regions. Data were collected via structured questionnaires organized around three main components: structure, process, and results. Subcomponent scores were analyzed, and the main components were classified into three levels of appreciation: good, average, or poor. An analysis of strengths and weaknesses was also conducted. Results: Among the 356 actors interviewed, 76.40 % were female, and the majority (51 %) were aged between and 60 years. A total of 89.9 % had a university-level education. The structure component achieved an overall score of 61 %, reflecting average appreciation. The subcomponents included human resources (69 %), logistics and health products (81 %), and health financing (32 %). The process component scored 60 %, with strong leadership and coordination (81 %) but weaknesses in care delivery (48 %) and logistics (35 %). The results component scored 88 %, which was considered good, with significant improvements in care (89 %), surveillance (96 %), diagnostic efficiency (78 %), and satisfaction with management (96 %). Conclusion: Guinea's response systems for epidemic-prone diseases show average performance with encouraging outcomes. However, structural and procedural gaps persist. Strengthening human resources, timely diagnostics, continuity of care for severe cases, and sustainable financing are essential to improve future epidemic management.

Backyard poultry-rearing contributes to income and food security for rural households in low- and middle-income countries. However, poultry are often kept inside the household dwelling at night, posing health risks to the people raising them. Housing poultry separately from the dwelling overnight is a potential intervention to limit exposure to poultry. The aim of this study was to describe practices and determinants of overnight poultry housing in rural Bangladesh as formative research for an intervention to separate young children from poultry and poultry feces. We conducted 19 transect walks in villages across Bangladesh to document overnight housing practices among backyard poultry raisers. We then conducted 27 semi-structured interviews to explore poultry-raising practices, including housing types and materials identified during transect walks. We found overnight poultry housing both inside and separate from the dwelling and found that most poultry raisers who kept their birds separate from the dwelling overnight did so in courtyard sheds. There was a preference and willingness to house birds outside, provided a shed was available, although overnight housing practices fluctuated. Having a shed was a function of household resources, including availability and access to materials and skilled labor, available physical space, area- and village-wide trends, and the preferences and concerns of poultry raisers. We recommend that future studies measuring human exposure to poultry and poultry feces assess exposure prospectively and at regular intervals to capture variations in housing practice, and include assessments of poultry housing hygiene practices. The promotion of sheds for overnight poultry housing may be an acceptable intervention approach in this setting, though programs will need to make recommendations for housing that address the risk of zoonotic disease transmission and accommodate the preferences and constraints of poultry raisers over a one-size-fits-all approach.

BACKGROUND:Stigma related to drug use is a well-documented barrier to engaging and remaining on medication for opioid use disorder (MOUD), yet little is known about how stigma operates across multiple social and institutional settings in low-resource contexts. METHODS:This qualitative study draws on 40 in-depth interviews with current and former MOUD clients and four focus groups with 35 current clients at an opioid treatment clinic in Dar es Salaam, Tanzania. Transcripts were thematically analyzed to explore how stigma influenced MOUD adherence and retention. RESULTS:Five themes emerged: stigma encountered while using public transportation; employment-related stigma; lack of family support due to misinformation; institutional stigma within the treatment setting; and stigma management strategies, including altering appearance and distancing from peers. Gendered expectations intensified stigma for women, while assumptions of untrustworthiness shaped client interactions across settings. These experiences posed significant barriers to consistent treatment engagement. CONCLUSIONS:To support MOUD retention, programs should integrate stigma reduction through expanded family engagement, more flexible clinic policies, and client-informed approaches. Public education efforts are also critical to addressing widespread misconceptions about MOUD and people who use drugs.

In Mali, the screening, diagnosis, and treatment of epilepsy face significant challenges due to a shortage of qualified health workers in rural areas, limited access to health services, and cultural barriers. This study assessed how mHealth platforms can support task shifting to community health workers (Relais) to screen and treat epilepsy at the community level. We conducted a cohort study involving persons with epilepsy (PWE) and Relais in 17 villages in the Nonkon health area of the Kolokani Health District, approximately 105 km northwest of Bamako, the capital city of Mali. Relais collected data using mobile phones equipped with an “Epi-Collect” application specifically designed for epilepsy management, enabling Relais to record patient information digitally. All collected data was securely stored in “telesante.ml,” a telemedicine platform utilized by healthcare professionals. Out of 64 patients suspected of having epilepsy by the Relais and indexed on the platform, 61 patients were confirmed by the neurologist through remote evaluation, resulting in a confirmation rate of 95

In 2023, an estimated 36 million pregnancies occurred in malaria endemic sub-Saharan Africa, but only 44