Integrating summary-level scientific knowledge into neural network models provides a practical strategy for transferring prediction models trained on adequately sampled source cohorts to underrepresented target populations, where individual-level data in the target domain are often limited or unavailable. In this study, we propose transfer prediction strategies incorporating external summary-level scientific knowledge and illustrate its application on the PRISMA Maternal and Neonatal Health Study, training a neural network model on the source data to predict adverse outcomes in the target cohorts. Besides, we also extend the existing GRU-D framework by incorporating static feature embeddings and attention weights to jointly leverage temporal and static information for improved prediction. Our approach employs soft labels derived from summary-level statistics describing the target population to fine-tune GRU-D-Static models that are initially trained on the source populations. We evaluate six maternal and neonatal outcomes, including stillbirth, preterm birth, low birth weight, small vulnerable newborn, neonatal death, and maternal near miss. Across all tested scenarios, fine-tuning using soft labels from just basic covariates substantially improved predictive performance compared with deep learning models trained on the source sample. Furthermore, the performance slightly improves more when additional covariates were incorporated into the logistic regression model or when partial input features from the target population were available for fine-tuning. These findings demonstrate that integrating existing scientific knowledge in the literature through transfer prediction of source neural network models can enhance prediction performance in underrepresented target populations, reducing reliance on large-scale data collection and supporting risk prediction in global health.

BACKGROUND:Rectovaginal colonization with Streptococcus agalactiae (Group B Streptococcus; GBS) during pregnancy is a major risk factor for neonatal invasive GBS disease and adverse birth outcomes. We investigated the prevalence of maternal GBS colonization, serotype-specific immunoglobulin G (IgG) immunity in mother-newborn dyads, and GBS associated stillbirths in Ghana and Zimbabwe. METHODS:A prospective cohort of 1238 pregnant women and their infants was enrolled (2018-2020). Recto-vaginal swabs collected at ≥36 weeks gestation or prior to delivery and chest aspirates from stillbirths were cultured for GBS. Isolates were serotyped using latex agglutination. Maternal and cord blood samples were analysed for GBS serotype-specific IgG using a multiplex bead-based immunoassay. RESULTS:The prevalence of recto-vaginal GBS colonization was 15.6% (68/437) in Ghana and 15.2% (50/329) in Zimbabwe. GBS was detected in 33.3% (3/9) of stillbirths. Dominant colonizing serotypes were Ia (25%), III (32%), and V (27%). Maternal IgG concentrations were significantly higher in Ghana than in Zimbabwe for serotypes Ib (0.11 vs 0.02 μg/mL; p = 0.0001), II (0.24 vs 0.06 μg/mL; p = 0.0001), and IV (0.03 vs 0.006 μg/mL; p < 0.0001). Transplacental IgG transfer ratios ranged from 0.81 to 1.08; highest for serotype II and lowest for Ia. Newborns with IgG above the serological thresholds for risk reduction for serotype Ia and III were 25.6% (Ia) and 38.4% (III) in Ghana; and 34.1% (Ia) and 26.8% (III) in Zimbabwe. CONCLUSIONS:The predominant GBS serotypes distribution in Ghana and Zimbabwe aligns with global epidemiological patterns. Despite evidence of natural maternal IgG immunity and efficient transplacental transfer, most newborns lacked protective antibody levels against GBS. A maternal GBS vaccine targeting dominant serotypes may reduce the risk of GBS neonatal invasive disease and GBS-associated stillbirths.

Background The COVID-19 pandemic significantly disrupted health systems globally and in sub-Saharan Africa (SSA) leading to reduction of health service utilization (HSU). Patients with non-communicable diseases (NCDs) had increased morbidity and mortality during the COVID-19 pandemic. We sought to determine the changes and impact of the COVID-19 pandemic on HSU among patients with NCDs comparing an epicentre to a non-epicentre region in Ghana. Methods We conducted a cross-sectional observational study of patients with NCD in the Ashanti and Northern regions in Ghana from February 2024 to July 2024. We distributed questionnaires to patients with NCD in selected facilities in the Northern and Ashanti regions of Ghana. The Andersen’s Behavioural Model was used as the conceptual framework to determine the factors affecting HSU. Multiple logistic regression was used to identify independent variables predicting reduction in HSU. P value of less than 0.05 was considered statistically significant. Results The study included 844 participants with NCDs equally sampled in the Ashanti and Northern regions of Ghana. The mean age of respondents was 61.4±11.6 years with 569(67%) females. Almost half 367 (43.5%) of all respondents reported COVID-19 led to a decrease in their HSU and over a third of respondents, 303(35.9%) missed their hospital appointments. The proportion of respondents reporting a decrease in HSU was significantly higher in the Northern region 276 (65.4%) than the Ashanti region 91 (21.6%), [p<0.001]. Reduction in HSU was associated with increasing age (aOR=0.97, 0.96 - 0.99, p<0.001), Northern region residence (aOR=9.60 CI 6.43 - 14.32, p<0.001), higher household income (aOR=1.36 CI 1.15-1.60, p<0.001), longer duration of NCD (aOR=1.03, CI 1.01 - 1.06, p=0.033) and possession of valid NHIS card (aOR=7.43, CI 2.44 - 22.57, p <0.001). Conclusion The COVID-19 pandemic led to reduction in HSU in Ghana. There was a significant reduction in NCDs in a non-epicentre region (Northern region) compared to the Ashanti region which was an epicenter region. Hence patients in non-epicentres should also be prioritized in pandemic situations.

Background Typhoid fever, a significant global health problem, demonstrates a multifaceted transmission pattern. Knowledge of the factors driving its transmission is critical for developing effective control strategies and optimizing resource allocation. Objective This review aimed to comprehensively synthesize evidence on risk factors associated with typhoid fever transmission from 1928 to 2024. Methods We searched PubMed, Scopus, Google Scholar, and Semantic Scholar databases using keywords related to risk, contributors, determinants, and causes of typhoid fever. We followed a registered protocol to support our search and triangulated the results. Results Overall, we retrieved 1614 articles, of which 219 were reviewed. Of these, 109 addressed multiple, non–mutually exclusive typhoid fever risk factors. Unsurprisingly, of the total articles reviewed on risk factors, approximately 70.6% (77/109) originated from the Asian continent (51/109, 46.8%) and the African continent (26/109, 23.9%). Half of the articles (55/109, 50.5%) focused on risk factors related to demographic and socioeconomic transmission, while 44% (48/109) of the articles examined foodborne transmission. Additional risk factors included water, sanitation, and hygiene practices: waterborne transmissions (45/109, 41.3%) and sanitation and hygiene practices (34/109, 31.2%), travel-related risk (19/109, 17.4%), antimicrobial use (14/109, 12.8%), climate-related factors (15/109, 13.8%), environment-related factors (9/109, 8.3%), typhoid carriers (11/109, 10.1%), and host-related risk factors (6/109, 5.5%). Conclusions This review identifies demographic and socioeconomic factors as key drivers of typhoid transmission, underscoring the need for targeted interventions. Strengthening street food regulation in urban Asia and investing in water infrastructure in rural Africa can significantly mitigate risk. Integrating water, sanitation, and hygiene interventions with typhoid vaccines can reduce immediate exposure while enhancing long-term immunity. Prioritizing these strategies in schools and high-risk communities is essential for sustainable typhoid control. Future research should focus on longitudinal studies to assess risk factor causality and vaccine impact, guiding more effective public health interventions.

Latent cytomegalovirus (CMV) can reactivate in times of immunosuppression or during critical illness and is associated with worse prognosis, but the benefit of using antiviral medications in otherwise immunocompetent individuals during CMV reactivation is unclear. This study aims to systematically review the effect of using antiviral medications on clinical outcomes in immunocompetent population. Database searches were performed in EMBASE, Medline, Scopus, CINAHL Complete, as well as in two trial registries ClinicalTrials.gov and ICTRP Search Portal. Search terms focused on CMV and antiviral medications among non-immunocompromised hosts admitted to the hospital. Effect estimates were combined using a Random Effects meta-analysis. Four randomized controlled trials and two cohort studies were included (total N = 785). There was no significant difference in the use of antiviral medications on composite measure of mortality (p = 0.18) either when given as preemptive treatment or as prophylaxis (p = 0.42), or when subgrouped by randomized studies versus observational studies were compared (p = 0.86). There was no difference in overall intensive care unit length of stay (p = 0.40) or duration of hospitalization (p = 0.25). Using antiviral medications in immunocompetent individuals with CMV reactivation did not affect mortality, ICU duration, or hospital duration. No conclusion can be reached regarding decrease in respiratory support post antiviral use. This study is not a clinical trial.

The study examined the determining factors of survival among people living with HIV (PLHIV) using data obtained from 4 public hospitals in the Volta Region of Ghana. Secondary data were gathered from the medical records of PLHIV (15 years and above) who have been tested and initiated on antiretroviral therapy at the ART units in 4 hospitals in Volta Region from January 2014 to December 2020. Descriptive analysis was done by assessing frequencies, percentages, means, and standard deviations. Cox-proportional hazards model was used to compute the crude and adjusted hazard ratios for the predictors of survival of PLHIV after ART initiation with 95% confidence intervals. Data were analyzed using Stata 16.0. The study found that out of the 1,856 patients, 2% experienced the outcome of interest (death). The length of follow-up for all participants was 4,960.7 years and 56.7 years for those who died. The rate of mortality recorded was 0.75 per 100 person-years. A multivariable analysis revealed that factors such as age, sexual active status, stage of HIV/AIDS infection, and ART treatment regimen were significantly associated with survival of PLHIV on ART. The rate of mortality of PLHIV receiving ART was generally low. The study also emphasizes the importance of addressing multiple factors, including age, sexual activity, disease stage, and choice of ART regimen, in the management and care of PLHIV.

The Surveillance Outbreak Response Management and Analysis System (SORMAS) is an open source digital tool created to enhance real time surveillance and outbreak response especially in resource poor settings like low- and middle-income countries (LMICs). Even though the tool has been deployed in several countries, there is no comprehensive review of the available research reporting its implementation and the evidence on utility and performance as experienced by countries. This review aims to systematically map out available evidence to assess the utility and performance of SORMAS across LMICs systematically. The review will follow the Joanna Briggs Institute (JBI) approach to scoping review. Pubmed, Scopus, Web of Science, Google Scholar and Google will be searched as well as relevant grey literature sources. Studies will be included if they described or evaluated the adoption, implementation, utility or functionality of SORMAS in any LMIC. Studies will be excluded if they just mentioned SORMAS as a digital surveillance tool but did not describe or evaluate it. Titles, abstracts and full text screening will be done. Results will be summarized using descriptive statistics and thematic analysis. Tables and other visual tools will also be used to present the results. The findings of this review will serve as the foundation for understanding how SORMAS is being used in LMICs and the specified context of implementation, as well as the reported performance. Gaps in implementation and research will also be highlighted. These findings will have important implications for policymakers, implementers, and researchers by highlighting best practices, areas needing capacity strengthening, and gaps requiring further investigation. https://doi.org/10.17605/OSF.IO/DV8RJ.

BACKGROUND:Anemia affects one in three pregnant women worldwide, with the greatest burden in South Asia and sub-Saharan Africa. During pregnancy, anemia has been linked to an increased risk of adverse maternal and neonatal health outcomes. Despite widespread recognition that anemia can complicate pregnancy, critical gaps persist in our understanding of the specific causes of maternal anemia and the cutoffs used to diagnose anemia in each trimester and in the postpartum period. METHODS AND ANALYSIS:The Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) study is a multisite, prospective, cohort study nested within the Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health study. Research sites are located in Kenya, Ghana, Zambia, India, and Pakistan. Participants are up to 12,000 pregnant women who provide serial venous blood samples for hemoglobin assessment at five time points: at <20 weeks, 20 weeks, 28 weeks, and 36 weeks gestation and at six weeks postpartum. We will use two analytical approaches to estimate hemoglobin thresholds for defining anemia: (1) clinical decision limits for cutoffs in each trimester and at six weeks postpartum based on associations of hemoglobin levels with adverse maternal, fetal, and neonatal health outcomes and (2) reference limits for gestational-week-specific cutoffs and at six weeks postpartum for mild, moderate, and severe anemia based on tail statistical percentiles of hemoglobin values in a reference (i.e., clinically healthy) subpopulation. We will also conduct biomarker-intensive testing among a sub-sample of participants in each trimester to explore underlying contributing factors of maternal anemia. ETHICS AND DISSEMINATION:The study received local and national ethical approvals from all participating institutions. Findings from multisite analyses will be published among open-access, peer-reviewed journals and disseminated with local, national, and international partners. STRENGTHS AND LIMITATIONS:Novel study design to allow multiple analytical approaches (clinical decision limits and reference limits) in the same population to establish hemoglobin thresholds.Use of gold standard methods and external quality assurance programs to ensure harmonized hemoglobin measurement across sites.Inclusion of biomarker-intensive study arm to examine the etiology of anemia among pregnant women.All data is contributed by populations historically underrepresented in research in low- and middle-income countries. TRIALS REGISTRATION:ClinicalTrials.gov (PRISMA-MNH 2022; NCT05904145).

Neonatal mortality in Afghanistan is among the highest worldwide, driven by rural–urban disparities, low maternal education, and poor healthcare access. Antenatal care (ANC) remains severely underutilized, with fewer than one in five women meeting minimum visits despite its link to neonatal survival, highlighting the need to assess its impact in conflict-affected settings. Determine whether the number of antenatal care visits during pregnancy is associated with neonatal mortality in Afghanistan and investigate whether 4 ANC visits could be a sufficient minimum requirement to prevent neonatal mortality in conflict settings such as Afghanistan. Analytic, population-based, cross-sectional study. Using data from the 2015 DHS for Afghanistan, logistic regression was performed to assess the association between fewer than 4 ANC visits and neonatal mortality. The overall prevalence of neonatal mortality was 1.85% (CI:1.56-2.20). The odds of neonatal mortality for children whose mothers attended ANC less than 4 times were 1.8 times higher in comparison to those whose mothers attended ANC 4 times or more. After adjusting for the age of the mother, sex, ANC provider, place of residence (urban/rural), wealth index, education of mother, and education of father, the odds of neonatal mortality were 1.1 (95% CI 0.72-1.71) with not enough evidence against the null hypothesis (p-value 0.637). While the mother’s education, place of residence, wealth index, ANC provider, and father’s education confounded the relationship, sex showed an interactive effect on the main relationship. ANC visits less than 4 times were 1.8 times more likely to result in neonatal mortality than ANC visits 4 or more times. This study confirmed the importance of setting 4 visits as a minimal threshold for improved pregnancy outcomes, even where access to health care could be challenging, such as in Afghanistan.

Children spend over 80% of their school time in a seated position yet, ergonomic principles are conservatively applied on adult work places without consideration to the school environment. This study assessed the compatibility of the school furniture of kindergarten and class one pupils in the Asokore Mampong and Oforikrom Municipalities, Ghana. A cross-sectional analytic study was used. The research covered four selected basic schools from two socioeconomic suburbs (relatively high and relatively low socioeconomic areas). The participants were chosen using stratified sampling. Anthropometric data were collected from 395 healthypupils during regular class lessons. The student furniture dimensions were taken and compared with their anthropometry to identify potential match or mismatch. For all sitting anthropometric parameters, students were seated in an upright position with 90º knees and elbow flexion. The findings revealed a considerable level of discordancy between the measured furniture and the anthropometrics of the learners due to the negligence of user anthropometry during the construction of educational furniture. The seat depth was too deep for 80.51% of participants, only 15.19% had appropriate seat depth. The seat to desk height had 25.06% match, 69.11% low mismatch and 5.82% high mismatch. The match percentages of seat desk clearance, seat width and desk depth were 72.91%, 66.08% and 36.46% respectively. The match percentages of seat height were 24.61% for low socio-economic area schools and 12.25% for high socio-economic area schools. The seat height was too low for 45.55% of pupils from low socio-economic area schools and 62.25% of those from high socio-economic area schools. The seat depth was too deep for 91.62% of pupils from low socio-economic area schools and 70.10% pupils from high socio-economic area schools. The study revealed considerable incompatibility between the classroom furniture and the body dimensions of the pupils. Thus, the classroom furniture require ergonomic improvements.

Background and Aim: Typhoid fever, a significant global health problem, demonstrates a multifaceted transmission pattern. Knowledge of the factors driving the transmission of infection is critical for developing effective control strategies and resource allocation. This comprehensive desk review aimed at synthesizing evidence from 1928 to 2023 on risk factors associated with typhoid fever transmission. Method: We conducted article searches in PubMed, Scopus, Google Scholar, and Semantic Scholar, using keywords related to risk, contributors, determinants, causes etc. associated with typhoid fever. We followed a registered protocol to support our search and triangulated the results. Results: We retrieved 1614 articles, of which 216 were reviewed. Of these articles reviewed, 106 provided data on typhoid fever risk factors. Unsurprisingly, of the total articles reviewed on risk factors, about 72% (76/106) originated from the Asian (48.1%, 51/106) and African (23.6%, 25/106) continents. A higher proportion, 47.2% (50/106) of the articles indicated risk factors related to socio-economic and housing transmission. Additional risk factors included foodborne transmissions (45.3%, 48/106), WASH: Waterborne transmissions (42.5%, 45/106), Sanitation and Hygiene practices (32.1%, 34/106), travel-related risk (16.0%, 17/106), antimicrobial agents (13.2%, 14/106), climate (13.2%, 14/106), environmental (8.5%, 9/106), typhoid carriers (10.4%, 11/106), and host risk (5.7%, 6/106) factors to disease transmission. Conclusion: These findings highlight the necessity for targeted and combined interventions including improved sanitation infrastructure, enhanced WASH practices and the use of vaccines in endemic areas. Implementing effective strategies informed by this review can aid clinicians, public health experts, and policymakers in efficiently mitigating the burden of typhoid fever. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement Authors received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study used published articles and as such, permission from the institutional review board was not required. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes This study used published articles and all data collected from included articles are compiled and attached as a supporting information (S2_file).

This study aimed to assess the effects of health education and community-level participatory interventions at the community level and the use of community maternal health promoters on the utilization of maternal health care services in poor rural settings of northern Ghana. A randomized controlled survey design was conducted from June 2019 to July 2020 in two rural districts of northern Ghana. A multistage cluster sampling technique was used to select the participants. Data were collected from a repeated cross-sectional household survey. Descriptive analysis, bivariate and covariates adjusted simple logistic regression analyses were performed using STATA version 16 statistical software. At post-intervention, the two groups differed significantly in terms of ANC (p = 0.001), skilled delivery (SD) (p = 0.003), and PNC (p < 0.0001). Women who received health education on obstetric danger signs had improved knowledge by 50

Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings.

BackgroundGlobally, the increasing rate of caesarean section (CS) delivery has become a major public health concern due to its cost, maternal, neonatal, and perinatal risks. In Ghana, the Family Health Division of the Ghana Health Service in 2016 opted to initiate a program to prevent the abuse of CS and identify the factors contributing to its increase in the country. This study aimed to determine the prevalence and factors influencing CS deliveries in the Kintampo Districts of Ghana.MethodsThe current study used secondary data from the Every Newborn-International Network for the Demographic Evaluation of Populations and their Health (EN-INDEPTH) project in Kintampo, Ghana. The outcome variable for this study is CS delivery. The predictor variables were socio-demographic and obstetric factors.ResultsThe prevalence of CS delivery in the study area was 14.6%. Women with secondary education were 2.6 times more likely to give birth by CS than those with primary education. Unmarried women were about 2.5 times more likely to deliver by CS compared to those who were married. There was an increasing order of CS delivery among women in the wealthy quintiles from poorer to richest. The likelihood of women with gestational ages from 37 to 40 weeks to give birth by CS was about 58% less compared to those with less than 37 gestational weeks. Women who had 4-7 and 8 or more antenatal care (ANC) visits were 1.95 and 3.5 times more likely to deliver by CS compared to those who had less than 4 ANC visits. The odds of women who have had pregnancy loss before to deliver by CS was 68% higher compared to women who have not lost pregnancy before.ConclusionsCaesarean section delivery prevalence in the study population was within the Ghana Health Service and World Health Organization ranges. In addition to known socio-demographic and obstetric factors, this study observed that a history of pregnancy loss increased the chances of a woman undergoing a CS. Policies should aim at addressing identified modifiable factors to stem the rise in CS deliveries.

Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

AbstractObjectives:To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels–Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs).Design:Cross-sectional analyses of yearly hospital administrative data.Setting:All Belgian hospitals and discharge destinations, focusing on LTCFs.Participants:All individuals from the Brussels–Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572).Methods:We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections.Results:Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22–1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85–0.90).Conclusions:Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.

Background To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate caregiver and neonate needed to be together continuously, which led to the concept of the Mother-Newborn Care Unit (MNCU). Health-care providers and administrators were concerned of the potential increase in infections caused by the continuous presence of mothers or surrogates in the MNCU. We aimed to assess the incidence of neonatal sepsis in sub-groups and the bacterial profile among intervention and control neonates in the study population.Methods This is a post-hoc analysis of the previous iKMC trial, which was conducted in five level 2 Newborn Intensive Care Units (NICUs) one each in Ghana, India, Malawi, Nigeria, and Tanzania, in neonates with birth weight 1 to <1.8 kg. The intervention was KMC initiated immediately after birth and continued until discharge and compared to conventional care with KMC initiated after meeting stability criteria. The primary outcomes of this report were the incidence of neonatal sepsis in sub-groups, sepsis-related mortality and bacterial profile of isolates during hospital stay. The original trial is registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12618001880235) and the Clinical Trials Registry-India (CTRI/2018/08/01536).Findings Between November 30, 2017, and January 20, 2020,1609 newborns in the intervention group and in the control group 1602 newborns were enrolled in iKMC study. 1575 newborns in the intervention group and 1561 in the control group were clinically evaluated for sepsis. Suspected sepsis was 14% lower in intervention group in sub-group of neonates with birth weight 1.0-<1.5 kg; RR 0.86 (CI 0.75, 0.99). Among neonates with birth weight 1.5-<1.8 kg, suspected sepsis was reduced by 24%; RR 0.76 (CI 0.62, 0.93). Suspected sepsis rates were lower in intervention group than in the control group across all sites. Sepsis related mortality was 37% less in intervention group than the control group; RR 0.63 (CI 0.47-0.85) which was statistically significant. The intervention group had fewer cases of Gram-negative isolates (n = 9) than Gram positive isolates (n = 16). The control group had more cases of Gram-negative isolates (n = 18) than Gram positive (n = 12).Interpretation Immediate Kangaroo Mother care is an effective intervention to prevent neonatal sepsis and sepsis related mortality.Funding The original trial was funded by the Bill and Melinda Gates Foundation through a grant to the World Health Organization (grant No. OPP1151718).Copyright & COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background Emergency Medical Technicians (EMTs) are the primary providers of prehospital emergency medical services. The operations of EMTs increase their risks of being exposed to occupational injuries. However, there is a paucity of data on the prevalence of occupational injuries among EMTs in sub-Saharan Africa. This study, therefore, sought to estimate the prevalence and determinants of occupational injuries among EMTs in the northern part of Ghana. Methods A cross-sectional study was conducted among 154 randomly recruited EMTs in the northern part of Ghana. A pre-tested structured questionnaire was used to collect data on participants’ demographic characteristics, facility-related factors, personal protective equipment use, and occupational injuries. Binary and multivariate logistic regression analyses with a backward stepwise approach were used to examine the determinants of occupational injuries among EMTs. Results In the 12 months preceding data collection, the prevalence of occupational injuries among EMTs was 38.6%. Bruises (51.8%), and sprains/strains (14.3%) were the major types of injuries reported among the EMTs. The key determinants of occupational injury among EMTs were male sex (AOR: 3.39, 95%CI: 1.41–8.17), an absence of a health and safety committee at the workplace (AOR: 3.92, 95%CI: 1.63–9.43), absence of health and safety policy at the workplace (AOR: 2.76, 95%CI: 1.26–6.04) and dissatisfaction with health and safety measures at the workplace (AOR: 2.51, 95%CI: 1.10–5.71). Conclusion In the twelve months before to the data collection for this study, the prevalence of occupational injuries among EMTs of the Ghana National Ambulance Service was high. The creation of health and safety committees, the creation of health and safety rules, and the strengthening of current health and safety procedures for EMTs are all possible ways to lessen this.

Background Studies on Mass drug administration (MDA) in Ghana targeting various diseases, have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and community perception of the program. Therefore, this study sought to provide empirical evidence on the knowledge of onchocerciasis, and awareness of and participation in the MDA among community members. Methods A community-based cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District, Ghana. Data was collected from 2,008 respondents. Bivariate and multivariate logistic regression analyses were performed to measure the associations between socio-demographics, having heard of onchocerciasis and its prevention, and levels of awareness of the MDA program. Results A total of 1268 respondents (63.2%) were aware of the MDA program. The majority ofMost respondents (74.4%) were of the view that the information given about the program was not enough and 45.4% of the respondents had no idea about the relevance of the MDA program. Respondents who had ever heard about onchocerciasis prevention and persons who had previously participated in the MDA program were more likely to be aware of the MDA program during implementation (AOR = 2.32; 95% CI 1.79–3.01 and AOR = 9.31; 95% CI 7.06–12.26, respectively). Conclusions We observed a significant association between being aware of MDA campaigns and knowledge of onchocerciasis and its preventive methods, and participation in previous MDA campaigns. We recommend intensification and improvement of prevention campaigns regarding the onchocerciasis MDA program as key to ensuring increased MDA program participation.