IJID regions最新文献

{"title":"Effectiveness of an e-Bug–based antimicrobial resistance education intervention: A prospective quasi-experimental study among Grade 12 students in Mogadishu, Somalia","authors":"Shafie Abdulkadir Hassan ,&nbsp;Maryan Jamal Isak ,&nbsp;Abdullahi Mohamed Osman ,&nbsp;Yonis Mohamud Hassan ,&nbsp;Ahmed Mohamed Ahmed ,&nbsp;Sara Ali Mire ,&nbsp;Kassim Abdi Jimale ,&nbsp;Abdifetah Ibrahim Omar ,&nbsp;Nur Rashid Ahmed","doi":"10.1016/j.ijregi.2025.100771","DOIUrl":"10.1016/j.ijregi.2025.100771","url":null,"abstract":"<div><h3>Objectives</h3><div>Antimicrobial resistance (AMR) is a severe global health threat, with a disproportionate impact on low-income countries like Somalia. This study aimed to evaluate the effectiveness of the e-Bug educational module in improving knowledge and understanding of AMR among secondary school students in Mogadishu, Somalia, a setting with limited public awareness and a high burden of infectious diseases.</div></div><div><h3>Methods</h3><div>A prospective quasi-experimental pre-post study was conducted among 384 Form four (Grade 12) students in Mogadishu. A structured questionnaire assessed knowledge of microbiology, hygiene, and AMR before and after the implementation of the e-Bug educational module. The intervention consisted of standardized, interactive lessons on AMR, hygiene, and infection prevention. Changes in knowledge were analyzed using descriptive statistics, and the McNemar-Bowker test was used to determine the statistical significance of the change in responses from pre-test to post-test.</div></div><div><h3>Results</h3><div>Participants were predominantly male (54.2%), with most aged 16-18 years (51.6%). Baseline data revealed strong knowledge of general hygiene, such as handwashing (93.5%), but notable misunderstandings regarding AMR. Notably, 61.5% of students incorrectly believed antibiotics are effective against viral infections like influenza. Following the e-Bug intervention, a statistically significant improvement in overall AMR knowledge was observed (<em>P</em> = 0.003). Post-test results showed enhanced understanding of key AMR concepts, including a 9.6% increase (from 84.4% to 94.0%) in the awareness that antibiotic misuse drives resistance. However, the misconception that antibiotics treat viral infections remained prevalent (58.3%).</div></div><div><h3>Conclusions</h3><div>The e-Bug educational module is an effective tool for improving AMR knowledge among secondary school students in Mogadishu. However, the persistence of critical misconceptions, particularly regarding the use of antibiotics for viral illnesses, highlights the need for sustained and reinforced educational efforts. Integrating the e-Bug module into the national curriculum and developing targeted public health campaigns are recommended to address these deep-seated misunderstandings and combat the growing threat of AMR in Somalia.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100771"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of rheumatic heart disease in New Zealand: High-dose subcutaneous benzathine penicillin is cost-saving compared with traditional intramuscular injections","authors":"William Leung ,&nbsp;Michael G. Baker ,&nbsp;Laurens Manning ,&nbsp;Julie Bennett","doi":"10.1016/j.ijregi.2025.100784","DOIUrl":"10.1016/j.ijregi.2025.100784","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute rheumatic fever is a preventable condition that can lead to chronic illness and early death. Standard prevention with 4-weekly intramuscular (IM) benzathine penicillin G (BPG) injections for ≥10 years may be associated with poor adherence. High-dose 10-weekly subcutaneous penicillin injections (SCIP) may improve adherence by reducing injection frequency. Since 2025, SCIP has been included in the repository of standard operating procedures in lower North Island hospitals in New Zealand (NZ). We compare the costs of delivering a full course of secondary prophylaxis using SCIP vs IM BPG injections in NZ children with a first acute rheumatic fever presentation and no/mild carditis.</div></div><div><h3>Methods</h3><div>Treatment administration costs and productivity losses from SCIP vs IM BPG were modeled using real-world survey data on time off school and work. Starting age of secondary prophylaxis, adherence, and administration site over the treatment period were varied. Costs are in 2024 NZ$, discounted at 3.5%.</div></div><div><h3>Results</h3><div>SCIP reduced 12-month costs by nearly half to NZ$ 1629 for a 10-year-old child. Over a full course, SCIP consistently offered societal cost-savings, especially in younger children and higher adherence scenarios.</div></div><div><h3>Conclusions</h3><div>Prevention using SCIP is cost-saving to NZ society. Increased adherence to SCIP may contribute to longer, healthier lives for those diagnosed with rheumatic fever.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100784"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study","authors":"Saadick Mugerwa Ssentongo ,&nbsp;Saidi Appeli ,&nbsp;Jonathan Izudi","doi":"10.1016/j.ijregi.2025.100778","DOIUrl":"10.1016/j.ijregi.2025.100778","url":null,"abstract":"<div><h3>Objectives</h3><div>Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count &lt;200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis.</div></div><div><h3>Results</h3><div>Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61).</div></div><div><h3>Conclusions</h3><div>The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100778"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metagenomics next-generation sequencing for diagnosis of invasive fungal diseases in patients with hematological diseases","authors":"Xi Chen ,&nbsp;Hongchao Qin ,&nbsp;Yuhua Song ,&nbsp;Yun Lian ,&nbsp;Qiqiang Long","doi":"10.1016/j.ijregi.2025.100780","DOIUrl":"10.1016/j.ijregi.2025.100780","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the clinical characteristics and risk factors of invasive fungal disease (IFD) in patients with hematological disorders.</div></div><div><h3>Methods</h3><div>From January 2023 to January 2025, 67 patients with blood diseases hospitalized at the Hematology Department who were suspected of infection with IFD underwent metagenomic next-generation sequencing (mNGS) and fungal pathogen detection. Their clinical characteristics and laboratory examinations were retrospectively analyzed.</div></div><div><h3>Results</h3><div>A cohort of 67 patients was enrolled in the study, among which 32 cases were diagnosed with IFD through mNGS and etiological culture, while no fungal pathogens were detected in the remaining 35 cases. The diagnostic yield of mNGS for fungal infection detection (47.76%) demonstrated superior sensitivity compared to conventional pathogenic microbial culture (14.93%), β-D-glucan assay (11.94%), and galactomannan assay (2.99%). Within the IFD cohort, <em>Candida</em> species constituted the most prevalent etiology (46.88%, n = 15), followed by <em>Aspergillus</em> (18.75%, n = 6), <em>Penumocystis</em> (12.5%, n = 4), and <em>Rhizomucor</em> (12.5%, n = 4), with other fungal species accounting for the remaining cases (9.37%, n = 3). Multivariate logistic regression analysis revealed six independent risk factors associated with IFD in patients with hematological disorders: cluster of differentiation 4+ T cell count &lt;400 cells/µL (odds ratio [OR] = 9.45, <em>P</em> = 8.9×10^–5), elevated C-reactive protein (OR = 3.18, <em>P</em> = 0.027), elevated interleukin (IL)-6 (OR = 5.75, <em>P</em> = 0.001), elevated IL-10 (OR = 3.31, <em>P</em> = 0.033), hypoproteinemia (OR = 42.17, <em>P</em> = 0.013), and neutropenia lasting for more than 10 days (OR = 4.11, <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>mNGS has high sensitivity in detecting IFD in patients with hematological diseases. Cluster of differentiation 4+ cell count below 400/uL, increased level of C-reactive protein, IL-6, and IL-10, hypoproteinemia, and neutropenia lasting for more than 10 days are independent risk factors for IFD in patients with hematological diseases.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100780"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of dengue virus among febrile patients in urban setting of Bamako, Mali","authors":"Yacouba Cissoko ,&nbsp;Mountaga Diallo ,&nbsp;Hermine Meli ,&nbsp;Emmanuel Mberkadji Dingamwal ,&nbsp;Ibrehima Guindo ,&nbsp;Fousseyni Kané ,&nbsp;Dramane Ouedraogo ,&nbsp;Bakary Monzon Diarra ,&nbsp;Ibrahim Cisse ,&nbsp;Daouda Thiero ,&nbsp;Bréhima Togola ,&nbsp;Demba Koita ,&nbsp;Oumar Magassouba ,&nbsp;Dramane Sogoba ,&nbsp;Mariam Soumaré ,&nbsp;Assetou Fofana ,&nbsp;Issa Konate ,&nbsp;Seydou Doumbia ,&nbsp;Sounkalo Dao","doi":"10.1016/j.ijregi.2025.100788","DOIUrl":"10.1016/j.ijregi.2025.100788","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to determine the prevalence of dengue among febrile patients in Bamako and explore its seasonal and demographic variations.</div></div><div><h3>Methods</h3><div>We conducted cross-sectional surveys in July 2021 and February 2022 among febrile patients seeking care at four community health centers in Bamako. Febrile patients were enrolled, and blood samples were tested for dengue using rapid diagnostic tests and polymerase chain reaction.</div></div><div><h3>Results</h3><div>A total of 325 patients were enrolled (175 in July and 150 in February). The overall prevalence of dengue in communes V and VI of Bamako was 16.9%. Females were more represented (66.2%). The median age of the participants was 20 years (interquartile range: 8-30). Adult age (≥18 years) was the only factor significantly associated with an increased risk of dengue infection (odds ratio = 3.2; 95% confidence interval: 1.1-9.4).</div></div><div><h3>Conclusions</h3><div>The prevalence of dengue (16.9%) in communes V and VI suggests that dengue is endemic in Bamako, with a predominance among young adults and females. Adult age was identified as the only significant factor associated with increased risk. Further studies are needed for more insight into the dynamics of dengue transmission and to guide public health actions, particularly those targeting the adult population, to reduce dengue transmission in Bamako.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100788"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-genome characterization of prevalent dengue virus serotype-1 in 2023 dengue outbreak of Xishuangbanna, a border area of Laos, Myanmar, and China","authors":"Chenqian Peng ,&nbsp;Tingting Li ,&nbsp;Dehong Ma ,&nbsp;Fen Zeng ,&nbsp;Kaiyun Ding ,&nbsp;Ziying Wu ,&nbsp;Linhong Li ,&nbsp;Yue Pan ,&nbsp;Junying Chen ,&nbsp;Yingcheng Guo ,&nbsp;Qiangming Sun","doi":"10.1016/j.ijregi.2025.100797","DOIUrl":"10.1016/j.ijregi.2025.100797","url":null,"abstract":"<div><h3>Objectives</h3><div>From June to November 2023, a severe dengue fever outbreak occurred in Xishuangbanna, China, a border area with Myanmar and Laos. This study aimed to identify the pathogen responsible for this outbreak and analyze the genomic characteristics of epidemic strains, providing reference data for dengue prevention and control.</div></div><div><h3>Methods</h3><div>Serum samples from dengue virus (DENV) NS1-positive patients (July-October 2023) were collected. RNA extraction, serotyping via probe quantitative polymerase chain reaction, and whole-genome amplification using 18 primer pairs followed by sequencing were performed. Base and amino acid mutations were analyzed using DNAMAN. Phylogenetic trees (maximum likelihood for the whole genome and neighbor-joining for the E protein) were constructed using MEGA11. Protein secondary structures were compared via online tools provided by PRABI Lyon-Gerland.</div></div><div><h3>Results</h3><div>Among 1465 samples, 833 were DENV-1 positive, with no other dengue serotype or flavivirus co-infection. Genomic analysis of 10 isolates showed high similarity to the 2023 Guangdong strain (PP540291). Non-structural proteins had higher base mutation rates than structural ones, with NS2 showing the highest (10.92%). Many unique 2013 Yunnan strain mutations were preserved. Phylogenetic trees clustered the epidemic strains with Guangdong and Southeast Asian isolates. NS1 RNA-binding sites remained stable.</div></div><div><h3>Conclusions</h3><div>This study provides valuable insights for dengue control in the China-Myanmar-Laos border areas, as well as for viral pathogenesis research and vaccine development.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100797"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scabies outbreak in Bangladesh: a growing public health crisis","authors":"Md Nasir Ahmed","doi":"10.1016/j.ijregi.2025.100747","DOIUrl":"10.1016/j.ijregi.2025.100747","url":null,"abstract":"<div><div>This study highlights the growing scabies crisis in Bangladesh, particularly affecting urban and rural areas, madrasahs, residential institutions, and Rohingya refugee camps. Drawing on epidemiological data and field studies, it identifies key factors contributing to transmission, such as overcrowding, inadequate sanitation, and low socioeconomic status, which disproportionately affect vulnerable groups, including children and displaced populations. Although permethrin remains the primary treatment, reinfection is prevalent, and oral ivermectin provides a valuable alternative in water-scarce environments. Behavioral factors and a fragile health infrastructure impede control efforts. Institutional interventions and mass drug administration have demonstrated success, but long-term prevention continues to pose challenges. The findings advocate for alternative pharmacological approaches, integrated WASH (Water, Sanitation, and Hygiene) strategies, enhanced primary healthcare and surveillance systems, public education initiatives, and policy-level recognition of scabies as a climate-sensitive infectious disease to reduce its impact on marginalized communities.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100747"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and characterization of post-acute sequelae of SARS-CoV-2 infection (PASC) in Rwanda","authors":"Fernand Rwamwejo ,&nbsp;Vivianne Umuhire Niyonkuru ,&nbsp;Gilbert Rukundo ,&nbsp;Eric Remera ,&nbsp;Edson Rwagasore ,&nbsp;Les Sztandera ,&nbsp;Charles Ruranga ,&nbsp;Elizabeth Krebs","doi":"10.1016/j.ijregi.2025.100738","DOIUrl":"10.1016/j.ijregi.2025.100738","url":null,"abstract":"<div><h3>Objectives</h3><div>Reliable, population-level estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) remain scarce for sub-Saharan Africa. We aimed to quantify PASC prevalence and identify associated factors among adult COVID-19 survivors in Rwanda.</div></div><div><h3>Methods</h3><div>A nationally representative cross-sectional telephone survey (August-October 2024) sampled 3143 adults from the national COVID-19 registry. PASC was defined as new or persisting symptoms ≥3 months after acute illness and lasting ≥2 months. The prevalence was calculated, and multivariable logistic regression identified factors independently associated with PASC.</div></div><div><h3>Results</h3><div>Overall, PASC prevalence was 34%. Leading symptoms were back pain, headache, dizziness, fatigue, and reduced sexual desire. Higher odds of PASC occurred in women, adults ≥35 years, individuals with ≥2 COVID-19 infections, and those screening positive for anxiety. Current alcohol use was linked to lower odds. COVID-19 vaccination showed no association with PASC.</div></div><div><h3>Conclusions</h3><div>Approximately one-third of adult Rwandan COVID-19 survivors continue to experience persistent symptoms. This burden signals that post-COVID care must become an integral part of routine health services, especially as new variants periodically drive fresh waves of infection. Preventing repeat infections and integrating mental health support emerge as actionable priorities. Harmonized longitudinal studies are needed to clarify PASC causality.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100738"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diverse respiratory viruses detected among hospitalized patients with pneumonia in Sri Lanka and Vietnam","authors":"Phuong Thu Phan ,&nbsp;Gaya Wijayaratne ,&nbsp;Champica K. Bodinayake ,&nbsp;Judith U. Oguzie ,&nbsp;Thang Nguyen-Tien ,&nbsp;Lyudmyla V. Marushchak ,&nbsp;Jessica Rodriguez ,&nbsp;Claudia M. Trujillo-Vargas ,&nbsp;Ismaila Shittu ,&nbsp;Nga Thanh Pham ,&nbsp;Sen Thi Le ,&nbsp;Ajith Nagahawatte ,&nbsp;Phuong Thai Truong ,&nbsp;Ruvini Kurukulasooriya ,&nbsp;Armstrong Obale ,&nbsp;Emily R. Robie ,&nbsp;Emily S. Bailey ,&nbsp;Bradly P. Nicholson ,&nbsp;Christopher W. Woods ,&nbsp;Gayani L. Tillekeratne ,&nbsp;Gregory C. Gray","doi":"10.1016/j.ijregi.2025.100757","DOIUrl":"10.1016/j.ijregi.2025.100757","url":null,"abstract":"<div><h3>Objectives</h3><div>We conducted surveillance for novel respiratory viruses among patients hospitalized with pneumonia in Sri Lanka and Vietnam.</div></div><div><h3>Methods</h3><div>We enrolled patients from January 2020 to July 2022 at one major hospital each in Sri Lanka and Vietnam. The participants’ nasopharyngeal swabs were studied with assays for previously recognized viruses as well as for assays for novel viruses.</div></div><div><h3>Results</h3><div>A total of 401 hospitalized patients were enrolled, 204 from Sri Lanka and 197 from Vietnam. Laboratory analyses detected a number of previously recognized viruses, including influenza A/(H1N1)pdm09, human respiratory syncytial virus B, human respirovirus 3, rhinovirus A59, enteroviruses, and a human mastadenovirus C. Although an assortment of common human coronaviruses was characterized, 18 (43.9%) of 41 coronavirus-positive samples from Vietnam had evidence of the newly described canine-like coronavirus, CCoV-HuPn-2018 (previously only detected in Malaysia and Haiti).</div></div><div><h3>Conclusions</h3><div>The detection of a novel, possibly emerging virus, CCoV-HuPn-2018, in multiple patients in Vietnam, demonstrates the value of such periodic novel virus surveillance, especially in regions at risk for viral emergence.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100757"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulatory gaps in over-the-counter antifungal access for vulvovaginal candidiasis in Uganda: A policy analysis framework","authors":"Bwambale Jonani ,&nbsp;Richard Kwizera","doi":"10.1016/j.ijregi.2025.100746","DOIUrl":"10.1016/j.ijregi.2025.100746","url":null,"abstract":"<div><h3>Objectives</h3><div>Vulvovaginal candidiasis (VVC) affects approximately 75% of women globally, with a particularly high prevalence (30-45%) among women of reproductive age in Uganda. Over-the-counter (OTC) antifungal medications are a critical access point for treatment in resource-limited settings; however, their unregulated availability raises important questions regarding appropriate use, diagnostic accuracy, and antimicrobial stewardship. We aimed to analyze Uganda’s regulatory framework governing OTC antifungal medications for VVC management, identify key policy gaps, and develop an evidence-based framework to balance accessibility with appropriate use.</div></div><div><h3>Methods</h3><div>This study employed a documentary analysis of Ugandan pharmaceutical policy documents (2000-2025) combined with a systematic review of the published literature on medication regulation and self-medication practices. A structured policy analysis framework was applied to examine the classification systems, implementation mechanisms, and provision of oversight for antifungal medications.</div></div><div><h3>Results</h3><div>Uganda’s current regulatory framework increases antifungal accessibility through liberal OTC classification but neglects complementary measures to ensure appropriate use and safety. Five critical policy gaps were identified: (i) diagnostic accuracy: no provisions ensure proper differentiation of VVC from other conditions; (ii) treatment completion: no mechanisms ensure adherence to recommended treatment durations; (iii) safety screening: absence of pregnancy screening requirements for contraindicated fluconazole; (iv) personnel training, inadequate VVC-specific training for drug shop operators; and (v) product regulation: insufficient oversight of combination products. These gaps exist within the healthcare context, where 62% of antimicrobials are supplied by private vendors with minimal oversight. We propose an evidence-based framework that balances accessibility with appropriate use.</div></div><div><h3>Conclusions</h3><div>The identified policy gaps potentially compromise women’s health outcomes through inappropriate treatment, incomplete therapy courses, preventable medication risks, and conditions that favor the development of antifungal resistance. The policy tensions between accessibility and appropriate use highlight the need for gender-sensitive pharmaceutical regulations that maintain access while implementing targeted safeguards for improved health outcomes and antimicrobial stewardship.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100746"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}