IJID regions最新文献

{"title":"Mortality hazards after treatment completion of pulmonary tuberculosis in a tertiary hospital in Uganda","authors":"Felix Bongomin ,&nbsp;Martha Namusobya ,&nbsp;Ritah Nantale ,&nbsp;Daniel S. Ebbs ,&nbsp;Charles Batte ,&nbsp;Norman van Rhijn ,&nbsp;Joseph Baruch Baluku ,&nbsp;David W. Denning","doi":"10.1016/j.ijregi.2025.100758","DOIUrl":"10.1016/j.ijregi.2025.100758","url":null,"abstract":"<div><h3>Objectives</h3><div>Treated pulmonary tuberculosis (PTB) is associated with long-term complications that contribute to substantial morbidity and mortality. We estimated the incidence and predictors of post-PTB mortality and evaluated whether chronic pulmonary aspergillosis (CPA) independently increases the risk of death.</div></div><div><h3>Methods</h3><div>Between July 1, 2020 and June 30, 2021, we enrolled 162 individuals with treated drug-susceptible PTB who had persistent respiratory symptoms and screened them for CPA using a symptom checklist, chest x-ray, <em>Aspergillus</em> immunoglobulin G-immunoglobulin M point-of-care test, and sputum culture. Between November and December 2024, we followed up all participants via phone calls to determine their vital status. On chest X-ray, PTB was classified as minimal, moderate, and far advanced disease based on involvement of one, two, or more zones, respectively, and coupled to unilateral or bilateral lung disease. Cox proportional hazards regression was used to identify independent predictors of mortality.</div></div><div><h3>Results</h3><div>Thirty-seven (22.8%) participants were lost to follow-up. The median follow-up duration was 3.8 years (interquartile range 3.6-3.9). Of the 125 participants with vital status, their mean age was 33.5 years (±11.7). At baseline, 46 (36.8%) had far advanced PTB, 64 (51.2%) had pulmonary fibrosis, 15 (12.0%) had a history of previous TB, and 34 (27.2%) were living with HIV. Coinfection with PTB and CPA was identified in 31 participants at baseline (24.8%). The median St. George’s respiratory questionnaire score was 50.9 (interquartile range 40.9-63.3), and 32.0% (n = 40) had scores above 60, indicating poor health-related quality of life. Overall mortality was 8.8% (95% confidence interval [CI] 4.4-15.2%), with a mortality rate of 24.3 deaths per 1000 person-years of follow-up. Mortality rates were comparable among participants with and without CPA-PTB coinfection. Independent predictors of mortality included a St. George’s respiratory questionnaire score &gt;60 (adjusted hazard ratio = 2.01; 95% CI 1.49-2.72; <em>P</em> &lt;0.001) and HIV infection (adjusted hazard ratio = 3.04; 95% CI 1.46-6.34; <em>P</em> = 0.029).</div></div><div><h3>Conclusions</h3><div>Post-PTB mortality remains high, with poor health-related quality of life and HIV co-infection emerging as significant independent predictors of death. Integrating long-term follow-up, respiratory rehabilitation, and fungal diagnostics into post-TB care pathways is essential to improve outcomes and reduce preventable mortality.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100758"},"PeriodicalIF":1.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267916","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":"Antibiotic consumption in 19 health care facilities in Southeastern Gabon (2016-2018): a pilot study using World Health Organization-defined daily doses and AWaRe classification","authors":"Yann Mouanga-Ndzime ,&nbsp;Cyrille Bisseye ,&nbsp;Michelle Bignoumba ,&nbsp;Annicet-Clotaire Dikoumba ,&nbsp;Richard Onanga","doi":"10.1016/j.ijregi.2025.100755","DOIUrl":"10.1016/j.ijregi.2025.100755","url":null,"abstract":"<div><h3>Objectives</h3><div>Inappropriate use of antibiotics is a major driver of antimicrobial resistance, especially in low- and middle-income countries where surveillance data remain scarce. This pilot study aimed to evaluate antibiotic consumption in 19 health care facilities in southeastern Gabon from 2016-2018, using the World Health Organization’s defined daily doses (DDD) and AWaRe (Access, Watch, and Reserve) classification frameworks.</div></div><div><h3>Methods</h3><div>This retrospective, descriptive study is based on data extracted from drug stock registers. Antibiotic consumption was measured in DDD and defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day or DID). Systemic antibiotics were categorized using the World Health Organization’s AWaRe classification.</div></div><div><h3>Results</h3><div>A total of 557,361 DDDs were recorded over the 3-year period. Antibiotics in the Watch category accounted for the majority of consumption (69.2%), followed by those in the Access category (29.5%). The overall annual DID (DDD/1000 inhabitants/day) declined significantly from 2.2 in 2016 to 0.13 in 2018, with the most notable reduction observed in Access-category antibiotics. The most commonly used antibiotics included doxycycline, gentamicin, and cotrimoxazole. Gentamicin was the most frequently used antibiotic across all facility types, representing over 50% of total DDDs in dispensaries, health centers, medical centers, and regional hospitals. AWaRe category distribution varied by facility level. Access-category antibiotics predominated in dispensaries and medical centers (83.4%), whereas Watch-category antibiotics were more prevalent in health centers (75.5%) and regional hospitals (78.6%).</div></div><div><h3>Conclusions</h3><div>This study provides foundational data on antibiotic consumption in southeastern Gabon, a region where such information was scarce. The high prevalence of Watch-category antibiotic use highlights the urgent need for enhanced regulation and targeted antimicrobial stewardship strategies to ensure appropriate use and curb the spread of antimicrobial resistance.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100755"},"PeriodicalIF":1.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268453","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":"Understanding barriers to HIV care and treatment adherence in Guyana and the Caribbean: A mixed-methods analysis","authors":"Tariq Jagnarine","doi":"10.1016/j.ijregi.2025.100744","DOIUrl":"10.1016/j.ijregi.2025.100744","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to identify and analyze the primary barriers to HIV care and treatment adherence in Guyana and the Caribbean.</div></div><div><h3>Methods</h3><div>A cross-sectional mixed-methods design was employed, incorporating quantitative surveys and qualitative interviews with 200 HIV-positive individuals attending clinics in Guyana and the Caribbean. The data were analyzed using both descriptive and inferential statistics. Ethical approval was obtained.</div></div><div><h3>Results</h3><div>Key findings revealed that stigma (60%), financial constraints (55%), and transportation issues (45%) were the most reported barriers. Stigma was particularly prevalent among unemployed participants (<em>P</em> &lt;0.05), while transportation challenges were more significant in rural areas (<em>P</em> &lt;0.01). Approximately 85% of participants reported adherence rates above 90%, but 15% had discontinued treatment due to side effects, stigma, or financial barriers. Follow-up support, such as peer counseling, significantly improved re-engagement in care (<em>P</em> &lt;0.01).</div></div><div><h3>Conclusions</h3><div>The study highlights the multifaceted barriers to HIV care in Guyana and the Caribbean, emphasizing the urgent need for targeted interventions to reduce stigma, improve financial accessibility, and enhance follow-up services.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100744"},"PeriodicalIF":1.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267914","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":"Knowledge and practices of anti-malarial treatment for children under five years among village health teams in Kasese District, Uganda: A cross-sectional study","authors":"Nakitto Irene Kisakye ,&nbsp;Helena C. Maltezou ,&nbsp;Robert Mugarura ,&nbsp;Arthur Nek Jonathan ,&nbsp;Charles Etyang","doi":"10.1016/j.ijregi.2025.100749","DOIUrl":"10.1016/j.ijregi.2025.100749","url":null,"abstract":"<div><h3>Objectives</h3><div>Malaria remains a leading cause of morbidity and mortality among children under 5 in Uganda, particularly in rural and hard-to-reach areas. Village health teams (VHTs) play a pivotal role in community-based malaria diagnosis and treatment, yet their knowledge and practices remain understudied. To assess the knowledge and practice of antimalarial drug use among VHTs for children under 5 years in Kasese District, Uganda.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional study was conducted among 102 VHTs using a structured, interviewer-administered questionnaire. Descriptive statistics were used to summarize VHT characteristics, knowledge, and practice scores. Chi-square tests were performed to assess associations between socio-demographic characteristics and key dispensing practices. Data were analyzed using SPSS, version 26.</div></div><div><h3>Results</h3><div>The majority of VHTs demonstrated basic knowledge in antimalarial treatment, with 70.6% routinely checking expiration dates and 76.5% instructing caregivers on when to administer medications. However, fewer VHTs informed caregivers about side effects (21.6%), drug interactions (29.4%), or the effects of herbal medicines (19.6%). Significant associations were found between educational level and multiple dispensing practices (<em>p</em> &lt;0.05), including giving drugs based on rapid diagnostic test results and appropriately addressing caregiver requests.</div></div><div><h3>Conclusions</h3><div>While VHTs in Kasese District generally adhere to key elements of antimalarial drug administration, gaps persist in their pharmacological knowledge and patient education practices. Strengthening ongoing training and supervision may improve rational antimalarial drug use and treatment outcomes in children under 5 years old.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100749"},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221684","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":"Co-infections with Multiple Viruses: A Frequent cause of Community-Acquired Pneumonia in Sarawak Malaysia","authors":"Teck-Hock Toh ,&nbsp;Jeffrey Soon-Yit Lee ,&nbsp;Sook-Min Yong ,&nbsp;Nur Alfreena Binti Alfie ,&nbsp;Siew-Ming Ting ,&nbsp;Chew-Ee Wong ,&nbsp;Kamilah Dahian ,&nbsp;See-Chang Wong ,&nbsp;Cheng-Foong Cheah ,&nbsp;Anantha Raman Selvarajan ,&nbsp;Bee-Shuang Lee ,&nbsp;Judith U. Oguzie ,&nbsp;Thang Nguyen-Tien ,&nbsp;Claudia M. Trujillo-Vargas ,&nbsp;Diego B. Silva ,&nbsp;Emily R. Robie ,&nbsp;Laura A. Pulscher ,&nbsp;Mohd Raili Suhaili ,&nbsp;Lyudmyla Marushchak ,&nbsp;Gregory C. Gray","doi":"10.1016/j.ijregi.2025.100748","DOIUrl":"10.1016/j.ijregi.2025.100748","url":null,"abstract":"<div><h3>Objectives</h3><div>Equatorial Sarawak, Malaysia, has been the site of important novel respiratory virus detections. During the COVID-19 pandemic, we sought to determine viral causes of pneumonia that were not SARS-CoV-2.</div></div><div><h3>Methods</h3><div>Using an informed consent process, we enrolled patients from four hospitals in Sarawak for this cross-sectional study. Patients permitted a nasopharyngeal (NP) swab collection and completed a risk factor questionnaire. We studied NP swabs with molecular diagnostics for previously recognized respiratory viruses such as influenza A and D viruses, and pan-species assays for adenoviruses, coronaviruses, enteroviruses, pneumoviruses, and paramyxoviruses.</div></div><div><h3>Results</h3><div>Among 441 patients, 78.2% had at least one virus detected, and 24.9% had multiple viruses detected. Among the viruses detected, a commercial multiplexing assay found the most prevalent detections were human rhinoviruses (43.1%), respiratory syncytial virus (18.6%), human metapneumovirus (8.6%), influenza A (7%), adenovirus (6.1%), and influenza B (5.6%). However, the pan-species assays detected evidence of 19 additional respiratory viruses that the commercial multiplexing assay missed.</div></div><div><h3>Conclusions</h3><div>Patients with pneumonia in this hot and humid region often had evidence of multiple viral infections, especially children under 5 years old. Clinicians who rely on singleplex molecular assays for prevalent viruses such as influenza A, SARS-CoV-2, and respiratory syncytial virus may miss other important viral causes of illness in such patients.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100748"},"PeriodicalIF":1.7,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267913","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":"Knowledge, attitudes, and practices on infection prevention and control among healthcare workers in Rohingya refugee camp","authors":"Md. Atiar Rahman Mondol ,&nbsp;Md. Monir Hossain Shimul ,&nbsp;Sikder Masud Raihan ,&nbsp;Saimum Arafat Pantho ,&nbsp;Salamat Khandker","doi":"10.1016/j.ijregi.2025.100750","DOIUrl":"10.1016/j.ijregi.2025.100750","url":null,"abstract":"<div><h3>Objectives</h3><div>The forcibly displaced Myanmar nationals (FDMN) camp in Cox’s Bazar, Bangladesh, is highly vulnerable to infectious disease outbreaks due to overcrowding and limited healthcare infrastructure. This study aimed to assess the knowledge, attitudes, and practices (KAP) related to infection prevention and control (IPC) among healthcare workers (HCWs) in the FDMN camp to identify gaps and inform targeted interventions.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted between September 2023 and July 2024 among 401 HCWs employed in Primary Health Care Centers, Health Posts, Community Clinics, and Upazila Health Complexes within the FDMN camp. Respondents were randomly selected from the healthcare workforce list of the local civil surgeon’s office. Data were collected using a semi-structured, pretested questionnaire. The questionnaire covered sociodemographics and a KAP survey was developed based on the World Health Organization IPC protocol. Descriptive statistics, chi-square tests, and association analyses were performed using SPSS version 22, with significance set at <em>P</em> &lt;0.05.</div></div><div><h3>Results</h3><div>Among 401 healthcare workers, 60.6% were female and 39.4% were male. Overall, 71.8% had good IPC knowledge, 64.4% showed positive attitudes, and 85.5% demonstrated good practices. Knowledge was significantly associated with age, experience, job station, and training (all <em>P</em> &lt;0.01), while attitudes were influenced by experience and training (<em>P</em> &lt;0.01). Practice was significantly associated with sex, experience, job station, and training (all <em>P</em> &lt;0.01).</div></div><div><h3>Conclusions</h3><div>Healthcare workers in the FDMN camp showed good IPC knowledge and practices, though attitudes varied. Training significantly improved all KAP domains. Strengthening NGO-led training, supervision at PHCCs, and routine KAP monitoring is vital for sustainable infection control in refugee settings.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100750"},"PeriodicalIF":1.7,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221683","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":"2025-09-05","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":"HIV-1 genetic diversity and pretreatment drug resistance survey prior to dolutegravir introduction in Senegal","authors":"Mengue Fall ,&nbsp;Nafissatou Leye ,&nbsp;Nicole Vidal ,&nbsp;Fatou Niasse ,&nbsp;Edmond Tchiakpe ,&nbsp;Bambo Diakhaby ,&nbsp;Mame Salane Thiam ,&nbsp;Abou Abdallah Malick Diouara ,&nbsp;Fabien Roch Niama ,&nbsp;Safiatou Thiam ,&nbsp;Coumba Toure-Kane ,&nbsp;Halimatou Diop-Ndiaye","doi":"10.1016/j.ijregi.2025.100741","DOIUrl":"10.1016/j.ijregi.2025.100741","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to document the prevalence of pretreatment drug resistance in antiretroviral therapy-naïve patients in Senegal, describe mutation profiles, and evaluate their potential impact on future therapy.</div></div><div><h3>Methods</h3><div>A pretreatment drug resistance survey was carried out in 35 sites throughout the country between 2017 and 2018 using dried blood spots and whole blood samples. Amplification and sequencing were performed on the partial reverse transcriptase (RT) gene using the Agence Nationale de Recherches sur le Sida et les hépatitis virales (ANRS: French National Agency for Research on acquired immunodeficiency syndrome [AIDS] and Viral Hepatitis)/AC11 method at the HIV National Reference Laboratory. Surveillance drug resistance mutations (SDRM) were analyzed using the Calibrated Population Resistance v8.1, and the proportion of SDRM was evaluated after grouping sites by geographical areas.</div></div><div><h3>Results</h3><div>A total of 237 samples from different patients were analyzed, and 131 (55.3%) were successfully amplified and sequenced. Among these, 14 (10.7%) harbored SDRM with significant variability across regions. For nucleoside reverse transcriptase inhibitors (NRTI), the SDRM rate was highest in Dakar (9.1%), followed by the Southwest (5.3%) and the Southeast (4.2%). For non-NRTIs (NNRTIs), the highest rate was observed in the Southeast (20.8%), followed by Dakar (13.6%), the Midwest (8.3%), and the Southwest (3.6%). Among NRTIs, the most frequent mutation was M184V (3/6), conferring high-level resistance to lamivudine and emtricitabine, and K103N (11/12) among NNRTIs, conferring resistance to efavirenz and nevirapine. Notably, four sequences harbored SDRMs for both NRTI and NNRTI, reflecting overlapping resistance in some patients. The higher prevalence of NNRTI resistance is consistent with the lower genetic barrier of these drugs compared to NRTIs, which may facilitate the emergence of pretreatment drug resistance.</div></div><div><h3>Conclusion</h3><div>Through a quasi-national survey, an intermediate level of NNRTI resistance was observed, with regional disparities in Senegal. These findings highlight the limitations of NNRTI-based first-line regimens in Senegal and support the transition to other antiretroviral therapy regimens, such as dolutegravir-based therapy in newly infected individuals as well as in treated patients.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100741"},"PeriodicalIF":1.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221682","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":"Low prevalence of concurrent active hepatitis E and B virus infection in high-risk groups in Southwestern Cameroon","authors":"Macqueen Ngum Mbencho ,&nbsp;Eric A. Achidi ,&nbsp;Stephen Mbigha Ghogomu ,&nbsp;Thirumalaisamy P. Velavan","doi":"10.1016/j.ijregi.2025.100745","DOIUrl":"10.1016/j.ijregi.2025.100745","url":null,"abstract":"<div><h3>Objectives</h3><div>Coinfection with the hepatitis E virus (HEV) and hepatitis B virus (HBV) can have clinical implications, particularly in immunocompromised and high-risk populations. This study investigated HEV seroprevalence and viraemia among individuals with HBV exposure in the Southwest region of Cameroon.</div></div><div><h3>Methods</h3><div>We analyzed three cohorts with prior HBV exposure, defined as anti-HBc total positivity: HIV-infected individuals (n = 174), pregnant women (n = 87), and blood donors (n = 167). Participants were screened for anti-HEV immunoglobulin (Ig)G and IgM using an enzyme-linked immunosorbent assay, and HEV RNA was detected by reverse transcription-polymerase chain reaction. HBV DNA was quantified in those with hepatitis B surface antigen positivity.</div></div><div><h3>Results</h3><div>Among anti-hepatitis B core total-positive participants, anti-HEV IgG seroprevalence was 8.6% in HIV-infected individuals, 5.7% in pregnant women, and 12.0% in blood donors. Anti-HEV IgM was detected in 1.7%, 0%, and 1.2%, respectively. Also, HEV RNA was detected in two blood donors (genotype 3a) and two pregnant women (genotype 3e), but not in HIV-infected individuals. No cases of concurrent active HBV and HEV replication were observed.</div></div><div><h3>Conclusions</h3><div>Previous HEV exposure is relatively common in this region, but active HBV-HEV coinfection appears rare among HIV-infected individuals, pregnant women, and blood donors in Southwest Cameroon.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"17 ","pages":"Article 100745"},"PeriodicalIF":1.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107690","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":"2025-09-04","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}