Search Results (754)

Background: The 2025 EPI Managers’ Meeting for West African countries in Guinea was a critical platform for EPI managers to make an in-depth analysis of immunization programmes. We present a structured analysis of immunization status in West Africa using a WHO Health System model to move beyond descriptive reporting toward systemic analysis for actionable solutions. Methods: The meeting convened EPI managers from 14 of the 17 West African countries and partners supporting the immunization program. Country and regional presentations, immunization and surveillance data and meeting discussions were analysed through a framework identifying (1) core problems, (2) systemic barriers using WHO health systems building blocks and (3) actionable recommendations or call for action. Results: Analysis revealed stagnating immunization coverage. Recovery from COVID-19 pandemic disruptions remained limited, with persistent outbreaks of vaccine-preventable diseases (VPD). Among the five Immunization Agenda 2030 objectives assessed, only Maternal and Neonatal Tetanus (MNT) elimination was on track. Four critical challenges emerged: (1) Routine immunization stagnation with DTP3 median coverage of 76%. This was associated with challenges related to poor data quality, weak implementation of innovative vaccination strategies and donor dependency, as 88.2% of countries financed less than 50% of routine vaccine costs domestically. (2) Sub-optimal progress in Big Catch-Up (BCU) implementation in some countries, revealing poor health system resilience. (3) Inability to sustain high coverage for new vaccine introductions despite significant progress, highlighting demand and service delivery gaps. (4) Persistent VPD outbreaks with geographical expansion and the resurgence of diphtheria epidemics since 2023. Conclusions: Persistent immunization challenges in West Africa appear to reflect interconnected systemic challenges, suggesting the need for a fundamental shift toward subnational strategies, integration of immunization services within primary health care (PHC) and improved data quality. Sustainable financing of the national EPI and acceleration of local vaccine manufacturing is essential to achieve immunization sovereignty in West Africa. Country Call for Action provides strategic guidance to reverse the trend toward the Immunization Agenda 2030 targets. Full article

Background/Objectives: Hepatitis B remains a major public health concern in the Democratic Republic of the Congo (DRC). This study investigated HBV seroprevalence in Kinshasa and evaluated the diagnostic performance of rapid diagnostic tests (RDTs) compared with dried blood spot (DBS)–based immunoassays. Methods: DBS samples collected between 2016 and 2022 were transported to Spain for HBsAg and HBc-Ab testing using two chemiluminescence platforms (ECLIA-COBAS (Roche) and ELFA-miniVIDAS (bioMerieux)). A subset of participants also underwent on-site HBsAg screening using Determine™ (Abbott) RDTs. Results: Overall, active HBV infection was detected in 4.3% of participants and resolved infection in 14.3%, with no significant differences by age, sex, cohort, or HIV/HCV status. The RDT showed poor sensitivity (60% (95% CI: 26–88)) but high specificity (100% (95% CI: 98–100)), resulting in a 40% misdiagnosis rate. In contrast, DBS-based HBsAg immunoassays demonstrated excellent diagnostic accuracy, with both platforms achieving 100% sensitivity (ECLIA-COBAS 100%, 95% CI: 66–100; ELFA-miniVIDAS 100%, 95% CI: 99–100) and specificity (ECLIA-COBAS 100%, 95% CI: 98–100; ELFA-miniVIDAS 100%, 95% CI: 99–100). HBc-Ab detection showed platform-dependent variability, with lower sensitivity on ELFA-miniVIDAS (66% (95% CI: 46–82)) compared with ECLIA-COBAS (100% (95% CI: 96–100)). Predictive values were high across all assays, and inter-method agreement for HBsAg between RDT and chemiluminescence was good (Cohen’s kappa 0.71, p < 0.001). Conclusions: These findings indicate moderate HBV transmission in Kinshasa and highlight the limited reliability of RDT-based screening. DBS proved to be a practical, robust, and scalable sampling method with outstanding diagnostic performance, making it well-suited for HBV testing in low-resource settings. Full article

Integrating complementary attention mechanisms into standard Convolutional Neural Networks (CNNs) is a promising strategy for improving feature discrimination without substantial computational overhead. This paper presents a controlled empirical study of a hybrid attention module that combines Squeeze-and-Excitation Networks (SENet) and the Convolutional Block Attention Module (CBAM) through an adaptive element-wise summation with a learnable weighting parameter $\alpha$ and a residual connection. This work contributes a systematic and statistically rigorous evaluation of attention fusion across four CNN backbones (ResNet18, VGG16, AlexNet, and SqueezeNet) on the CIFAR-10 benchmark at $32\times 32$ resolution. All models were trained from scratch under a deliberately conservative protocol (50 epochs, no pretrained weights, standard augmentation) to isolate the incremental effect of attention mechanisms under controlled conditions. Under this protocol, the hybrid SENet+CBAM configuration achieves statistically significant accuracy improvements over the corresponding baselines ($p<0.001$, 5-fold cross-validation): ResNet18 improves from 77.93% to 90.71% (+12.78%), VGG16 from 55.78% to 70.17% (+14.39%), AlexNet from 62.67% to 71.82% (+9.15%), and SqueezeNet from 71.91% to 78.29% (+6.38%). These gains must be interpreted within the scope of this controlled setting. Absolute accuracy values are below fully optimized literature benchmarks. For VGG16 in particular, part of the improvement likely reflects correction of underfitting under the conservative protocol, not the full potential of the hybrid mechanism. Parameter overhead remains modest at 1.5–5.8%, and training convergence improves by 16.5% on average. The hybrid approach outperforms the best previously reported SENet+CBAM result for each architecture by an average of 2.32%. Grad-CAM visualizations and attention entropy analysis provide qualitative evidence of more concentrated spatial attention patterns under the hybrid configuration. These should be understood as proxy indicators rather than rigorous interpretability measures. Validation on higher-resolution benchmarks such as CIFAR-100, STL-10, and ImageNet subsets is a necessary next step before broader applicability can be claimed. Full article

Accurate detection and monitoring of antimicrobial resistance (AMR) in Helicobacter pylori mainly rely on phenotypic methods and culture, which can sometimes fail when bacterial load is low or after recent treatment. We investigated whether gastric biopsies classified as H. pylori-negative by standard diagnostic techniques still contain detectable bacterial DNA, including regions linked to AMR, and assessed whether selected DNA fragments can mediate allelic exchange in vitro. Gastric biopsies from 46 dyspeptic patients in the Democratic Republic of the Congo (including 23 phenotypically positive and 23 phenotypically negative individuals) were analyzed using long-read amplicon sequencing of seven resistance-associated loci, selective whole-genome amplification (sWGA) followed by long-read sequencing of H. pylori-enriched reads, and a proof-of-concept natural transformation assay. Phenotypically negative biopsies exhibited significantly lower sequencing depth across multiple loci (including 23S rRNA, gyrA, gyrB, and pbp1A; p = 0.003–0.014), indicating a reduced H. pylori DNA burden. However, AMR-associated mutations linked to various antibiotic classes were found in both groups. sWGA enabled recovery of fragmentary H. pylori sequence data from phenotypically negative samples, including reads that map to resistance- and virulence-associated genes. In vitro, 23S rRNA A2143G amplicons from both phenotypically positive and negative biopsies produced clarithromycin-resistant transformants in strain 26695. These findings indicate that phenotypically negative gastric biopsies might contain low-abundance and fragmentary H. pylori DNA. Although certain DNA fragments can mediate allelic exchange under controlled in vitro conditions, these results do not confirm bacterial viability, active infection, or clinically relevant in vivo resistance transfer. Therefore, they should be interpreted with caution in molecular AMR surveillance and detection contexts. Full article

The Aristolochia genus contains aristolochic acids (AAs), nephrotoxic and carcinogenic compounds found in many species. Although the use of Aristolochia has been restricted worldwide due to safety concerns, no information is currently available on the species occurring in the flora of the Democratic Republic of the Congo (DRC). This lack of information regarding occurrence, use, and chemical composition of Aristolochia species limits the evaluation of potential exposure risks associated with traditional medicinal practices. This study identified Aristolochia species reported in the DRC through a bibliographic survey and assessed the presence of AAs in A. heppii, a species native to Katanga. Microscopic examination of root powders and HPLC-DAD/MS analysis of hydroalcoholic and aqueous extracts were performed according to the European Pharmacopoeia on one authenticated sample and twelve commercial samples purchased in Lubumbashi. Microscopy confirmed diagnostic features consistent with Aristolochia. Mass spectrometry analysis identified AAs, with AA-I quantified in hydroalcoholic extracts at 566 ± 5 ppm to 3533 ± 32 ppm (0.057–0.353% w/w) and in the aqueous extract at 204.2 ± 0.4 ppm (0.020% w/w). These results demonstrate that traditional preparations of A. heppii may lead to exposure to AA-I and underline the need for risk assessment and regulatory oversight. Full article

Plant species can significantly influence soil micronutrients. We assessed how soil micronutrients (B, Fe, Cu, Zn, Mn) and aluminum (Al) were affected by soil depth (SD) and plant species (PS) in a secondary forest at Masako Forest Reserve. Soil samples were collected in June 2022 and June 2023 along five PS (Entandrophragma utile, Hevea brasiliensis, Milettia laurentii, Musanga cecropoides, and Triculia africana). Four trees (replications) were selected per plant species. A completely randomized design was used with five PS and three SD (0–10 cm, 10–20, and 20–30 cm) and was replicated four times. To collect soil samples, a pit was dug at each sampling location (near a tree), and three soil samples were taken horizontally in the middle of each layer on one of the four faces of the pit, with a 5 cm height and 5 cm diameter cylinder. Soil samples were air-dried, mixed, and sieved to 2 mm, and a 20 g subsample was sent to Brookside Laboratories (OH, USA) for analyses of soil micronutrients. The results showed that most micronutrients were concentrated in the topsoil (0–10 cm). Plant species such as Treculia africana, Millettia laurentii, and Musanga cecropoides enhanced micronutrients in the soil in which they grew, especially iron (Fe) and zinc (Zn). The effect of the year of sampling on micronutrients was prevalent for many micronutrients, which remained significantly higher in 2022 than in 2023. These findings provide a foundational framework for developing nature-based biofortification strategies. By prioritizing key native plant species, local stakeholders can optimize soil health in the Congo Basin. Full article

Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Acute kidney injury (AKI) is increasingly recognized as a frequent and severe complication of pediatric severe malaria, yet it remains largely underdiagnosed. This under-recognition is driven by important limitations in current diagnostic approaches. The World Health Organization (WHO) criteria rely on fixed serum creatinine (SCr) thresholds that are poorly adapted to children, whereas Kidney Disease Improving Global Outcomes (KDIGO) criteria require baseline SCr (bSCr) values that are rarely available in low-resource settings. The estimation of bSCr using back-calculation methods is further complicated by population-specific factors, particularly malnutrition, which reduces creatinine generation and may mask kidney injury. In addition, urine output (UO) monitoring is often underutilized despite its diagnostic value, and access to laboratory testing remains limited. Emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) show promise for early detection and risk stratification but remain insufficiently validated in African pediatric populations. In this narrative review, we highlight key challenges in diagnosing malaria-associated AKI (MAKI) in children and discuss potential strategies to improve early detection in resource-limited settings, with the aim of reducing morbidity and mortality. Full article

The rapid expansion of mining activities in the Katangese Copperbelt has led to the accumulation of large volumes of mine waste, which are increasingly shaping extractive landscapes. However, their spatial dynamics and morphological evolution remain insufficiently documented. This study analyses the spatio-temporal evolution of mine waste dumps in Lualaba Province (Democratic Republic of the Congo) between 2009 and 2025 to characterise their growth patterns, morphological changes, and spatial organisation. Mine waste dumps were mapped through multi-temporal interpretation of high-resolution imagery in Google Earth Pro and analysed using GIS-based spatial metrics and statistical approaches. Results reveal a strong increase in dump area from approximately 1900 ha in 2009 to more than 6400 ha in 2025. The dynamics shift from a phase dominated by the proliferation of dumps between 2015 and 2020 to one characterised by the expansion and consolidation of existing deposits after 2020. Mutshatsha territory emerges as the main hotspot of mining intensification, while Lubudi territory displays more irregular dynamics and greater morphological changes. Spatial metrics indicate a clustered distribution of dumps around active mining areas, followed by a partial spatial expansion toward new zones after 2020. Although most dumps occur relatively close to the road network, statistical analyses show that transport accessibility has only a limited influence on their size or emergence. Overall, these results highlight the importance of morpho-spatial monitoring of mine waste dumps for understanding mining landscape transformations and for supporting the spatial prioritisation of ecological remediation strategies. Full article

Background: In sub-Saharan Africa, missed opportunities for vaccination are a major obstacle to reaching the global target of vaccination coverage. The study’s aim was to identify the factors driving missed opportunities for vaccination indicators, including crude missed opportunities for vaccination, all corrected, uncorrected, and some corrected missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa. Methods: This was a multilevel mixed-effects population-based cross-sectional analysis using Demographic Health Surveys and Multiple Indicators Cluster Surveys data collected from 1 January 2019 to 31 December 2023 from twenty-one countries in sub-Saharan Africa. Both multilevel mixed-effects logistic regression and multilevel multinomial logistic regression were undertaken to assess the strengths of association between missed opportunities for vaccination indicators and covariates. Results: We included a total of 23,490 children aged 12–23 months. In multilevel fixed-effects logistic regression, our findings revealed that mothers’ education levels, listening to radio, sales ‘occupation, bicycle as mode of transportation to the nearest health facility, and health insurance were all associated with lower crude missed opportunities for vaccination. In contrast, father’s primary education and watching television were associated with increased risk of missed opportunities for vaccination. In multilevel fixed-effects multinomial logistic regression, mothers’ education levels, watching television, Muslim, and health-insured children were all associated with all corrected missed opportunities for vaccination. In the same line, mothers with primary education, watching television, private health facilities as delivery place, and health-insured children were associated with some corrected missed opportunities for vaccination. In the random-effects, the intraclass correlation coefficient showed missed opportunities for vaccination variances of 18% for crude missed opportunities for vaccination and 27% for all corrected, some corrected, and uncorrected missed opportunities for vaccination between communities in SSA. Conclusions: A variety of driving factors influence MOVs indicators in children aged 12–23 months, mainly caregivers’ education, media exposure, health insurance, occupation, religion, and mode of transportation to the nearest health facility. Effective evidence-based strategies are needed to minimize the influence of barriers on missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa. Full article

Background: Malaria remains hyperendemic in the Democratic Republic of the Congo, while arboviral infections are increasingly reported but remain under-surveilled, particularly in remote regions. Overlapping ecological niches and non-specific clinical presentations complicate case management and surveillance. Methods: A cross-sectional door-to-door survey was conducted in December 2023 in Inkanamongo village (Lokolia Health Area, Boende Health Zone, Tshuapa Province). Blood samples were collected from 379 adults; malaria infection was assessed by using HRP2-based rapid diagnostic tests, and arboviral IgG antibodies were measured on dried blood spots using Luminex^® multiplex immunoassay. Sociodemographic data were collected via standardized questionnaires. Results: Malaria prevalence was 51.7% (95%CI: 46.7–56.7). Overall arboviral seroprevalence reached 78.4% (95%CI: 73.1–81.5), dominated by O’nyong-nyong virus, 42.8% (95%CI: 37.6–47.5), Rift Valley fever virus, 32.0% (95%CI: 26.9–36.2), and chikungunya virus, 23.4% (95%CI: 19.0–27.4). Concurrent malaria infection and arboviral exposure were observed in 40.4% (95%CI: 35.6–45.4) of participants. No sociodemographic factors were significantly associated with co-exposure in the multivariable analysis. Conclusions: Substantial co-exposure of malaria and multiple arboviruses occurs in this remote Congo Basin setting. Integrated surveillance and improved diagnostics are urgently needed to guide febrile illness management and preparedness in under-resourced regions. Full article

Background: The end of the COVID-19 public health emergency of international concern (PHEIC) in May 2023 marked a transition from disruption to recovery and rebuilding of health systems. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. We conducted a critical narrative synthesis of post-PHEIC recovery and the transformation of immunization systems in the region from 2023 to 2025. Methods: We thematically analyzed publicly available data from the WHO and other sources using a systems-oriented framework covering immunization coverage, equity, vaccine introductions, disease control, governance, financing, and data systems. Results: Regional coverage for most antigens was restored to 2019 pre-pandemic levels by 2024, e.g., three doses of diphtheria-tetanus-pertussis-containing vaccines at 76%. However, progress remains insufficient to meet the Immunization Agenda 2030 (IA2030) target of 90% coverage. In addition, there were 6.7 million zero-dose children in the 2024 birth cohort (6.3% higher than the 6.3 million in 2019), concentrated in a few countries. The IA2030 target is a 50% reduction in the number of zero-dose children by 2030, compared to 2019. Recovery initiatives have restored services, while accelerated introductions (e.g., malaria vaccines introduced in 20 new countries in 2024–2025) signal renewed system momentum. Yet, progress has plateaued at pre-pandemic levels, reflecting structural constraints rather than sustained transformation. Concurrently, recurrent outbreaks of measles, yellow fever, and other vaccine-preventable diseases highlight persistent immunity gaps and surveillance limitations. Structural constraints (including financing fragility, subnational inequities, and system fragmentation) continue to limit sustained progress. Conclusion: This study offers important insights that can inform immunization policymaking in the WHO African Region and beyond. Current post-PHEIC trends reflect recovery without transformation. Achieving IA2030 targets will require a shift from broad coverage expansion to precision delivery approaches that prioritize zero-dose and underserved populations. Immunization must be positioned as a central pillar of primary health care and health security systems. Full article

Background: The Democratic Republic of the Congo accounts for approximately 12–13% of the global malaria burden. While international guidelines oppose the use of Artemisia annua infusions due to risks of sub-therapeutic dosing and resistance selection, the plant remains widely used in resource-limited regions. This study evaluates the clinical acceptability and perceptions of healthcare providers regarding the integration of Artemisia annua tea into formal malaria control in the Maniema province. Methods: A cross-sectional survey was conducted among 337 healthcare professionals in the Kalima health district using the KoboCollect digital platform. Multivariate logistic regression was employed to identify the primary socio-professional determinants of clinical acceptability. Results: The overall clinical acceptability of Artemisia annua integration was 81.0%, with 82.8% of providers perceiving the preparation as effective. Rural residency was the strongest predictor of adherence (AOR = 6.847; p = 0.003), reflecting a pragmatic response to frequent ACT stockouts and high treatment costs. Despite high acceptability, 49.0% of providers identified the lack of clinical evidence as a major barrier, and 91.4% demanded formal training on standardized dosage and biological mechanisms. Conclusions: A significant “policy–practice gap” exists between international guidelines and field realities in the DRC. Healthcare providers demonstrate high readiness for integration but emphasize the absolute necessity of galenic standardization to mitigate resistance risks. To address these concerns, a complementary genomic investigation is currently underway in the same study area, comparing PfKelch13 mutation prevalence among Artemisia tea users versus ACT-treated patients. This molecular surveillance will provide essential evidence to define safety parameters for future phytopharmaceutical integration. Full article

In recent years, unmanned aerial vehicles (UAVs) have increasingly become carrying platforms for Earth observation systems equipped with optical, microwave, and other types of sensors, primarily enabling high-resolution observations of above-ground targets. With the development of geophysical methods, bulky instruments originally designed for deep subsurface detection have been progressively miniaturized and made more lightweight, allowing their integration with civilian UAVs and opening new technological avenues for subsurface investigation. We have developed a semi-airborne transient electromagnetic system based on a UAV that is capable of simultaneously obtaining underground resistivity and polarization rate parameters. A survey was conducted over the M’sesa mining area in the Democratic Republic of the Congo. This is a mine pit that has been abandoned for over 50 years and has been flooded to form a lake, making it difficult to detect its deep mineralization potential using traditional ground-based methods. The results clearly delineate the spatial distribution of the Shangoluwe–M’sesa compressional fault and reveal a deep low-resistivity and high-chargeability zone, which provides clues for the exploration of deep deposits. This study will be of significant importance for accelerating the promotion and application of UAV-based semi-airborne electromagnetic exploration technologies. Full article

The urban trade in non-timber forest products (NTFPs) plays a key role in sustaining livelihoods in the Global South, while also suggesting potential pressure on resource supply systems. This study provides an integrated analysis of NTFP diversity, market structure, economic importance, and perceived drivers of resource decline in Kolwezi, a rapidly expanding mining city where such dynamics remain poorly documented. Data were collected through surveys conducted with 35 sellers across two major urban markets and 384 consumers from different neighbourhoods and analysed using descriptive and inferential statistics to examine patterns, associations, and socio-demographic influences. A total of 65 NTFP species were recorded, including 49 plant, 14 animal, and 2 fungal species, reflecting strong dependence on Miombo ecosystems. Medicinal (59.3%) and food uses dominate, with multifunctional species such as Bobgunnia madagascariensis (Desv.) J.H.Kirkbr. & Wiersama, Canarium schweinfurthii Engl., Terminalia mollis M.A.Lawson, Gardenia ternifolia subsp. jovis-tonantis (Welw.) Verdc., and Albizia antunesiana Harms, playing a central role in both household use and market supply. The trade is largely female-dominated (79.1%) and constitutes a major component of the informal urban economy, with monthly incomes ranging from USD 9 to 429.3, primarily driven by sales volume rather than unit price. However, the sector is constrained by structural and logistical limitations, including remoteness of supply areas, seasonality, and limited value addition. The perceived declining availability of high-use-value species, attributed by respondents to deforestation, mining expansion, and overexploitation, highlights perceived sustainability concerns. These pressures are perceived differently across socio-demographic groups, indicating heterogeneous understandings of environmental change. Overall, the results indicate a perceived mismatch between rising urban demand and declining resource availability, which may reflect an emerging socio-ecological imbalance between urban demand and perceived resource availability. Addressing these challenges requires integrated strategies that combine the domestication of priority species, the development of processing chains, improved infrastructure, and strengthened governance mechanisms. Such approaches are essential to reconcile livelihood support with the sustainable management of NTFPs in rapidly transforming urban landscapes. Full article