BackgroundPost-conflict health systems experienced surveillance and delivery challenges that hindered tuberculosis (TB) and TB-human immunodeficiency virus (HIV) control. Recent evidence shows that fragile and conflict-affected health systems still lack integrated TB-HIV services, routine testing, and reliable data, delaying lower incidence rates even as case detection rises.AimThis study examined TB and TB-HIV dynamics in Liberia and Sierra Leone to identify practice-oriented lessons for integrated surveillance and system resilience.SettingStudy was conducted on data from Liberia and Sierra Leone, 2000–2022.MethodsA two-country annual panel was assembled from World Health Organisation (WHO) TB indicators, World Bank gross domestic product (GDP) and health expenditure per capita, and conflict events. Primary estimation used two-way fixed effects with Driscoll-Kraay inference, and robustness checks used linear mixed-effects and ordinary least squares (OLS) with Heteroskedasticity–consistent standard error estimator, type 3 (HC3). A 2016–2022 subset assessed TB-HIV testing coverage. Effect sizes with Driscoll-Kraay 95% confidence intervals (CIs) were emphasised.ResultsAcross specifications, higher GDP per capita was consistently associated with lower TB incidence. Tuberculosis-human immunodeficiency virus co-infection indicators showed varied associations. In 2016–2022, TB-HIV testing coverage was positively associated with TB incidence, suggesting that expanded testing may increase detection before incidence declines. Health expenditure per capita was similarly positively associated with incidence in 2016–2022, consistent with higher spending during periods of increased case detection. Results were robust across alternative estimators, and standard collinearity diagnostics did not indicate problematic multicollinearity.ConclusionIn post-conflict settings, strengthening economic capacity, integrating TB-HIV services, and improving surveillance quality were foundational for sustained TB control. Short-run increases in detected cases should be anticipated as testing expands. Programme resources, integration, and data systems were needed to convert detection gains into incidence reduction.ContributionThe study identified practice-oriented lessons for integrated surveillance and system resilience in post-conflict settings.

BackgroundDespite all the benefits of family planning (FP), African countries still have low contraceptive use and very high fertility rates.AimTo measure modern contraceptive use among young lactating mothers in the context of the free contraceptive policy in the Kaya municipality setting.SettingThis study was conducted in the Kaya municipality, in the Koulsé region, Burkina Faso.MethodsThis study is a secondary data analysis of the Kaya Demographic and Health Surveillance System data collected in the households between May 2022 and October 2022 (cross-sectional study). The dependent variable was the use of a modern contraceptive method (binary). Modified Poisson regression was used to identify associated factors.ResultsThe prevalence of modern contraceptive use among young lactating mothers was 53.9% (n = 536/995), with 41.4% using implants, followed by male condoms (38.2%), injectables (14.6%) and pills (5.4%). Modern contraceptive use was significantly higher among women who discussed FP with their spouses (adjusted prevalence ratios [aPR] = 1.4, 95% confidence interval [CI]: 1.2–1.8, p = 0.001) and among women who had ever used modern contraceptives before the last pregnancy (aPR = 1.9, 95% CI: 1.6–2.4, p < 0.001). Similarly, women in the rich quintile (aPR = 1.5, 95% CI: 1.1–2.0, p = 0.013) and the richest quintile (aPR = 1.5, 95% CI: 1.1–2.1, p = 0.014) were more likely to use modern contraceptives compared to the poorest.ConclusionThe prevalence of modern contraceptive use among young lactating mothers in Kaya is relatively high, with some modifiable factors that still explain contraceptive use.ContributionThis study documented evidence on contraceptive use among young lactating mothers under Burkina Faso’s free FP policy, highlighting equity gaps and actionable levers (communication between couples, prior exposure and men’s involvement).

BackgroundThe WHO African Region Strategic Plan for Immunisation 2021–2030 aims to eliminate measles in at least 80% of countries by 2030. What could the situation in Côte d’Ivoire be like?AimTo predict the incidence of measles by 2030.SettingCôte d’Ivoire, a country in West Africa.MethodsNational routine measles surveillance data were analysed using seasonal time series models. Stationarity was assessed using standard unit root tests, and seasonality was addressed through appropriate differentiation. Structural breaks were examined using break and stability tests, which identified a major break around 2020. An Autoregressive Integrated Moving Average (ARIMA) model incorporating an intervention variable was adjusted to account for this change. Model performance was evaluated using cross-validation and compared to a naive seasonal benchmark. Projections were generated through 2030. The annual incidence per 1 000 000 population was estimated.ResultsA significant structural break around 2020 was identified. Projections show a slight downward trend in incidence for the overall population. However, among children, an increase in incidence from 146 to 164 by 2030 was observed. During cross-validation, the ARIMA model with intervention did not outperform the naive seasonal benchmark for short-term forecasts.ConclusionBy 2030, Côte d’Ivoire will not have eliminated measles, with a high incidence among children. Sustained high vaccination coverage, strengthened surveillance, and scenario-based planning remain critical to achieving measles elimination.ContributionThe study guides decision-makers on the prospects and the necessity of adopting innovative strategies aimed at eliminating measles.

BackgroundDespite efforts to expand health insurance in low- and middle-income countries, uptake remains low. Poor quality of care, especially in public facilities, is often cited as a barrier to health insurance enrolment but limited empirical evidence exists.AimWe examine whether the quality of antenatal care (ANC) influences women’s enrolment in health insurance programmes in Namibia.SettingIn Namibia, insurance uptake is modest but growing, and health facility density and ANC quality vary regionally.MethodsWe link Namibia’s 2009 Service Provision Assessment (SPA), a census of all health facilities, with the 2013 Demographic and Health Survey (DHS). Using geospatial data, we construct a cluster-level ANC quality index covering structural readiness, process adherence and client experience. Multivariate regressions estimate the association between ANC quality and insurance uptake, adjusting for socioeconomic and demographic factors.ResultsWe find no statistically significant association between ANC quality and insurance uptake nationally. However, the relationship varies by region: in areas with low health facility density (south), higher ANC quality is marginally associated with increased insurance uptake, while no significant association is found in regions with greater facility density (north). Indicators of wealth and education consistently predict higher enrolment, regardless of ANC quality.ConclusionImproving ANC quality is essential for health outcomes but, on its own, is unlikely to drive insurance uptake nationally. Quality appears more influential in underserved regions, while socioeconomic inequalities dominate enrolment patterns.ContributionThis study expands scarce low- and middle-income countries (LMICs) evidence on quality and insurance demand, applies a novel geospatially linked ANC quality index using a facility census and highlights the need to tailor insurance expansion strategies to subnational contexts of socioeconomic inequality and service access.

Herein, we report on the first identification of a human case of Molluscum contagiosum virus (MOCV) in Senegal. In 2024, a male child living in Diamniadio, Dakar region, with no history of travel, tested positive for MOCV. The aetiology was identified using metagenomic sequencing in the framework of the ongoing preparedness activities for the 2024 mpox public health emergency of international concern (PHEIC). Given the overlapping clinical features of MOCV infection and mpox, further research on MOCV is warranted in the West African region, particularly in the current context of high mpox circulation.

BackgroundMaternal health knowledge enables pregnant women to access, understand and apply health information to support maternal and foetal well-being, while inadequate knowledge may impair caregiving and lead to adverse pregnancy outcomes.AimThis study aimed to assess maternal health knowledge and identify associated factors among pregnant women attending antenatal clinics in the Western Cape.SettingThe study was conducted in three antenatal clinics in the Western Cape, South Africa.MethodsA descriptive survey was conducted from August 2022 to November 2022 among 248 pregnant women using a researcher-administered questionnaire incorporating the validated 21-item Maternal Health Literacy Inventory in Pregnancy scale. Data were analysed using Statistical Package for Social Sciences (SPSS) version 29. Descriptive statistics and the Mann–Whitney test were employed to examine the associations between demographic characteristics and maternal health knowledge.ResultsRespondents demonstrated low to moderate maternal health knowledge (mean = 58.50/100, standard deviation [s.d.] = 13.79, with over half (51.2%, 95% confidence interval [CI]: 45.0–57.4) classified as having problematic levels of maternal health knowledge. The highest ratings for knowledge were for foetal well-being (mean = 3.33, s.d. = 0.65) and lowest for postnatal care (mean = 3.26, s.d. = 1.17). Higher knowledge score was significantly associated with secondary or higher education (χ2 = 3.570, p < 0.001) and living with others (χ2 = 4.568, p = 0.028).ConclusionMaternal health knowledge was inadequate, highlighting the need for strengthened and targeted maternal health education, especially for less-educated women and those living alone.ContributionThe study provides evidence to guide healthcare practitioners and programme planners in improving maternal health education in antenatal clinics in the Western Cape.

BackgroundIn April 2001, African Union (AU) Heads of State adopted the Abuja Declaration, pledging to allocate at least 15% of government expenditure to health. More than two decades later, many African health systems remain underfunded, with external aid increasingly unsustainable as official development assistance declines.AimThis article examines progress towards the Abuja target, the role of political economy in shaping government health expenditure (GHE), and policy options for sustainable domestic financing.SettingThe authors examined the Global Health Expenditure across 53 AU Member States.MethodsThe authors analysed the Global Health Expenditure Database on GHE as a proportion of total government expenditure between 2000 and 2022. Additional political economy analysis explored the governance and economic correlates of GHE.ResultsMean GHE in Africa has stalled, rising only 0.5% points since 2001. In 2022, only South Africa met the 15% Abuja benchmark, with seven countries allocating 10% – 14.9% and 45 countries allocating less than 10%. Compared to slightly better off countries, low-income countries such as Rwanda and Mozambique allocated a larger proportion of their government expenditure to health, indicating the importance of political will.ConclusionProgress toward the Abuja target has been slow and uneven, highlighting the need for a multi-pronged approach to expand fiscal space for health, anchored in strong regional governance and accountability frameworks. Strengthening these foundations will be critical to building resilient health systems, reducing reliance on external aid, and accelerating progress toward universal health coverage in Africa.ContributionThis study advances existing research by demonstrating that political commitment and institutional factors, rather than gross domestic product per capita alone, are key determinants of health spending priorities, thereby challenging the prevailing assumption in the health financing literature that fiscal capacity is the primary driver of health budget prioritisation.

BackgroundComprehensive primary healthcare (PHC) can address over 80% of global health needs across a lifetime. Adopting health-seeking behaviour (HSB) within PHC frameworks is critical for achieving Universal Health Coverage (UHC) and Resilient and Sustainable Systems for Health (RSSH) by 2030.AimEvidence on the adaptation of comprehensive PHC-HSB in Tanzania remains limited. This study explored opportunities and challenges for adopting comprehensive primary healthcare-seeking behaviour (PHC-HSB) in two districts of Tanzania.SettingThis study was conducted in two district councils (DCs) in Tanzania (Iringa and Sumbawanga DCs) selected based on the population served by skilled healthcare workers (HCWs).MethodsAn exploratory qualitative case study design was employed, using in-depth interviews (IDIs) with HCWs and community health workers (CHWs). Data were analysed thematically using NVivo software.ResultsThe study found that key opportunities for adopting comprehensive HSB include the existence of exemptions and waiver, presence of special clinics, benefits of early seeking behaviour, availability of outreach services, community’s interest in health issues, presence of CHWs and health education provided at the household level.ConclusionThe challenges mentioned were frequent stockout of drugs, overburdened health facilities (HFs) because of large catchment areas, cultural and behavioural barriers to timely health-seeking, unreliable and inadequate transport systems, poor continuity of preventive health-seeking after campaigns, and low health insurance coverage.ContributionAdopting comprehensive HSB in Tanzania is feasible but requires government efforts to strengthen infrastructure, drug supply chains and community education.

Low birth weight (LBW) is a major public health concern in Lesotho, linked to higher infant mortality, long-term morbidity and intergenerational poverty. Despite expanded maternal and child health services, socio-economic disparities in birth outcomes persist. This study investigates the drivers of LBW inequality, quantifying and decomposing socio-economic and geographic disparities to inform equity-oriented health policy. The study used nationally representative data from the 2018 Lesotho Multiple Indicator Cluster Survey, covering all 10 districts. A hybrid econometric framework was applied. Low birth weight inequality was first assessed by using the Concentration Index (CI), Erreygers Index (EI) and Wagstaff Index (WI). Fairlie decomposition was then used to compare LBW probabilities between poor vs. rich and rural vs. urban households. Finally, recentred influence function regressions examined the distributional impact of maternal and household factors across the 28th, 50th and 75th birth weight percentiles. Maternal education, antenatal care (ANC) attendance, maternal disability and digital connectivity were key determinants of LBW, with effects varying across the birth weight distribution. Only 20.5% of the poor-rich LBW gap was explained by observable characteristics, primarily education and ANC. Recentred influence function regressions revealed stronger protective effects of education and ANC at lower percentiles, while maternal disability and Internet access were more relevant at higher percentiles. LBW in Lesotho reflects both structural barriers and compositional disadvantages. Addressing these requires equity-focused, distribution-sensitive maternal health interventions. This study provides evidence-based insights to inform targeted policies to reduce LBW among vulnerable populations.