Ten-year subtype survival and systemic-therapy pathways analysis after breast-cancer recurrence in the LACRN MPBC multicountry cohort study.

The Trump administration’s 2024–2025 restrictions on National Institutes of Health (NIH) funding have triggered a global crisis in biomedical research. By curtailing foreign grants and dismantling capacity-building programs like the Fogarty International Center, these policies have stalled critical clinical trials and eroded decades of international "science diplomacy". The socio-economic fallout is particularly severe in the Global South, where U.S. aid is a cornerstone of health systems. Ultimately, these isolationist measures jeopardize the United Nations' Sustainable Development Goals (SDGs), risking the lives of millions and ceding global leadership in innovation.

Incidence and prevalence of orphanhood in Rakai, Uganda: a population-based cohort study, 1995-2022.

BackgroundNeurological disorders remain a challenge in sub-Saharan Africa, with limited expertise and credible research data to guide interventions and disease prevention. Training the next generation of clinical researchers requires a focused and concerted effort to stem the growing neurological disease burden. The US National Institute of Health (NIH) research training funded through the Fogarty International Center (FIC) Global Brain Disorders Research program gave trainees an opportunity to participate in mentored neurology research and training for 1–2.5 years. We conducted a descriptive cross-sectional study among mentees of 2 FIC research programs to assess the training experience and inform program refinement.MethodsThe data were collected via an online questionnaire created using Google Forms. All participants who had participated in the prior brain health research training programs received an online survey form. The form included a brief instruction with review guidance on the methodology to be used in training, and its objectives were provided. We used a descriptive analytical approach where we assessed the perceived interest in medical research, barriers to mentorship, satisfaction with the current mentorship and barriers to the current training program.ResultsAbout half of the trainees are male, and the majority, 62/72, reported that they had participated in research studies before enrolling for their training and few (11.1%) had a research experience of more than 3 years. Overall, 97.2% (70/72) reported that they were interested in conducting medical/neurology research as part of their career as a clinician, with 80.5% indicating that they were very interested. There were no significant differences across the several areas of interest regarding the level of satisfaction based on age groups and gender.ConclusionBarriers still exist for brain health research training in sub-Saharan Africa (SSA) and efforts to improve more protected time for research, mentorship growth and tailored research training courses are still needed to increase support for young research scientists in SSA.

We examine public funding for health research through the United States National Institutes of Health Fogarty International Center's AIDS International Training and Research Program, which sought to strengthen scientific capacity in AIDS-endemic countries by providing African researchers with training opportunities in the U.S. We use a difference-in-differences framework with information on scientists who participated in the program and the research activities of African scientists working at their home institutions in adjacent topics of neglected tropical diseases. Relative to comparable scientists, those at institutions with returning trainees subsequently publish more on HIV-related topics, receive more grant funding, engage in more clinical trials, and their work contributes to a greater number of policy documents. These patterns suggest that following the Fogarty program, research, innovation, and health policy related to the AIDS epidemic in African countries became more active.

Plasma biomarkers hold promise for improving dementia diagnosis but remain insufficiently validated in diverse populations. While AT(N) biomarkers for Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) are widely used in high‐income countries, their evaluation in Latin America (LA) is limited, despite the region's genetic, lifestyle, and diagnostic complexities. This study addresses these gaps by evaluating plasma biomarkers (Aβ40, Aβ42, Aβ42/Aβ40 ratio, p‐tau181, and NfL) in a multicountry cohort spanning five LA countries (n = 637). Aβ42/Aβ40 ratio was significantly decreased in AD and FTLD compared to cognitively normal participants, reflecting amyloid pathology. Elevated p‐tau181 levels in AD and FTLD patients indicate tau‐related changes, while higher NfL levels in FTLD compared to AD highlight its role in neurodegeneration. Ridge regression analyses identified biomarker‐specific cognitive associations: in AD, p‐tau181 and NfL correlated with memory, global cognition, and functionality impairments, whereas in FTLD, these markers primarily reflected global cognitive decline. Machine learning models trained with AT(N) biomarkers achieved high diagnostic accuracy (ROC‐AUC: AD=83%, FTLD=88%). Integrating neuroimaging further enhanced performance (AD=88%, FTLD=89%) and revealed structural and functional brain changes in temporoparietal and frontotemporal regions associated with biomarker alterations. These findings highlight the global utility of AT(N) biomarkers when integrated with clinical and neuroanatomical assessments for enhancing dementia diagnosis in diverse populations.CDA is supported by ANID/FONDECYT Regular 1210622, ANID/PIA/ANILLOS ACT210096, Alzheimer's Association (AARGD‐24‐ 1310017), ANID/FOVI240065 and ANID/Proyecto Exploracion 13240170. Data in this manuscript were collected by the MULTI‐PARTNER CONSORTIUM TO EXPAND DEMENTIA RESEARCH IN LATIN AMERICA (ReDLat), supported by NIH research grant R01 AG057234 funded by the National Institute on Aging (NIA) and the Fogarty International Center (FIC), an Alzheimer's Association grant (SG‐20‐725707‐ReDLat), the Rainwater Charitable Foundation, and the Global Brain Health Institute with additional support from the Bluefield Project to Cure Frontotemporal Dementia, an NIH Contract (75N95022C00031), and NIA under award numbers R01 AG075775, R01 AG082056, and R01 AG083799. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health, Alzheimer's Association, Rainwater Charitable Foundation, Bluefield Project to Cure Frontotemporal Dementia or Global Brain Health Institute.

Association between transitioning to a dolutegravir-based regimen and risk of incident hypertension in adults with HIV in West Africa: a multicentre target trial emulation study

SummaryBackgroundMore than 250,000 children <18 years were incarcerated globally in 2020, and 1.5 million cycle through custody annually. We reviewed studies reporting associations of vision/hearing impairment with the criminal justice encounters among young people aged 10–24 years.MethodsWe searched PubMed, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane, legal and social science data bases to identify studies that describe vision impairment/eye disease and hearing impairment/ear disease among incarcerated youth from inception to 1 June 2025. We included studies of any design assessing criminal justice system contacts among young people with such impairments. Study selection, data extraction and evaluation of bias and quality were done by two reviewers. We performed narrative summaries of prevalence due to high heterogeneity and provided a meta-analysis for odds of vision/hearing impairment among incarcerated youth compared to controls. This study is registered with PROSPERO, CRD42022319876.FindingsWe identified 94 eligible full-texts for screening among 10070 assessed. Twenty-three studies (median year of publication 1989) including 34,993 participants (mean age 15.8 years, range 10.2–20.9) were included in analyses. The reported prevalence of vision impairment among incarcerated youth ranged from 1.35% to 66.0% (16 studies), hearing impairment from 1.36% to 50.4% (11 studies). In meta-analysis of four studies providing control samples, odds of hearing impairment were increased among incarcerated youth compared to controls (Odds Ratio [OR] 4.20, 95% CI 1.79–9.86; p < 0.001, I2 = 48.4%). Six studies on vision impairment reported a pooled OR of 1.60 (95% CI 0.95–2·70; p = 0.08, I2 = 69.9%); leave-one-out meta-analysis found removal of a single outlying study left a highly significant OR (OR 1.90, 95% CI 1.65–2.19; p < 0.001).InterpretationThe prevalence of vision and hearing impairment are higher among incarcerated youth than the general population, although highly variable. These results highlight the need for screening and treatment of vision and hearing conditions at reception into prisons and follow up on release.FundingCo-first author Mapa Prabhath Piyasena was funded by the Wellcome Trust United Kingdom (Grant No: 222490/Z/21/Z) from year May/2022 to April/2024. Co-author Thomas Hampton is supported by the Wellcome Trust United Kingdom (Grant No: 203919/Z/16/Z). Co-author Dr Rolvix Patterson is supported by the NIH NIDCD training grant R25DC020172, NIH Fogarty International Center Grant D43TW009340, and the Duke Hubert Yeargan Center for Global Health.

Background Diabetic nephropathy (DN) is a major complication of type 2 diabetes mellitus (T2DM) and a leading cause of kidney failure. Evidence on the influence of ACE I/D polymorphisms in DN risk is inconsistent across populations. Methods A systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines. Studies published between January 1990 to February 2025 were retrieved from PubMed, EMBASE and Web of Science. Eligible observational studies reported the frequency of ACE genotypes with DN in T2DM. Independent reviewers screened studies using Rayyan software, extracted data, and assessed risk of bias using the ROBINS-E tool. Reporting on the quality of studies was determined using the STREGA guidelines. Pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated using random-effects models in R version 4.4.2. Subgroup, meta-regression, and sensitivity analyses addressed heterogeneity; Egger’s test assessed publication bias. Registered in PROSPERO (CRD42024577680). Funding from Fogarty International Center of the National Institutes of Health (D43TWO11632). Results Of the 46 studies included in this review, the combined sample size was 16,322 participants. The majority of studies (29 out of 46) were conducted in Asia. Only 5 studies reported DN–related comorbidities by ACE genotypes and one assessed mortality. Twenty-five of the included 46 studies contributed data to the meta-analysis. The ACE II genotype was protective against DN; II vs. ID [OR= 0.70 (CI: 0.63–0.77)] and II vs. DD [OR= 0.68 (CI: 0.55–0.84)]; Heterogeneity was (I2 = 71.7%, τ2 = 0.1776, p &lt; 0.0001). Stronger associations were observed in studies using urinary Albumin-Creatinine-Ratio over Albumin-Excretion-Rate. Egger’s test showed no publication bias (p = 0.55). Conclusion The ACE II genotype is significantly protective against DN risk in T2DM. Standardization of urinary albumin measurement and further genotype-phenotype studies are needed to strengthen clinical utility of the ACE I/D polymorphisms.

The health research landscape in southern Africa is becoming increasingly complex as research efforts intensify to address the region's significant disease burden. The increasing volume and complexity of health research in low- and middle-income countries (LMICs) highlights the ongoing need for enhanced research ethics capacity. To supplement a review published in 2014, this paper provides an overview of research ethics capacity-building initiatives supported through substantive long-term competitive awards from the Fogarty International Center of the US National Institutes of Health between 2014 and 2024. These programs aimed to enhance the capabilities of research ethics committees (RECs) and strengthen research ethics capacity throughout Southern Africa, with broader benefits to the African continent and globally as collaborative health research increases. The programs have successfully developed and delivered comprehensive research ethics curricula tailored to research ethics concerns in the region. Trainees and graduates include clinicians, researchers, REC members, REC administrators, lawyers, and ethicists, with focused efforts to ensure gender parity. This increased representivity of scholars has improved the membership on RECs and in skilled research ethics leadership in the region. For the benefit of future planning, this paper also describes some of the many challenges faced in delivering on program goals - including COVID-19. We also describe innovative solutions developed to address these challenges and meet the needs of students, faculty and institutions, while cultivating excellence in health research ethics. The paper concludes by highlighting areas for future research, underscoring the importance of continued diverse global investment in research ethics capacity to protect research participants and maintain and improve ethical standards and practice in health research within the region and globally. This will enable the development of innovative evidence-based global health solutions based on ethical research.

Advancing doctoral and postdoctoral international bioethics training in low-and-middle income countries (LMICs) is essential to address the emerging and reemerging healthcare needs of local populations. The COVID-19 pandemic underscored the need for sustenance of global collaboration and rapid adaptability in the future to further prioritize research frameworks to benefit LMICs. Thus, the purpose of the manuscript is to share the successes, challenges, and future considerations of building bioethics research capacity in seven federally funded training programs supported by the Fogarty International Center of the National Institutes of Health D43 mechanism. We advocate for continued investment in training programs recognizing that it requires committed time and effort, specialized funding opportunities, cultural sensitivity, and interdisciplinary faculty support both domestically and internationally. This investment supports cross-disciplinary collaboration, enhances the ethical conduct of research and recognizes the importance of context-sensitive research that generates evidence-based data for global solutions.

1019-P: Artificial Intelligence (AI)-Driven HbA1c Estimation from Retinal Images and Its Correlation with Lab-Measured HbA1c

ABSTRACT.The optimal global health (GH) workforce should be racially and ethnically diverse, yet few persons from historically underrepresented minority (URM) groups in the United States participate in GH training programs. We conducted a study to explore barriers and facilitators for URM individuals to participate in the NIH Fogarty International Center’s GH Program for Fellows and Scholars (FGHFS), which offers yearlong international research training opportunities. We used an exploratory sequential mixed methods study design that used qualitative in-depth interviews (n = 18) to inform a subsequent quantitative online survey (n = 82). We assessed URM interest and engagement in GH training at three stages of FGHFS (applicants, alumni, and eligible persons who had not applied). Most participants in both phases were female, Black or African American, aged between 31 and 39 years, and had completed graduate or postgraduate training; a third or less were Hispanic. We identified four principal barriers to participation in GH training programs including lack of exposure to GH, lack of mentorship or support, challenges of global travel and work, and finances. The barriers compounded across training stages. Principal facilitators of training engagement included encouraging mentors and supportive families. Recommendations for increasing the participation of URM individuals in GH research training programs included increased financial support and exposure to GH in academic studies, as well as exposure to role models and mentors who can provide career advising in GH. Our findings suggest that early exposure, mentorship, and sufficient financial support will facilitate URMs’ entry into GH.

The heritability of salt-sensitive hypertension suggests an origin in early life. The normal response to salt stress in salt-resistant individuals is inhibition of prolyl hydroxylase domain-containing proteins 2 (PHD2), which leads to an increase in the production of hypoxia-inducible factor-1 alpha (HIF-1α) and activation of its target antihypertensive genes (nitric oxide synthase (NOS-3) and heme oxygenase-1 (HO-1)) and consequently, the prevention of hypertension. However, this adaptive mechanism is impaired in salt-sensitive hypertension. To investigate the effects of perinatal maternal high salt diet (HSD) on vascular oxygen-sensing mechanisms in weanling offspring, female Dahl salt-resistant (SR) and salt-sensitive (SS) rats were mated with corresponding SR and SS males and were placed on either 0.3% NaCl normal salt diet (NSD) or 8% NaCl HSD post-positive mating for the duration of pregnancy and lactation. Trunk blood was collected from sacrificed 4-week-old weanling offspring (100-120g) for biochemical assays of plasma direct (DB) and total bilirubin (TB), nitric oxide (NO) and Asymmetric Dimethyl Arginine (ADMA). Tissue RNA in abdominal aorta extracted with Qiagen miniprep was converted to cDNA, and NOS3 (eNOS), HMOX-1 (HO-1), HIF-1α, and EGLN1 (PHD2) gene expression were measured using real-time quantitative PCR (rt-qPCR) methods. Perinatal HSD reduced DB (1.43±0.15 vs. 0.128±0.05 mg/dL; p&lt;0.01) and TB (14.8±2.16 vs. 9.42±0.43 mg/dL; p&lt;0.01) concentrations in SR rats. However, DB was elevated in SS HSD compared to SR HSD (0.128±0.05 vs. 0.93±0.27 p&lt;0.0.01). TB concentrations were reduced in SS NSD (14.8±2.16 vs. 7.79±1.39 p&lt;0.01) and SS HSD (14.8±2.16 vs. 4.49±0.26 p&lt;0.001) when compared with SR NSD (control). NO concentration was higher in SR HSD compared with SR NSD (14.3±1.42 vs. 21.5±1.5 nmol/L; p&lt;0.05); however, NO concentration was lower in SS HSD when compared with SR HSD (21.5±1.53 vs. 14.0±0.76 p&lt;0.05). Perinatal HSD increased ADMA concentrations in both SR (359±29.8 vs. 626±47.2 µmol/L; p&lt;0.01) and SS (501±35.1 vs. 787±68.5, p&lt;0.001). Changes in gene expression are presented as fold changes compared to the control group (SR NSD). There was a decrease in vascular NOS3 gene expression in both SS NSD (1.57±0.39 vs. 0.36± 0.11, p&lt;0.01) and SS HSD (1.57±0.39 vs. 0.72± 0.11, p&lt;0.05). HOMX-1 gene expression was reduced in SS HSD (1.43±0.29 vs. 0.04±0.02, p&lt;0.01). The HIF-1α gene expression in SR HSD was higher (2.11±0.16 vs. 5.12±0.85, p&lt;0.001). However, there was a decrease in expression of vascular HIF-1α gene in SS NSD (2.11±0.16 vs. 0.25±0.13, p&lt;0.01) and SS HSD (2.11±0.16 vs. 0.014+0.009, p&lt;0.001). Likewise, expression of the ENGL1 gene in SS NSD (6.89±0.96vs.1.33±0.62 p&lt;0.001) and SS HSD (6.89±0.96 vs. 0.02±0.003, p&lt;0.0001) were reduced. Findings of this study reveal that perinatal maternal HSD diet dysregulates vascular oxygen-sensing mechanisms in offspring revealing that this mechanism is involved in the fetal programming of salt-sensitive hypertension. This study is supported by the Fogarty International Center of the National Institutes of Health under Award Number K43TW011009. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Several Asian countries, including India, Malaysia, Myanmar, and Pakistan, face challenges aligning rapid healthcare and biomedical research growth with necessary ethics oversight. To help address this, the Fogarty International Center of the United States National Institutes of Health funded initiatives to enhance research ethics capacities in these countries. In India, the Yenepoya University's Master's in Research Ethics program was established in collaboration with Monash University. In Malaysia, the Master of Health Research Ethics (MOHRE) program, based at Universiti Malaya, was developed in collaboration with the Johns Hopkins University. In Myanmar, a Diploma in Research Methodology and Research Ethics (DipRMRE) was introduced in cooperation with the University of Maryland Baltimore. In Pakistan, a Master of Bioethics (MBE) program was designed to address the country's unique ethical challenges in healthcare and research. Graduates from these programs have significantly contributed to health research and policy, enhancing research ethics infrastructure across these diverse Asian countries.

The Middle East Research Ethics Training Initiative (MERETI), established in 2004 with funding from the Fogarty International Center at the NIH, aimed to enhance research ethics capacity in the Middle East North Africa (MENA) region. Initially focused on Egypt, MERETI expanded to other Arab countries, providing advanced training in international research ethics to over 100 individuals. The program emphasized additional skills in research methodology, pedagogy, scientific writing, and leadership. MERETI's training evolved from a one-year program to a two-year model incorporating sequential hybrid/blended and asynchronous online components and, eventually, included a fully online 12-credit graduate certificate in research ethics. The program's impact is demonstrated through the professional achievements of its trainees, which included publishing in peer-reviewed journals, assuming key roles in national research ethics committees and ministries of health and contributing to the development of ethics research practices in their respective countries. MERETI also fostered a sustainable Egyptian network of research ethics committees.

Cystic echinococcosis (CE) is a widespread neglected zoonotic disease caused by Echinococcus granulosus sensu lato (EG) with a global burden of control in the billions of dollars. E. granulosus' life cycle involves definitive, intermediate, and humans as dead-end hosts. Echinococcosis control programs use strategies that focus on any of these hosts. We aimed to provide a comprehensive and up-to-date overview of the EG control interventions worldwide. We conducted a scoping review by mapping all studies on interventions for EG control following the Arksey and O'Malley Framework. We screened identified articles, and charted and coded selected papers. We classified the data based on target host, type of study, and control mechanism. We described the efficacy or safety outcomes, and the associated barriers/facilitators for the intervention. Critical appraisal was conducted. From 7,853 screened studies, we analyzed 45: seven centered on human interventions, 21 on animals, and 17 on both. Studies on humans focused on educational strategies and human CE monitoring. The studies on animals were field trials and most were based on Praziquantel (PZQ) for dogs. Studies focused on both animals and humans had, in general, more participants, lasted longer, and covered larger geographical areas. Overall, the quality of studies was moderate to low. Available evidence suggests that long-term interventions aimed at both animals and humans can achieve significant reduction in EG transmission, particularly when PZQ treatment for dogs is included. Higher quality evidence, standardization of methodologies, and better reporting on post-intervention outcomes are necessary for drawing stronger conclusions. Further evidence is needed to assess the sustainability and scalability of control measures. Nonetheless, an integrative One Health approach is essential for overcoming the multiple challenges associated with sustaining long-term control efforts for Echinococcosis. RCN was supported by the National Institute of Allergy and Infectious Diseases (grant nos. K01AI139284 and R01AI168291). LOC, JAB, and RCN were supported by the Fogarty International Center (grant no. D43TW012741). TAD, CG and JAB were supported by the Fogarty International Center (grant no. D43TW001140). Cystic echinococcosis is a disease caused by the parasite Echinococcus granulosus sensu lato . This parasite can be found in specific areas on all continents, especially in poverty-stricken regions, increasing costs and losses. Some countries have achieved control, but most are still in the process. Our review provides a clear picture of what we currently know about these control strategies and points out where more research is needed. It highlights how the findings can improve control practices by showing what works best and address practical challenges. The review also identifies gaps in current knowledge and suggests that comparing different control methods could help find the most effective and cost-efficient solutions. Key areas needing attention include increasing support and funding for echinococcosis, as the disease is often overlooked. More research from different fields is needed to better understand and manage the disease's complexities. Better and ongoing surveillance is crucial for maintaining effective control strategies. Finally, comprehensive reviews that bring together findings from different studies are needed to identify what works best and improve and combine future control efforts.

Tuberculous meningitis is fatal if untreated and can lead to lifelong neurological sequelae. However, to our knowledge, there are no data on the number of children affected by this disease. We aimed to estimate the global disease burden and attributable mortality of childhood tuberculous meningitis by WHO regions, age groups, treatment status, and HIV status in 2019. We developed a Bayesian mathematical model to estimate the number of children aged 0-14 years who developed tuberculous meningitis, died from tuberculous meningitis, and did not die from tuberculous meningitis but had neurological sequelae in 2019. We reviewed the literature and used meta-analyses to quantify key parameters used as model inputs: risk of tuberculous meningitis after Mycobacterium tuberculosis infection, tuberculous meningitis as a proportion of tuberculosis notification data (ie, routine surveillance data that countries report to WHO), and risk ratios for tuberculous-meningitis mortality by age group. We identified routine tuberculosis surveillance data from countries and literature that reported the proportion of notified childhood tuberculosis that was due to tuberculous meningitis. Country-level data were from Brazil; the USA; Ukraine; South Africa; and the European Centre for Disease Prevention and Control, which included 29 countries but was aggregated and considered as one site. We assumed tuberculosis notification was synonymous with detection and treatment, combined age-disaggregated risk ratios and published meta-analytic estimates of the case-fatality rate in children who received treatment to produce estimates of tuberculous-meningitis mortality by age group and HIV status, and assumed that untreated tuberculous meningitis was always fatal. We assumed similar age-disaggregated risk ratios for neurological sequelae among children who had treatment for tuberculous meningitis and lived as for children who died. An estimated 24 000 (95% credible interval 22 300-25 700) children younger than 15 years developed tuberculous meningitis in 2019. Of these children, 13 000 (12 100-13 900) were estimated to have been diagnosed and treated for tuberculous meningitis. Most untreated children were younger than 5 years. Among the 24 000 children with tuberculous meningitis, 16 100 (14 900-17 300) were estimated to have died in 2019, of whom 1101 (6·8%) had HIV. 13 380 (83·1%) of 16 100 deaths were estimated to be in children younger than 5 years and 11 000 (68·3%) were estimated to be in children who did not receive tuberculous-meningitis treatment. Of the 7900 (5800-10 000) children who did not die, 5550 (5110-5980) were estimated to have neurological sequelae. Our estimates of tuberculous meningitis in children younger than 15 years showed substantial mortality and morbidity. Improved diagnostics and strong health-care systems to facilitate early diagnosis are crucial to improve outcomes, and tuberculosis prevention should be a public health priority. Fogarty International Center of the US National Institutes of Health.

BackgroundThe undergraduate medical training programme is demanding and rigorous. This underlines the importance of a peer mentorship strategy to improve the well-being, self-determination, school connectedness, and performance of struggling medical and nursing students. This study is aimed at identifying struggling medical and nursing students using two cumulative continuous assessment test (CAT) scores, assess their subjective vitality and school engagement and evaluate the impact of the peer mentorship intervention on them.MethodsThe study will adopt a mixed-methods approach and will be conducted in the medical colleges of Nnamdi Azikiwe University, Awka, Nigeria, and the University of Rwanda. Three instruments will be used: The subjective Vitality Scale (SVS), the University Student Engagement Inventory (USEI), and the academic records of the students before and after the commencement of the intervention programme. The consenting least-performing medical and nursing students identified by their low CAT scores (below 45%) in basic medical sciences will be selected for study in each institution. The outcome measures will include students’ CAT scores, subjective vitality, and school engagement scores. The data will be analysed both quantitatively and qualitatively. Thematic content analysis will be adopted in the analysis of the responses generated from the focus group discussion. The mean ± standard deviation or median and interquartile range statistic will be adopted for the quantitative data.DiscussionGiven the paucity of data on struggling medical and nursing students in Nigeria and Rwanda, this research was designed to help in exploring evidence-based interventions to improve and prevent poor subjective well-being of struggling students. The study is expected to fill these knowledge gaps. Trial registration: Pan African Clinical Trial registry, PACTR202405546896613, registration date: 27th May, 2024. This proposal has been supported by grant 1R25TW011217 from the US National Institutes of Health (NIH)/Fogarty International Center (FIC) which also includes co-funds from the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and the President’s Emergency Plan for AIDS Relief (PEPFAR) to the African Forum for Research and Education in Health (AFREhealth). The Grant Principal Investigators are Profs. Nelson K.Sewankambo (contact PI), Prisca Adejumo, Jean Bisimwa Nachega, Fatima Suleman.

Objectives: To investigate the association of exclusive or predominant breastfeeding (EBF or PBF) from 0 to 5 mo of age with cognitive outcomes in 9-11 yr old Ghanaian children. Methods: This is a secondary analysis using data from the 9-11 y follow-up study of the International Lipid-based Nutrient Supplement (iLiNS)-DYAD trial in Ghana that evaluated the impact of small-quantity lipid-based nutrient supplements or multiple micronutrient supplements during the first 1000 days on child growth and development. Maternal report of breastfeeding and complementary feeding practices was elicited at birth and monthly up to 6 months using food frequency questionnaires and 24-hour recalls. EBF was defined as the infant receiving no other liquids or foods other than breastmilk, with the exception of medicines and supplements; PBF allowed for water-based drinks. We created binary indicators of EBF and PBF from 0-5 mo and continuous indicators for duration of EBF and PBF, defined as the youngest age at which the infant was no longer exclusively or predominantly breastfed. When the children were 9-11 y old, cognitive tests were administered to measure general intellectual ability, literacy, arithmetic ability, declarative memory, procedural memory and executive function. We examined the association between 0-5 mo EBF/PBF or duration of EBF/PBF and cognitive outcomes using linear regression controlling for child age, sex, and outcome assessment enumerator. Results: In our study sample (n=1187), 695 (61%) had been EBF, 876 (77%) had been PBF, and 1115 (99.6%) had been breastfed for 5 mo. The median durations of EBF and PBF were 5.1 and 6.0 mo, respectively. Neither duration of EBF nor of PBF was significantly associated with age-adjusted z-scores of the 6 cognitive outcomes at 9-11 yrs. Similarly, the binary indicators for EBF/PBF 0 to 5 mo were not associated with the outcomes. Conclusions: In a population with high breastfeeding rates from 0-5 months, exclusivity and duration of breastfeeding were not associated with cognitive outcomes in 9-11 yr old Ghanaian children. Funding Sources: Bill & Melinda Gates Foundation, NICHD, and Fogarty International Center.