Cross-sectional Mixed Methods Study Research Articles

Environmental and socio-economic determinants of fecal sludge emptying in Sub-Saharan Africa: A cross-sectional mixed-methods study in Abidjan, Côte d'Ivoire.

This study sought to understand the determinants of household's choices for fecal sludge (FS) emptying to help fighting against unhygienic/unsafe practices and environmental pollution. A cross-sectional mixed study used in the municipality of Yopougon (Abidjan, Côte d'Ivoire), involved surveys (559 household), and 24 semi-structured interviews. Adjusted odds ratios (aORs) from logistic regressions indicated the variables significantly associated with these practices while thematic content analysis helped assessing stakeholders' perceptions. Respondents (47.6%) reported unhygienic/unsafe emptying, mainly direct FS discharge into open drains or the immediate environment via illegal toilets/pits connections (38.1% out of 47.6%). Household heads with a high monthly income (aOR = 0.59; 95% CI 0.35-0.98; p = 0.04), house ownership (aOR = 0.27; 95% CI 0.15-0.47; p < 0.001) and distance to a water body (aOR = 0.03; 95% CI 0.009-0.12; p < 0.001) were the main explanatory variables, significantly reducing the likelihood of unsafe emptying. This likelihood increases when the household is close (≤ 100m) to gully/gutter (aOR = 1.73; 95% CI 0.99-3.03; p = 0.05). Our recommendations for improving sanitation in low-income settings include reducing environmental pollution caused by unhygienic/unsafe emptying practices requires, enhancing and enforcing current regulations and making implementing texts effective, raising public awareness focusing on the benefits associated to hygienic sanitation practices, and subsidizing sanitation interventions for the poor that includes homeowners.

Knowledge about handling hazardous materials as factors associated with adherence to healthcare waste management practices among waste handlers at government district hospitals of Madhesh province, Nepal: A quantitative-qualitative methods study.

Healthcare Waste (HCW) is a special waste produced in healthcare institutions, including hospitals. It has a high potential for infection and injuries. The issue of waste disposal is growing as the number of hospitals, clinics, and diagnostic laboratories in Nepal continues to increase. The study aimed to assess the adherence to healthcare waste management (HCWM) practices and knowledge among waste handlers at the government district hospitals of Madhesh Province of Nepal which lies in the southern part of the country. A cross-sectional mixed-method study design was employed to assess the adherence of healthcare waste management practices and knowledge of healthcare waste management guideline among HCW handlers from 10 district-level hospitals in Madhesh Province. We developed a semi-structured questionnaire from Nepal's National HCWM Guideline 2014 and the World Health Organization HCWM Rapid Assessment Tool 2011, to interview 60 HCW handlers for quantitative information. Then 10 key informant interviews were conducted using KII guidelines with related stakeholders of district hospitals of Madhesh Province. A four-point Likert scale was used to assess the practices and knowledge of HCW handlers and health facility-related factors. Descriptive data analysis was presented in tables for frequency, percentage, mean, and standard deviation, and correlation was presented in Graphs. A thematic analysis was performed for qualitative data by using RQDA and discussing the findings before concluding the study. Among the sixty participants, the median age was thirty-five years while thirty percent were less than the median age. Among total participants, the majority of female were 65% and almost all of them (96.67%) were married. The majority (65%) were females and almost all (96.67%) were married. About one-third (36.67%) of participants were illiterate. Most of the participants had experience of 5 to 10 years. The mean adherence of HCWM was 74.88±9.66 SD. Among the participants, half of them had adequate knowledge while the median knowledge of HCWM was 39 and the inter-quartile range was 5 (q3 = 41, q1 = 36). The mean of the HCWM practice was 24.18±5.96. The median of health facilities-related factors was 13 and the interquartile range was 3 (q3 = 15 and q1 = 12). The full adherence to HCWM guideline 2014 was extremely low among healthcare waste handlers. The HCWs had less adequate knowledge of HCWM and they did not practice to manage HCW adequately in district hospitals. However, the hospitals had adequately provided amenities to manage healthcare waste.

Influence of trust on the acceptance of the RTS,S malaria vaccine in the Kassena-Nankana districts of Ghana

BackgroundVaccines have increasingly become some of the most effective public health tools for promoting health and reducing the burden of infectious diseases. The availability of a malaria vaccine for routine use will be a major milestone, nonetheless, trust by the public for the vaccine could pose a major challenge for its acceptance. Documented evidence such as the boycott of the oral polio vaccine in northern Nigeria and the failure of the Ebola vaccine trial in Ghana among others highlight the impact of public trust on vaccine acceptance.MethodsThis is an explorative cross-sectional mixed-method study conducted in the Kassena Nankana districts. The study was conducted in the Kassena Nankana Districts between May and December 2020. A total of 390 structured questionnaires were administrated to mothers and caregivers of children under five years of age while 15 in-depth interviews were conducted with mothers and health workers. STATA software Version 16.0 was used to interpret the quantitative data, where bivariate and multivariate regression analysis was performed to determine the influence of trust on vaccine acceptance while QSR NVivo 12 software was used to code the qualitative data to aid the thematic analysis.ResultsThe results revealed that the level of knowledge of the RTS,S vaccine among participants was high. About 95.4% of the mothers had good knowledge of the malaria vaccine and more than half 61.2% of them got information about the vaccine from the health facility. The level of trust for the malaria vaccine was equally high with 91.4% of the mothers reporting that the vaccine treats childhood malaria. In a bivariate analysis, educational status (P = 0.013), ethnicity (P = 0.008), marital status (P = 0.041), education on the vaccine and perceived ineffectiveness P < 0.05, and trust for the malaria vaccine (P < 0.05) were found to be statistically associated with vaccine acceptance. Compared with participants who agree that vaccines are harmless to children, those who disagree were significantly less likely to accept vaccines (OR = 0.25, 95%CI [0.08, 0.83], p = 0.017). The qualitative data correspondingly revealed that mothers trusted vaccines which thus accounted for the high uptake of the malaria vaccine in the districts.ConclusionThe results of this study suggest that trust in the malaria vaccine is critical for its uptake. Therefore, efforts towards improving acceptance of the vaccine should be focused on building and sustaining trust for the vaccine among mothers and community members.

Bridging knowledge gaps: impact of remedial classes on first-year medical students in biochemistry – a cross-sectional study

BackgroundRemedial teaching is a tailored educational approach dedicated to enhancing the academic performance of students facing challenges within the curriculum. By identifying and addressing specific learning difficulties, it provides essential support and guidance to bring students closer to expected standards while preventing future setbacks. We hypothesize that underperforming medical students who receive daily, tailored remediation will demonstrate significant improvement in their formative and summative assessment scores in biochemistry.MethodsA cross-sectional mixed-method study was conducted on 56 underperforming first-year medical undergraduates to assess the effect of targeted remediation on formative and summative assessments in Biochemistry. Training sessions included various remediation techniques over six months. Post-remediation feedback was collected to gather insights into students’ attitudes, perceptions, and the effectiveness of the methods in improving their understanding of the subject. Logistic regression analysis was employed to determine the most effective remediation for student performance. Benefits and weaknesses of remedial training approaches for future application as perceived by the students were derived through deductive thematic analysis of their feedback.ResultsThe mean marks, evaluated out of a maximum of 100, showed improvement from 29.86 ± 7.71 to 71.48 ± 10.19, with statistical significance (p < 0.001). From the students’ perspective, the most effective remediation method was grade incentives in formative assessments (odds ratio 6.19). Five major themes were identified: perceived barriers prior to remediation, positive outcomes and behavioral changes observed after remediation, and strengths and areas for improvement in remediation.ConclusionsThe study concludes that identifying underperformers in the early stages of the medical curriculum and providing them with tailored remediation can enhance their performance in exams. Grade incentives in formative assessments, mind maps, quizzes, quick revisions, and assignments were beneficial remedial tools. Targeted remediation proved advantageous for students in improving their academic skills, exam preparation, time management, and attitudes towards the subject.

Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya

ABSTRACT The Kenyan government implemented a Universal Health Coverage (UHC) pilot project in four (out of 47) counties in 2019 to address supply-side gaps and remove user fees at county referral hospitals. The objective of this study was to examine the UHC pilot implementation experience using a mixed-methods cross-sectional study in the four UHC pilot counties (Isiolo, Kisumu, Machakos, and Nyeri). We conducted exit interviews (n = 316) with health facility clients, in-depth interviews (n = 134) with national and county-level health sector stakeholders, focus group discussions (n = 22) with community members, and document reviews. We used a thematic analysis approach to analyze the qualitative data and descriptive analysis for the quantitative data. The UHC pilot resulted in increased utilization of healthcare services due to removal of user fees at the point of care and increased availability of essential health commodities. Design and implementation challenges included: a lack of clarity about the relationship between the UHC pilot and existing health financing arrangements, a poorly defined benefit package, funding flow challenges, limited healthcare provider autonomy, and inadequate health facility infrastructure. There were also persistent challenges with the procurement and supply of healthcare commodities and with accountability mechanisms between the Ministry of Health and county health departments. The study underscores the need for whole-system approaches to healthcare reform in order to ensure that the capacity to implement reforms is strengthened, and to align new reforms with existing system features.

Socioecological drivers of burnout - a mixed methods study of military health providers.

Health provider burnout is highly prevalent (28-51%) in the US and may contribute to a projected national health provider shortage by 2030. The Socioecological Model (SEM) is a proven conceptual framework used to identify influencing factors and design relevant solutions to improve health outcomes across multiple ecological levels. This study applied the SEM to identify modifiable drivers and solutions of burnout across multiple levels among US Military health providers. We conducted a cross-sectional mixed methods study using an online survey (N = 129) and in-depth interviews (N = 25) of active duty military health providers. Our primary quantitative outcome was self-reported definite, unrelenting, or complete burnout. Our quantitative analysis included chi-square tests of association and bootstrapped multivariable logistic regressions to explore SEM-informed correlates of burnout, controlling for contextual variables. Our qualitative data explored providers individual experience with workplace stress and burnout, providing details on factors influencing burnout at the individual, interpersonal, organizational and military levels. The qualitative data was systematically coded and analyzed using grounded theory. About two-thirds (63%) of surveyed providers self-reported burnout. Individual-level factors significantly associated with burnout included a positive coping style (AOR = 0.21; 95% CI: 0.08-0.56), perceived control over workload (AOR = 0.17; 95% CI: 0.04-0.66), and satisfaction with the current job (AOR = 0.11; 95% CI: 0.03-0.39). At the organizational level, providers described as overworked (AOR = 10.58; 95% CI: 3.30-33.91) or in hectic or chaotic primary work areas (AOR = 7.54; 95% CI: 2.33-24.38) had higher rates of burnout. At the military level, providers who were happy with their career path and promotion plan (AOR = 0.16; 95% CI: 0.06-0.44) reported lower rates of burnout. The organizational level had the highest cumulative impact of modifiable factors on burnout (AOR: 0.15; 95% CI: 0.06, 0.36). Qualitative interviews corroborated survey findings and highlighted the individual level manifestations of burnout, the role of interpersonal support as mitigators of burnout and the complexity of governmental and military policies impacting provider wellness. Identified factors influencing burnout at various levels may inform potential data-driven interventions to ensure a functional and vibrant US Military health. Data-driven strategies may include opportunities to balance work demands with resources and ability to cope as well as improve positive coping skills, attitudes and experiences related to work.

Opportunities to optimize patient experience in the in vitro fertilization (IVF) clinic and the role of genetic counselors.

To understand factors influencing patient satisfaction with genetics education and psychosocial support in an IVF clinic without a genetic counselor (GC), and how the role of a GC may fill gaps in care using a mixed-method cross-sectional study. Previous IVF patients (n = 133) completed a survey assessing satisfaction with genetics education and psychosocial support and decisional conflict about genetic testing. Kruskal-Wallis tests were used to compare satisfaction level to demographic and clinical variables. Spearman's correlation was used to analyze decisional conflict. Focus groups with 12 total participants expanded on themes identified in survey responses. Thematic analysis was performed using interpretive description. Participants reported satisfaction with their genetics education experience (78.9% somewhat or extremely satisfied). Satisfaction with genetics education was associated with satisfaction with information received about genetic testing results (H = 21.3, p < 0.01) and confidence using results in future decisions (H = 9.9, p < 0.01). Participants desired thorough pre-test and post-test counseling regarding genetic testing and directive guidance. Decision conflict about genetic testing was low (mean of 22.3, range 0-100). Satisfaction with genetics education was inversely correlated with decisional conflict (rs = - 0.42, p < 0.05). In-person GC visit scored highest among proposed education methods (mean score of 84.1). Patients felt satisfied with genetics education and psychosocial support provided by clinical providers. Gaps in care included misconceptions regarding genetic testing, a desire for more thorough counseling about genetic testing options, more directive guidance, and increased psychosocial support through external sources such as support groups.

Sexual Health Among Young Adults Treated with Chimeric Antigen Receptor T Cell Therapy: A Mixed-Methods Study.

Purpose: Chimeric antigen receptor T cell therapy (CAR-T) is a breakthrough treatment for hematological malignancies, but sexual health, crucial for quality of life among young adults (YAs) ages 18-39, remains unexplored among YA CAR-T recipients. This study explored sexual health and patient-provider sexual health communication among YAs post-CAR-T. Methods: This cross-sectional mixed-methods study recruited YAs ≤5 years post-CAR-T. Participants completed Patient-Reported Outcomes Measurement Information System measures assessing sexual health and study-specific items assessing patient-provider sexual health communication. A subset completed a semistructured interview exploring the impact of CAR-T on sexual health and patient-provider sexual health communication. Descriptive statistics compared quantitative data to evidence-based thresholds. Qualitative data were thematically analyzed. Results: Fourteen YAs participated; 11 completed interviews. Median age was 33 years (range: 22-39), 64.3% were male, 92.9% were heterosexual, and median time post-CAR-T was 22 months. Interest in sexual activity was low among females (mean [M] = 35.1, standard deviation [SD] = 10.0), and orgasm ability was low among males (M = 39.3, SD = 19.5). Females reported less interest in sexual activity than males. Most YAs had not (50.0%) or did not recall (35.7%) discussing sexual health with a provider pre-CAR-T. Most (78.6%) had not discussed sexual health with a provider post-CAR-T. Three higher level qualitative themes emerged as follows: (1) treatment negatively affected libido, sexual activity, and romantic relationships, (2) YAs face challenges communicating with health care providers about sexual health, and (3) there is limited sexual health education and support for YAs. Conclusion: Findings highlight a need for improved patient-provider communication about sexual health and educational resources for YA CAR-T recipients.

Codesign and evaluation of advanced therapeutic information resources for and with families of children with neurological conditions: a mixed methods cross-sectional study

ObjectiveParents and caregivers of children with neurological conditions express interest in new and developing treatments and trials; however, they have limited knowledge of, and access to, reliable information. This study...

How Intense and Authentic Communication in Foreign Language Classes Has a Positive Effect on Learner Emotions

This cross-sectional mixed methods study investigates how intense and authentic communication shapes learners’ enjoyment (FLE), anxiety (FLCA), and boredom (FLCB) in class. Participants were 181 beginning English foreign language learners aged 11 in three secondary schools in France. Statistical analyses revealed that pupils in classes with a special focus on intense and authentic communication experienced significantly more FLE and less FLCA and FLCB than their peers in standard classes. Structural equation modelling revealed that intense and authentic communication had the strongest (positive) effect on FLE, followed by negative effects on FLCB and FLCA. FLE was found to be negatively correlated with FLCA and FLCB, while FLCA and FLCB were positively correlated. An axiological analysis of the qualitative data showed that pupils in intense, authentic communication classes reported more FLE, less FLCB, and equal FLCA compared with peers in the standard teaching classes. Pedagogical implications are presented.

A Mixed Methods Investigation of Trends in COVID-19 Pandemic-Specific Positive Changes Across Three Academic Years Following Pandemic Onset

Abstract: This study sought to identify levels and types of positive changes experienced during the pandemic and determine whether different patterns of positive changes existed across academic years. In this repeated cross-sectional mixed methods study, different samples of undergraduate students at a large, public university were recruited in Fall 2020–Spring 2021 (N = 719), Fall 2021–Spring 2022 (N = 1,243), and Fall 2022–Spring 2023 (N = 1,102). Participants completed an online survey that included the Stress-Related Growth Scale-Short Form-Revised (SRGS-SF-R) and an open-ended question about positive change due to the pandemic. Based on SRGS-SF-R scores, 41–45% reported low growth, 11–21% moderate growth, and 3–4% high growth across samples; means were significantly higher each subsequent academic year while remaining low. Common qualitative categories across years were enhanced social relationships (32–35%), personal development (24–28%), and enhanced academics (11–16%). Quantitative and qualitative analyses resulted in 15 overarching domains of positive change, including areas of psychological (e.g., change in perspective) and non-psychological (e.g., technology) change. Most students experienced some pandemic-specific positive change in each of the three academic years following the pandemic onset. Certain types of positive change may reflect specific impacts of particular phases of the pandemic.

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Utilization of cervical cancer screening services among women aged 18 to 59 years in Laikipia East Sub-County, Kenya

INTRODUCTION Cervical cancer, a preventable disease, continues to be the leading cause of death resulting from cancers in Kenya. Despite free cervical cancer screening services in all government hospitals in Laikipia County, the screening uptake remains low at 19% compared to the WHO target of 70%. Hence, understanding the barriers and facilitators is important in informing targeted interventions. MATERIALS AND METHODS A mixed-method cross-sectional study was done in Laikipia East Sub-County, Kenya, between July and August 2022. The participants were women aged between 18 to 59 years. Data was collected on demographic factors and cervical cancer screening utilization. Also, qualitative data was collected using 5 FGDs and 6 KIIs to get more insights. Chi-square tests and odds ratios were calculated using STATA version 15 to assess associations and determine the level of significance. RESULTS Out of the 272 participants, 32.4% (n=88) had ever screened for cervical cancer. The logistic regression analysis indicates that as women age, their likelihood of undergoing screening increases, particularly for those aged 50-59, who show a tenfold higher likelihood of screening [ OR 10.40 (3.20-33.82), p-value &lt;0.001]. Conversely, unemployment is associated with a reduced likelihood of screening [OR 0.42 (0.18-0.99), p-value 0.047] while individuals earning 50-200 USD per month exhibit an increased likelihood [OR 2.25 (1.30-3.87) p-value 0.004]. However, religion, marital status, and education level factors do not show a significant association with the utilization of cervical cancer screening as indicated by p-values of 0.735, 0.069, and 0.765, respectively. CONCLUSION AND RECOMMENDATIONS Laikipia county government offers free cervical cancer screening in all government-run facilities but many, especially those aged 25-49, lack awareness. It is vital to boost awareness through community education on cervical cancer causes and prevention, emphasizing screening as preventive. Affordable treatment is also crucial for community reassurance post-diagnosis.

Perception and Effectiveness of Online Anatomy Lab Exercise on Undergraduate Students of BPKIHS During COVID-19 Pandemic

Introduction: Online mode of teaching learning activities were started for medical students of Nepal to reduce the risk of spreading virus during COVID-19 pandemic. BPKIHS started the modified online lab exercise (LABEX) for the undergraduate students after six months of pandemic. Objective: The main objective of study was to evaluate the student’s perception and effectiveness of modified online LABEX (prior content video uploading) during pandemic. Methods: The mixed method cross-sectional study design using semi-structured questionnaire was conducted. The questionnaire had sub-sections such as questions regarding students’ means of study, students’ perception on modified online lab exercise during pandemic and reflective writing. We collected the responses from 129 students after institutional ethical clearance and informed consent. Student’s paired test for analysis of effectiveness of modified online LABEX was done by using pre-test/post-test score. Thematic analysis was performed for reflective writing. A p&lt;0.05 was considered as statistically significant. Results: The mean age was calculated as 20.84 year. The modified online LABEX increase the scoring of students for three consecutive sessions with an average score of 1.71; 1.55 &amp; 1.09 respectively (p&lt;0.001). We formulated 15 codes and 3 themes from reflective writing such as strength, weakness and recommendation of modified online LABEX. We found that “Accessibility of recorded Labex” (n=54) was major strength and “less efficient of online LABEX” (n=57) was major weakness. Conclusions: Although physical form of anatomy education is best way of learning but modified online LABEX can be used as alternative during pandemic like situations in future

Complementary and Integrative Health Use in Binge Eating Disorder: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Perspectives

Complementary and Integrative Health Use in Binge Eating Disorder: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Perspectives

Vaccine decision-making among pregnant women: a protocol for a cross-sectional mixed-method study in Brazil, Ghana, Kenya and Pakistan

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited from either 2 or 3 maternity hospitals and/or clinics that represent a diverse population in terms of socio-economic and urban/rural status. Data collection includes cross-sectional surveys in pregnant women and semi-structured in-depth interviews with both pregnant and postpartum women. The instruments were designed to identify attitudinal, behavioral, and social correlates of vaccine uptake during and after pregnancy, including the decision-making process related to COVID-19 vaccines, and constructs such as risk perception, self-efficacy, vaccine intentions, and social norms. The aim is to recruit 400 participants for the survey and 50 for the interviews in each country. Qualitative data will be analyzed using a grounded theory approach. Quantitative data will be analyzed using descriptive statistics, latent variable analysis, and prediction modelling. Both the quantitative and qualitative data will be used to explore differences in attitudes and behaviors around maternal immunization across pregnancy trimesters and the postpartum period among and within countries. Each country has planned dissemination activities to share the study findings with relevant stakeholders in the communities from which the data is collected and to conduct country-specific secondary analyses.

Amphimeriasis in Ecuador-Prevalence, Knowledge, and Socio-Cultural Practices Among Indigenous Chachi and Montubios Populations: A Mixed-Methods Cross-Sectional Study.

Amphimerus, a liver fluke, is the causative agent of amphimeriasis, a foodborne disease acquired thought the consumption of infected raw or undercooked river fish-a practice embedded in traditional culinary customs. Amphimeriasis represents a significant public health issue and has been endemic in Ecuador since 2011, particularly among the Chachi Amerindians and Montubios populations residing in tropical ecoregions. By employing a mixed-methods research design, we conducted a community-based, cross-sectional study. A survey comprising of 63 questions on KAP was administrated in person to community members, health personnel, and academic staff in the two populations. Additionally, 67 semi-structured interviews were performed. Microscopy was achieved on 273 human and 80 dog fecal samples to detect Amphimerus eggs. A total of 86 questionnaires (54 Chachi) and 67 interviews (44 Chachi), out of 300 residents, were completed. Among the respondents, 31.4% were aware of Amphimerus, locally referred to as "liver worm". Although 79.1% reported not consuming raw fish, most admitted eating raw fish with lime juice and salt, a preparation known as "curtido", and 59.3% reported consuming smoked fish. Here, 86.1% of participants considered "liver worm" a serious disease, and 55.8% recognized raw or marinated fish as a potential transmission route. The Chachi showed a preference for smoked fish, whereas the Montubios favoured "curtido". The prevalence of Amphimerus infection was 23% in humans and 16.2% in dogs. Differences in KAP were observed between infected and non-infected individuals. Local health and academic personnel demonstrated insufficient knowledge about amphimeriasis. Some religious individuals refrained from participating, stating that they were "with God". Despite the high prevalence of Amphimerus infection in both humans and dogs, knowledge about the parasite, the disease, and its transmission routes remains limited. Health education initiatives should be designed to modify the population's KAP. It is crucial for national and local health authorities, as well as religious leaders, to be informed and actively involved in the prevention and control of amphimeriasis.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

A mixed-method exploration of #vapingcessation videos on TikTok.

E-cigarette use has risen rapidly, especially among young people. TikTok is one of the most commonly used social media platforms among young people. The representation of vaping cessation messages in TikTok content remains unexplored. We aimed to address this gap by analyzing the vaping cessation content prevalent on TikTok. This cross-sectional mixed methods study analyzed the top 100 TikTok videos-determined based on view-counts-related to vaping cessation. Our quantitative analysis examined video characteristics, while our qualitative analysis identified key thematic representations. The final sample included 87 videos, with a combined total of over 100 billion views. Most videos were created by regular users (general TikTok content creators) rather than those identifying as health experts or professionals such as doctors, acupuncturists or dental hygienists. Very few posts mentioned evidence-based cessation aids or support. Videos scored high on understandability but low on actionability based on standardized criteria. Qualitative analysis identified nine key themes: motivations for quitting, barriers to quitting, use of aids and strategies, relapse experiences, identity and self-image, celebrating cessation success, emotional journey of quitting vaping, seeking social support, and limited mentions of healthcare providers. TikTok appears to be a useful influential forum for studying quitting behavior through the sharing of personal experiences and perspectives on vaping cessation. Opportunities exist to integrate evidence-based messaging and support into this platform. Findings can inform social media interventions designed to counter pro-vaping content and promote quitting e-cigarette use. Partnerships among health professionals, public health experts, and social media influencers may be leveraged to disseminate proven vaping cessation techniques on leading social media platforms such as TikTok.

Dental education amid armed conflict in Sudan: Unveiling the impact on training.

The ongoing conflict in Sudan has severely disrupted the health professions education, notably in dentistry. This study aims to explore the impact of the armed conflict on dental education and training. A mixed-method cross-sectional study encompassed 29 dental schools in Khartoum, Darfur, Kordofan States, and Merowe City. Five key informants from the Sudanese Medical Specialization Board, the Human Resource Development Administration, and a university offering clinical dental master's programs were interviewed. Quantitative data on attacks against dental schools were collected through a structured Google form, and qualitative data on postgraduate training were obtained through semi-structured key informant interviews. Findings reveal that 79.3% of dental schools faced military assaults, with 73.9% experiencing looting and 60.9% repurposed as military bases. Notably, 44.8% of schools shifted to online education,3.4% collaborated with other universities, and 27.6% adopted a combined approach. Key informants' interviews unveiled disruptions in specialty training and housemanship, limiting access to crucial training facilities. The primary proposed solution was overseas training. Recurrently emphasized strategies to enhance the resilience of the training system included establishing dental centers in all states, collaborating with external training bodies, and anticipating and preparing for potential disasters. The adverse effects of the conflict on both undergraduate and postgraduate dental education are discernible, manifested through resource limitations, a shortage of dental materials and supplies within training facilities, and direct disruptions to clinical training due to attacks on healthcare institutions. The imperative need for urgent interventions is underscored to alleviate these consequences and safeguard the continuity of educational and training efforts.