BackgroundLong COVID affects millions worldwide, straining health systems and workforce stability. This first nationwide survey among French civil servants combines epidemiological assessment with a Knowledge, Attitudes, and Behaviors approach. Long COVID remains a diagnostic and epidemiological challenge with evolving symptoms and uncertain categorization, particularly among self-suspected cases. Beyond prevalence and risk factors, understanding behavioral dimensions is essential to developing prevention strategies and maintaining workforce resilience.ObjectiveThis study aimed to (1) assess the prevalence of long COVID among French civil servants; (2) identify associated sociodemographic, occupational, and health-related factors; (3) assess disease-related knowledge of long COVID and (4) examine attitudes and behaviors regarding COVID-19 vaccination.MethodsThis cross-sectional survey was conducted in 2024 among active or retired civil servants in France. A Knowledge, Attitudes, and Behaviors–validated questionnaire, based on World Health Organization guidelines, was used. Responses were compared across 4 COVID-19 status groups (no COVID, COVID-19 without long COVID, diagnosed long COVID, and suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected long COVID.ResultsAmong 3962 eligible respondents, 61 (1.54%; 95% CI 1.20‐1.97) reported a formal diagnosis of long COVID and 241 (6.08%; 95% CI 5.38‐6.87) without diagnosis. Diagnosed long COVID was significantly associated with long-term sick leave (odds ratio [OR] 1.15, 95% CI 1.03‐6.28; P=.04) and long-term illness coverage (OR 0.72, 95% CI 0.27‐0.92; P=.03). Suspected long COVID was associated with being in a relationship (OR 1.65, 95% CI 1.08‐2.52; P=.02), widowed (OR 2.25, 95% CI 1.18‐4.31; P=.01), and uncertain (OR 1.90, 95% CI 1.32‐2.74; P<.001) or incomplete COVID-19 vaccination status (OR 1.67, 95% CI 1.16‐2.42; P=.01). Knowledge scores differed significantly across groups (ANOVA F3,3476=24.31, P<.001; χ²6=54.92, P<.001), with diagnosed cases showing the highest proportion of high knowledge (13/61, 21%) compared to 12.4% in the non-COVID group. Among 61 diagnosed cases, 36 (59%; 95% CI 46.4‐70.5) were vaccinated, 13 (21%; 95% CI 12.9‐33.2) intended to get vaccinated, and 12 (20%; 95% CI 11.6‐31.3) remained unvaccinated; among suspected cases, these proportions were 173 (71.8%; 95% CI 65.9‐77.1), 30 (12.4%; 95% CI 8.8‐17.3), and 38 (15.8%; 95% CI 11.6‐21.0), respectively.ConclusionsUnlike previous studies that examined the clinical or behavioral factors separately, this nationwide analysis linked epidemiological data with knowledge and vaccination behaviors. Among French civil servants, long COVID remains underdiagnosed, where absenteeism and sick leave threaten essential services. The study highlights disparities in disease-related knowledge, vaccination attitudes, and behaviors, underlining the importance of workplace health education and systematic screening. Vaccination is associated with lower odds of long COVID, reinforcing its preventive value. Thus, findings reveal organizational implications and support workplace-based prevention strategies integrating vaccination promotion, early detection, and health literacy to sustain the resilience of public services.

Abstract Background: The World Health Organization and international treatment guidelines recommend rapid initiation of antiretroviral therapy (ART) for all treatment-naive (TN) people living with human immunodeficiency virus (HIV) (PLWH). However, data on temporal trends and clinical outcomes of ART initiation and regimen selection among TN PLWH remain limited in China. This study is designed to evaluate the real-world effectiveness of contemporary treatment strategies within the Chinese context. Methods: We conducted a retrospective study of 1460 TN PLWH who initiated ART between January 2021 and December 2023 at Beijing Ditan Hospital. Data on sex, age, initiation time, ART regimens, CD4 counts, and HIV viral load were collected. Initiation time was categorized based on the time from diagnosis to ART initiation: same-day initiation (0 days), rapid initiation (1 – 7 days), regular initiation (8 – 30 days), and delayed initiation (&gt; 30 days). The main endpoint was the rate of PLWH with virological suppression (HIV-1 RNA &lt; 40 copies/mL) during the study period. Additionally, the durability of ART regimens and the CD4 T-cell count recovery were also evaluated. Factors associated with regimen durability were assessed using univariate and multivariate Cox proportional hazards models. Generalized Estimating Equations (GEE) were used to identify factors associated with virological suppression among TN PLWH. Results: From 2021 to 2023, the proportion of patients with same-day initiation and that of patients with rapid initiation significantly increased, rising from 8.4% (55/656) to 14.0% (69/493) and from 49.5% (325/656) to 57.6% (284/493), respectively ( P &lt; 0.001). Furthermore, 32.9% (46/140) and 36.3% (269/741) of PLWH who underwent same-day and rapid initiation, respectively, chose initial regimens containing two nucleoside reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor. A representative regimen was efavirenz, lamivudine, and tenofovir disoproxil fumarate (EFV+3TC+TDF). All patients achieved a viral suppression rate of over 95.0% at the 24- and 36-month follow-up visits. In TN PLWH who adhered to initial regimens, GEE analysis of virological suppression factors showed both bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) were non-inferior to EFV+3TC+TDF (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 0.75 – 2.39, P = 0.318; OR = 1.92, 95% CI: 0.54 – 6.80, P = 0.311, respectively). Moreover, BIC/FTC/TAF and DTG/3TC were associated with a lower likelihood of regimen switching, with hazard ratios of 0.35 ( P &lt; 0.001) and 0.39 ( P = 0.004). Besides, BIC/FTC/TAF achieved CD4 T cell counts above 350 cells/μL significantly earlier ( P = 0.015). Conclusion: Our findings revealed the positive trend in rapid initiation in China and several challenges in clinical practice. More targeted interventions are needed to promote the use of BIC/FTC/TAF and DTG/3TC, enhance the accessibility, and ultimately improve health outcomes for PLWH.

Mosquitoes are among the most notorious insect vectors responsible for transmitting numerous life-threatening diseases, posing serious public health challenges and hindering development in many of the world’s poorest nations. Effective vector control remains a crucial component in managing these diseases. However, the widespread emergence of insecticide resistance, along with the negative impacts of chemical insecticides on non-target organisms and the environment, underscores the urgent need for safer, eco-friendly, and sustainable mosquito control strategies. This study evaluated the larvicidal potential of Ocimum gratissimum (scent leaf) methanolic extract against Anopheles species larvae. The extract was prepared using the cold extraction method, while phytochemical screening was carried out through standard qualitative procedures. Larvicidal assays were performed following the World Health Organization (WHO) guidelines. The methanolic extract yielded 8.14% and revealed the presence of several bioactive compounds, including alkaloids, flavonoids, tannins, steroids, saponins, anthraquinones, phenolics, and glycosides. Bioassay results indicated strong larvicidal activity, with LC₅₀ and LC₉₀ values of 4.38 mg/ml and 25.40 mg/ml after 72 hours, respectively. These findings suggest that O. gratissimum possesses significant potential as a natural larvicide against Anopheles species, offering a promising alternative to synthetic insecticides. The aromatic plant extract could serve as a safe, economical, and environmentally friendly mosquito control agent.

Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality in children worldwide. Inappropriate antibiotic use by healthcare workers contributes significantly to the growing problem of antibiotic resistance. This study assessed the knowledge, attitudes, and practices (KAP) of Indonesian primary healthcare workers in diagnosing and treating paediatric CAP, alongside challenges in guideline adherence. Three studies were conducted in Indonesia. The first study reviewed medical records from Riau Islands and Central Java Provinces to assess adherence to CAP guidelines. The second evaluated KAP using pre- and post-tests, and online follow-up. The third used focus group discussions to explore the challenges in diagnosis and management. Out of 921 records, 37.6% of patients were misclassified as having CAP according to the World Health Organization (WHO) guidelines, while 53.3% were misclassified based on the Indonesian Ministry of Health guidelines. Antibiotics were prescribed in 89.3% and 87.6% of these cases. Among correctly classified cases, 73.2% were prescribed amoxicillin in line with WHO guidelines, but only 11.6% were dosed within the recommended 75-100mg/kg/day range. Furthermore, 74.6% of patients were prescribed antibiotics more frequently, and only 28.3% received the appropriate treatment duration. The training significantly improved KAP among healthcare workers. Separately, nurses and midwives showed better practical application of the guidelines compared to physicians. Qualitative analysis identified themes highlighting diagnostic accuracy, antibiotic prescribing practices, and tailored training programs. This study highlights significant inconsistencies in paediatric CAP management among healthcare providers in Indonesia and emphasises the need for targeted training to enhance guideline compliance and improve patient outcomes.

Research into the "Heavy Metal Concentration of Mini-Owhua Stream in Ibaa Community" was the driving force behind this investigation. In order to accomplish this, sterile sample bottles were used to collect water from three different stations: Station A, Mini-Owhua, Station B, Mini-Aliwechenta, and Station C, Mini-Nku stream. The samples were then sent to the Chemistry Laboratory at Rivers State University for heavy metal analysis within 24 hours of collection. The Heavy Metal Analysis was conducted using the Atomic Absorption Flame Spectrophotometer (AAFES) technique. A one-way Analysis of Variance (ANOVA) using the SPSS statistical program was applied to the acquired data. In accordance with the World Health Organization's guidelines for potable water, the results showed that heavy metals such iron, copper, lead, chromium, and cadmium were present at mean concentrations of -0.189 ppm, 0.0036 ppm, -0.006 ppm, 0.0016 ppm, and -0.0046 ppm, respectively. While station A's arsenic content was 0.011 ppm, just beyond the threshold established by the World Health Organisation and the Federal Environmental Protection Agency. The statistical analysis showed that the concentration of heavy metals in the three sample locations were not significantly different from one another. Using Mini-Owhua creek as a water supply might be risky. Hence, we are requesting an immediate public education campaign on the possible health risks of consuming untreated Mini-Owhua stream. Additionally, the Ibaa community has an immediate need for a reliable alternate water supply.

In 2022, the World Health Organization (WHO) adapted its pediatric tuberculosis disease (TBD) treatment guidelines, recommending a shortened 4-month treatment regimen for nonsevere TB, based on a single study in high TB prevalence, low-resource settings. This study investigated to what extent the recommendations apply to a high-resource setting. Retrospective cohort study of patients with TBD <16 years of age treated at the Austrian Reference Centre for Paediatric TB from 2010 to 2023. One hundred fifty-nine patients were included in the final analysis. Based on the WHO guidelines, 104 (65.4%) met the criteria for nonsevere TBD. Compared with children with severe TBD (n = 55; 34.6%), children with nonsevere TBD were significantly more commonly asymptomatic (26.0% vs. 83.6%; P ≤ 0.0001), more commonly detected by TB screening (14.6% vs. 74.0%; P ≤ 0.0001) and less commonly microbiologically-confirmed (36.5% vs. 85.5%; P ≤ 0.0001). Eight children categorized as nonsevere had evidence of severe disease on chest computed tomography; 9 had evidence of severe disease on bronchoscopy. Nineteen children in the nonsevere group had positive polymerase chain reaction results for Mycobacterium tuberculosis complex. Taking computed tomography, bronchoscopy and polymerase chain reaction results into account, 28 (26.9%) of the 104 cases initially classified as nonsevere would have to be reclassified as severe (equating to a 50.9% increase in the severe group). Consequently, only 76 (47.8%) patients would ultimately qualify as nonsevere TBD, while 83 (52.2%) had severe TBD. Our results suggest there is a substantial risk of underestimating disease severity when using the WHO criteria in isolation. Incorrect classification of disease severity may result in insufficient treatment and potentially treatment failure.

Safe medication use during pregnancy and lactation is fundamental to protecting maternal and neonatal health. However, global variability in regulatory frameworks, pharmacovigilance systems, and access to therapies presents major challenges-particularly for emerging treatments such as biologics, GLP-1 receptor agonists, and novel small molecules. This review aimed to synthesize international regulatory frameworks, evaluate safety monitoring practices, and explore disparities in access to medicines for pregnant and lactating populations. A narrative review was conducted using PubMed, Embase, Scopus, Web of Science, and regulatory agency websites (FDA, EMA, Health Canada, MHLW Japan, WHO), supplemented by pharmacovigilance databases (FAERS, VigiBase, EudraVigilance). Publications in English from 2000-2025 addressing regulatory policies, safety monitoring, or access inequalities were included. Extracted data were analyzed to identify global trends, gaps, and best practices in maternal-fetal pharmacotherapy. High-income countries demonstrate mature systems, including the FDA Pregnancy and Lactation Labeling Rule, EMA risk management plans, and comprehensive pharmacovigilance infrastructures. In contrast, low- and middle-income countries (LMICs) often face fragmented regulations, limited monitoring capacity, and restricted access to innovative therapies. Global initiatives such as the World Health Organization (WHO) guidelines, the International Council for Harmonization (ICH) E11(R1) guideline, and TransCelerate programs promote harmonization, yet substantial gaps remain. Active and passive surveillance mechanisms, pregnancy registries, and real-world data enhance safety assessment for emerging therapies, while access inequalities persist due to regulatory delays, cost, and sociocultural barriers. Despite meaningful advances in high-resource settings, LMICs continue to experience major challenges in ensuring safe and equitable access to medicines. Strengthening evidence-based, harmonized regulatory frameworks, expanding pharmacovigilance coverage, and integrating real-world evidence are essential to safeguarding maternal and neonatal health. Coordinated global collaboration is imperative to achieve equitable access to innovative therapies worldwide.

WHO guideline adherence and AWaRe antibiotic use in severe childhood pneumonia in Ethiopia: Associations with treatment outcomes.

Audit and re-audit regarding the current practice of ABCDE approach in the emergency department at selected university hospitals in Syria.

Concentrations of nitrogen dioxide (NO2) measured outdoors using satellites and ground-level stations across the United States are regularly used to estimate NO2 exposures and disease burdens. In contrast, exposures attributable to sources of NO2 indoors are neither systematically monitored nor estimated. Here, to our knowledge we produce the first nationwide, ZIP-code-level estimate of total residential NO2 exposure that integrates both outdoor sources and the primary indoor source—gas- or propane-burning stoves. To estimate exposure by ZIP code, we combine our measurements of indoor NO2 emissions and concentrations in more than 15 cities across seven regions with outdoor NO2 concentrations and comprehensive housing stock data for 133 million residential dwellings and statistical samplings of occupant behavior. We estimate average total residential long-term NO2 exposure across the United States to be ∼10 ppbv for people who own a gas stove (∼18 ppbv or more for households in the top 5% of gas burned while cooking) and ∼8 ppbv from total outdoor exposure for those with electric stoves, which cause no additional NO2 exposure. Across the United States, the NO2 exposure of ∼22 million people would fall below the World Health Organization (WHO)'s long-term exposure guideline (10 µg/m3 or 5.2 ppbv) if they reduced or stopped cooking with gas or propane. Gas and propane stoves are also responsible for virtually all (>99%) of the residential exceedances of the WHO's 1-h-averaged air quality guideline across the United States. Gas and propane stoves are a substantial source of residential NO2 exposure even when compared with all outdoor sources combined.

Background. Fine particulate matter (PM2.5) is a leading global health risk. Latin American cities exhibit some of the world's highest urban PM2.5 levels, yet studies of neighborhood-level PM2.5 exposure and associated disparities in the region are limited. Methods. We conducted a cross-sectional ecological analysis of 53 041 neighborhoods across 340 cities in eight Latin American countries, leveraging the Salud Urbana en America Latina study dataset. Annual PM2.5 concentrations were derived from satellite data and linked to socioeconomic and urban characteristics. A multilevel model analyzed associations between neighborhood PM2.5 levels and neighborhood- and city-level characteristics. Results. The median annual neighborhood PM2.5 concentration was 18.49 µg m-3. Of the 256 million residents, all lived in neighborhoods with ambient PM2.5 concentrations that exceeded the 2021 World Health Organization guidelines (5 µg m-3). Variability was greatest between cities (54.3% of total variance), but substantial within-city variation (26% of variance) was observed. Higher neighborhood PM2.5 levels were associated with higher neighborhood educational attainment (mean difference [MD] comparing top to bottom tertile = 0.17 µg m-3), higher neighborhood intersection density (MD comparing top to bottom tertile = 0.17 µg m-3), and older cities (MD comparing top to bottom tertile = 1.45 µg m-3). Lower neighborhood PM2.5 levels were related to higher neighborhood population density (MD comparing top to bottom tertile = - 0.55 µg m-3), more greenness (MD comparing top to bottom tertile = - 0.76 µg m-3), and larger distance from city centers (MD comparing top to bottom tertile = - 0.86 µg m-3). Conclusions. Neighborhoods with higher PM2.5 concentrations tended to have higher educational attainment, more intersections, and be located in older cities, while lower concentrations were associated with denser populations, more green space, and greater distance from city centers. Our findings reveal important within-city heterogeneity in PM2.5 and the factors associated with it, suggesting strategies to mitigate air pollution within cities.

What is the recommended prevention, diagnosis, and treatment of infertility among individuals and couples? The World Health Organization (WHO) made 40 recommendations and six good practice statements for the prevention, diagnosis, and treatment of infertility. The field of sexual and reproductive health care, including family planning has progressed in the last several decades. Significant progress has also been made in the field of medically assisted reproduction. Globally, one in six people experience infertility in their lifetime. However, many countries do not include the prevention, diagnosis, and treatment of infertility in health policies, financing, and services, and many do not have national clinical guidelines for the prevention, diagnosis, and treatment of infertility. The guideline was developed according to the WHO handbook for guideline development. A Guideline Development Group (GDG) was assembled and included a multidisciplinary and regionally diverse set of clinicians, policymakers, researchers, implementers, and representatives of patient groups (n=30). The GDG prioritized key recommendation questions to address in the guideline. New systematic reviews were conducted, or existing reviews updated, to inform the recommendations. The GRADE approach was used to assess the certainty of the evidence and to guide the formulation of recommendations. The GDG interpreted evidence and made judgments about the balance between benefits and harms (including patients' values) as well as costs, feasibility, acceptability, and equity. The recommendations were drafted, reviewed by an External Review Group (ERG) comprising 30 members, and approved by the WHO. The guideline makes good practice statements related to the general management of infertility (n = 6) including (i) selection of tests, (ii) listening to individuals and couples with infertility, (iii) choosing treatment decisions, (iv) clinical follow-up, and (v) documenting outcomes of treatment. In relation to prevention, it provides recommendations related to the provision of information about fertility and infertility (n = 1) and reduction of infertility risk from sexually transmitted infections (STIs; n = 1), lifestyle factors (n = 1), and tobacco use (n = 1). In terms of diagnosis, recommendations for diagnosing infertility caused by ovulatory dysfunction (n = 3), tubal disease (n = 1), or uterine cavity abnormalities (n = 5) among females are provided. For males, the guideline provides recommendations regarding when a semen test should be repeated (n = 2). Also included is a recommendation for diagnosing unexplained infertility (n = 1). Regarding treatment, the guideline provides recommendations related to the treatment of polycystic ovary syndrome (n = 6), tubal disease (n = 5), uterine septae (n = 1), varicocele (n = 4), and unexplained infertility (n = 6). Based on available evidence, the GDG did not make a recommendation for or against the use of antioxidant supplements in males. Most recommendations were conditional because relevant evidence was either absent, or of low or very low certainty. Critical research gaps were identified. The recommendations do not cover all aspects of infertility and fertility care, but subsequent editions of the guideline will expand the scope of recommendations. By centring equity, science, and the imperative to provide fertility care as part of universal health coverage, the guideline aims to support countries in delivering high-quality, equitable, and effective healthcare for all. Although the guideline is primarily intended for use by health care professionals, it is an important source for policymakers to inform national guidelines and to inform the work of professional patient support, including advocacy organizations, funding and philanthropic agencies, civil society, professional societies, and other nongovernmental organizations that provide social, financial, and technical support to reproductive health programmes. This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). Full details of declared interests of all named authors are shown in Supplementary Table S1, those for members of the GDG who are not named authors are shown in Supplementary Table S2 and those for members of the ERG are shown in Supplementary Table S3. N/A. This manuscript reports a summary of recommendations from a WHO guideline. All reasonable precautions have been taken by WHO to verify the information contained in the guideline publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.

Health-related Quality of life (HRQoL) is associated with multimorbidity, but the underlying mechanisms remain poorly understood. This study aimed to explore the association between multimorbidity and HRQoL, focusing on intrinsic capacity (IC) as a mediator. This cross-sectional study was conducted under the World Health Organization (WHO) Integrated Care for Older People (ICOPE) pilot program in Lianyungang, China, between April and July 2024. Multimorbidity was classified by clinicians' experience, Charlson Comorbidity Index, and Cumulative Illness Rating Scale for Geriatrics. HRQoL was assessed using EQ-5D-3L. IC was assessed based on the WHO's guidelines for ICOPE. Logistic regression was used to calculate the correlation between multimorbidity and HRQoL. Mediation model was further constructed to assess the mediating role of IC. This study recruited 468 adults aged ≥ 60 years (207 males [44.2%]). In logistic regression, the risk of reduced HRQoL increased by 22% per additional condition (adjusted for gender, age, IC, marital status, education, nursing home resident status). Specifically, compared to Q1 (multimorbidity number = 0), the risk of poor HRQoL increased by 148% (95% CI: 1.39-4.43, p = 0.002) in Q2 (number = 1), 172% (95% CI: 1.48-5.01, p = 0.001) in Q3 (number = 2-3), and 194% (95% CI: 1.57-5.50, p < 0.001) in Q4 (number ≥ 4), respectively. Additionally, mediation analysis showed that IC mediated 25.90% of the multimorbidity-HRQoL association (p < 0.001). Our findings suggest that multimorbidity was a risk factor for poorer HRQoL. IC was a useful indicator for identifying HRQoL and mediated the multimorbidity-HRQoL association.

Body mass index-for-age (BMI-for-age) is widely used indicator to assess the nutritional status of adolescent, however, its application in field settings can be challenging due to equipment and logistical constraints. Mid-upper arm circumference (MUAC) offers a simpler, low resource alternative, but its accuracy and validity among adolescents remain a subject of debate. This study aims to validate MUAC as a feasible alternative for assessing nutritional status in resource-limited settings like Ethiopia. Particularly, the study aimed to evaluate the screening performance of MUAC in detecting thinness compared to BMI-for-age Z-scores (BAZ) and to determine optimal MUAC cut-off points identifying undernutrition status among school students (10–19 years) in the West Hararge zone of Oromia, Ethiopia. A school based cross-sectional study was conducted involved 706 adolescents recruited from 10 schools in the West Harerghe Zone, Oromiia, Ethiopia. Participants were selected using a combination of simple random sampling at the school level and multistage sampling within schools. MUAC was measured on the left arm at the midpoint between the acromion and olecranon using a non-stretchable tape. Body mass index (BMI) was calculated from weight and height measurements taken using calibrated SECA electronic weighing scale (UNICEF) and a SECA portable stadiometer (SECA 213) respectively. All anthropometric measurements adhered to standardized World Health Organization (WHO) guidelines. The diagnostic performance of MUAC in predictor of thinness, as defined by BAZ was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) for MUAC in detecting thinness compared to against BAZ was 0.76 (95% CI: 0.69–0.85) for adolescents aged 10–14 year group and 0.83 (95% CI: 0.68–0.96) for those aged 15–19 year group. Optimal MUAC cut-offs for detecting thinness were ≤ 19.85 cm the 10–14 year group and ≤ 22.1 cm for the 15–19 year group. For detecting severe thinness, the optimal cut-offs were ≤ 19.1 cm and ≤ 21.4 cm respectively, showed high sensitivity and specificity. MUAC demonstrated moderate effectiveness in detecting thinness among adolescents when compared to BAZ, with particularly high accuracy among those aged 10–14 years and 15–19 years. These findings support the use of MUAC is a reliable and feasible screening tool for undernutrition in resource limited settings. Age-specific MUAC cut-offs should be adopted for screening thinness in adolescents, particularly where BMI measurements are impractical. Further research and integration of MUAC into routine public health nutrition programs are recommended.

Background: The World Health Organization (WHO) developed the AWaRe, which is the Access, Watch, and Reserve framework to optimize antibiotic use and promote stewardship, with a target of having at least 60% of the prescribed antibiotics come from the Access category. However, data on pediatric outpatient antibiotic prescribing in Thailand remain limited. Objective: To evaluate the frequency, patterns, and appropriateness of antibiotic prescriptions among pediatric outpatients with suspected infections, focusing on respiratory symptoms. Materials and Methods: A point-prevalence study was conducted over two years, in 2022 and 2023, in the pediatric outpatient department of King Chulalongkorn Memorial Hospital (KCMH), that included all children under 18 years of age who presented with acute infection symptoms on the survey day. Data on demographics, symptoms, and antibiotic prescriptions were collected and classified by a single investigator using the WHO AWaRe classification. The rationality of prescriptions was evaluated based on WHO guidelines. Results: Among 354 pediatric patients, 39 (11.0%) received antibiotics. Most prescriptions (77.5%) were from the Access group, primarily amoxicillin at 47.5% and amoxicillin-clavulanic acid at 20.0%, both of which were recommended first-line treatments for respiratory infections. Antibiotics from the Watch group accounted for 22.5%, while no Reserve group antibiotics were prescribed. All cases of sinusitis received antibiotic treatment, and the overall antibiotic prescribing rate for respiratory illnesses was 10.8%. Additionally, 87.5% of all prescriptions complied with WHO guidelines. Conclusion: The present study highlights a low rate of antibiotic prescriptions among pediatric outpatients, accompanied by high adherence to WHO guidelines and a predominant use of Access group antibiotics. These findings underscore the importance of maintaining rational prescribing practices.

ABSTRACT Access to safe sanitation and wastewater reuse in rural Sub-Saharan Africa remains a critical challenge, impacting both public health and socio-economic development. This study presents the implementation of a decentralized treatment system using constructed wetlands with Typha and Vetiver plants for wastewater treatment and irrigation reuse at Ndiebene Gandiol School in Senegal. The treatment system comprises a septic tank followed by two horizontal subsurface flow wetlands. Over ten months of monitoring, the system demonstrated high pollutant removal efficiency, achieving over 90% reduction in Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD5), and Suspended Solids (SS). Additionally, fecal coliform levels were reduced to below 200 CFU/100 mL, and helminth eggs were completely eliminated. The treated effluent meets World Health Organization guidelines for restricted irrigation, ensuring safe and sustainable water reuse. The project emphasizes the use of locally sourced materials and strong community engagement, promoting long-term operational sustainability in resource-limited settings. Beyond improving sanitation, it enhances school environments by creating green spaces and supporting sustainable water management practices. This initiative provides a scalable and cost-effective model for decentralized sanitation, with significant potential for replication in other rural schools across the Sahel region.

Air pollution is a major environmental health concern in Nigeria’s Niger Delta, where gas flaring and oil-related activities heighten community exposures. This study assessed both ambient air quality and the knowledge, attitudes, and practices (KAP) of residents in Ebocha and Obrikom, Rivers State. Over seven weeks during the rainy season (April–May 2025), concentrations of PM₂.₅, PM₁₀, O₃, CO, NO₂, and SO₂ were measured using portable air quality monitors and compared with World Health Organization (WHO, 2021) guidelines. Mean concentrations were PM₂.₅: 8 µg/m³, PM₁₀: 25 µg/m³, O₃: 35 µg/m³, CO: 317 µg/m³, NO₂: 30 µg/m³, and SO₂: 5 µg/m³—all well within permissible limits and lower than values commonly reported in Nigerian urban centers. Alongside monitoring, a structured KAP survey was conducted among 187 respondents (98 in Ebocha and 89 in Obrikom). Awareness of air pollution was high (84%), and all respondents acknowledged health and environmental consequences. However, only 42% considered it a serious threat, and just 58% expressed willingness to act. Gender differences were evident: women reported higher daily exposure, while men were more likely to consider relocation or activism. These findings point to a gap between awareness and effective action, shaped by socioeconomic and cultural factors. Sustained year-round monitoring and community-based interventions are needed to reduce long-term risks in the Niger Delta.

Tannery effluents contain a diverse blend of chemical, physical, and biological pollutants that threaten environmental quality and public health. This study offers a comprehensive evaluation of pollution profile and associated health risks resulting from untreated tannery wastewater discharges in Naraguta area of Jos, Nigeria. A total of 84 surface water samples were collected over a course of one year. Samples were examined for major physicochemical parameters (like pH, electrical conductivity, total suspended solids, total dissolved solids, total solids, Biochemical Oxygen Demand BOD5, and Chemical Oxygen Demand COD) according to American Public Health Association (APHA) and World Health Organization (WHO) methods. Heavy metals (iron and chromium) were also measured using atomic absorption spectrophotometry (AAS), while levels of nutrients (nitrate, sulfate, chloride, and total nitrogen) were analyzed through spectrophotometric and titrimetric methods. Microbial pathogens such as Escherichia coli and helminth eggs (Ascaris lumbricoides, Hookworm, Trichuris trichiura, and Strongyloides stercoralis) were detected through multiple-tube fermentation and parasitological concentration methods. Pollution was quantified using established indices, including Geo-Accumulation Index (I_geo), Environmental Hazard Index (EHI), and Pollution Load Index (PLI), using National Environmental Standards and Regulations Enforcement Agency (NESREA) and World Health Organization (WHO) guideline values serving as reference standards. Pollution Index (PI) values were 3-6 times over permissible levels. Contamination Index (CI) rated samples taken from stations downstream were highly polluted based on the cumulative impacts of several contaminants. Geo-Accumulation Index (I_geo), for chromium was as high as 5.06, reflecting “very strong pollution,” while I_geo, for turbidity (3.3) and colour (3.6) reflected a significant anthropogenic contribution. Health hazards were measured by the Health Risk Index (HRI) model, which included Chronic Daily Intake (CDI) and Reference Dose (RfD) models to predict ingestion-based pathways of exposure. Principal Component Analysis (PCA) revealed three principal components that accounted for 85.9% of the total variance, indicating both industrial (anthropogenic) and microbial origins of contamination. These results emphasize the pressing ecological and public health risks posed by ineffective tannery waste management. The study calls for an immediate implementation of stricter effluent discharge controls, investment in modern wastewater treatment systems, and establishment of continuous environmental monitoring programs to prevent long-term exposure and degradation.

Nail salon workers are routinely exposed to occupational hazards, including volatile organic compounds (VOCs), ultraviolet radiation, fine particulate matter (PM2.5), and heavy metals. With the industry projected to double in size over the next decade, identifying exposure risks and intervention gaps is essential for workforce protection. This systematic scoping review synthesized peer-reviewed exposure assessments, health outcome studies, and intervention research in nail salons published between 2013 and 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the National Institute of Environmental Health Sciences National Toxicology Program Handbook for Conducting Systematic Reviews. Risk of bias was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Forty-two studies met inclusion criteria: 29 exposure assessments, 11 health outcome studies, and two intervention evaluations. Most were conducted in the U.S. (88 %), with sample sizes ranging from 20 to 150 workers. Common findings included inadequate ventilation (71 %), VOC concentrations above Occupational Safety and Health Administration limits, and persistent detection of methyl methacrylate, despite its U.S. Food and Drug Administration ban. PM2.5 was evaluated in one study and exceeded World Health Organization guidelines. Heavy metals were infrequently measured, though one study raised concerns about chronic exposure. Only 17 % of studies examined exposure-health outcome associations, with limited evidence on cognitive and psychosocial impacts. Two intervention studies reported improved knowledge and reduced exposures but lacked randomized designs. This review highlights the urgent need for evidence-based interventions, stronger regulatory oversight, and comprehensive evaluation of health impacts in this socially vulnerable workforce.

This study examines the quality of drinking water in the regions of Al-Jamil, Ragdalin, and Zalten through an assessment of nitrate and manganese concentrations in both desalinated and groundwater sources. A total of ten desalinated water samples and eight well water samples were collected and analyzed. The obtained results were evaluated in comparison with the drinking water quality standards specified by both Libyan regulations and the World Health Organization (WHO). Nitrate concentrations in the desalinated water samples ranged from 23.6 to 62 mg/L. Two samples (A5 and A9), with recorded values of 62 mg/L and 55 mg/L, respectively, exceeded the permissible limits established by national and international standards. Similarly, several well water samples (B2, B4, and B5), showing concentrations of 58, 52, and 55 mg/L, surpassed the maximum allowable levels set by Libyan and WHO guidelines. Additionally, samples B3, B6, and B7 exhibited nitrate concentrations of 47, 46, and 50 mg/L, exceeding the limit according to Libyan specifications alone. Manganese concentrations in desalinated water were consistently within acceptable limits, maintaining a concentration of 0.2 mg/L. In contrast, manganese levels in well water samples varied between 0.2 and 2.78 mg/L, with samples B4 and B6 exceeding permissible thresholds, recording 1.11 mg/L and 2.78 mg/L, respectively. These findings highlight the need for continuous monitoring and potential intervention measures to ensure safe drinking water quality in the studied regions.