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Factors associated with the uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: The experiences of postpartum women attending child welfare clinics in three rural districts in the Western Region of Ghana.

Background Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is a key preventive strategy. However, optimal uptake remains inconsistent despite high antenatal care (ANC) attendance. This study assessed factors associated with IPTp-SP uptake and explored the experiences of postpartum women in rural Ghana. Methods A mixed-method study was conducted among 1,155 postpartum women attending child welfare clinics in Jomoro, Prestea-Huni Valley and Ellembelle districts of the Western Region of Ghana. Quantitative data were collected using structured questionnaires and analysed using descriptive statistics and chi-square tests. Qualitative data from in-depth interviews and focus group discussions were analysed thematically to explore womens experiences and perceptions. Results Overall, 73.5% (812/1105) of respondents received at least three doses of SP during pregnancy, in line with WHO recommendations. The most common number of doses received was three doses (31.5%, 348/1105), followed by four doses (26.4%, 292/1105), while a smaller proportion (8.1%, 90/1105) received only one dose. Knowledge of malaria in pregnancy was generally high: 92.7% (1027/1155) of respondents correctly identified its mode of transmission, while 75.1% (830/1155) and 83.5% (923/1155) were aware of the effects of malaria on pregnancy and the foetus, respectively. Uptake was not significantly associated with socio-demographic characteristics, including age, education, occupation, marital status, gravidity, and parity (p > 0.05). However, number of ANC visits was significantly associated with uptake (p = 0.006). Although not statistically significant, lower uptake was observed among peri-urban residents and uninsured women. Qualitative findings indicated that while women recognized the benefits of IPTp-SP, side effects such as nausea, dizziness, and discomfort, as well as challenges with tablet formulation and dosing negatively influenced adherence. Conclusions IPTp-SP uptake was high and largely independent of socio-demographic factors but strongly influenced by ANC attendance. Addressing experiential barriers and strengthening patient-centered counselling during ANC may further improve uptake and adherence.

Reducing stillbirth in high burden settings using biomarkers and ultrasound technologies: protocol for the multi-centre prospective iTECH cohort study

Introduction Stillbirth prevention requires reliable detection of potential causes for timely interventions. Currently, there is no effective screening strategy to identify fetuses at risk of stillbirth. Prognostic models have been proposed as a potential solution, but there is a shortage of robust, clinically applicable models in low- and middle-income countries. Early birth is frequently initiated without proper risk stratification, leading to increased neonatal and infant morbidity and mortality. This study aims to develop and validate multi modal multivariable prediction models for stillbirth and pathologies that lead to stillbirth (preeclampsia & fetal growth restriction) using widely accessible and cost-effective markers. Stakeholder perspectives will also be assessed. Methods and analysis This multi-center prospective cohort study is running in four high volume regional referral hospitals in Uganda: Kawempe, Hoima, Lira, and Mbale. We will enroll at least 6,075 pregnant women attending routine antenatal care (ANC), above 13 years of age, and greater than or equal to11 weeks of gestation. Data and biological samples will be collected at 11-23 weeks, 35-37 weeks and at birth in all women. In a subset of women, additional measurements will be obtained between 24-34 weeks and 38-42 weeks to allow for spread of the data across the full spectrum of pregnancy. This data will enable us to investigate the physiological changes with gestational development in healthy or unhealthy pregnancies, to guide future monitoring and management of women and establishment of reference values for novel markers. The placenta will be collected for histopathological analysis in women diagnosed with intrauterine fetal demise at greater than or equal to 20 weeks of gestation, stillbirth nearmiss and their corresponding controls. Data on socio-demographics, obstetric history, current pregnancy conditions, and tests such as maternal hemodynamics, ultrasound, and biochemical markers will be collected from each participant, and used to develop regression and machine learning prediction models. Models will be validated and evaluated by comparing their calibration plots, precision and recall, F1 scores and accuracy, aiming for less complexity and reliable predictions. Emerging models will be translated into software as a medical device (SAMD), while taking into account user experiences, regulatory requirements, data pipelines in clinical workflows and user-friendly interfaces that facilitate access and the interpretation of outputs, to allow for seamless integration into existing electronic health information systems and decision support tools. To assess stakeholder perceptions, we will employ an exploratory qualitative component using focus group discussions, semi-structured and key informant interviews. The sample will include 81 purposively selected women and their partners who use maternity care services, local leaders and healthcare providers in and out of the four hospitals implementing iTECH in Uganda. Qualitative data will be audio recorded, transcribed verbatim and thematic analysis performed using Nvivo 12.

Clinician knowledge and self-efficacy in snakebite management: A cross-sectional assessment in Northern Uganda

Background: Snakebite envenomation (SBE) is a major public health crisis in rural Uganda, yet it remains a neglected tropical disease. Effective management is often compromised by systemic barriers and a lack of clinician training. This study assessed clinician self-efficacy and objective knowledge regarding SBE management in Northern Uganda. Methods: A descriptive, cross-sectional study was conducted between February and July 2025 among 379 healthcare workers in Gulu, Omoro, and Pader districts. A validated questionnaire was used to collect data on socio-demographics, self-reported efficacy (scale 1-10), and objective knowledge. Knowledge scores [&ge;]70% were categorized as adequate. Multivariable logistic regression identified independent predictors of adequate knowledge, and Spearmans correlation ({rho}) assessed the relationship between knowledge and self-efficacy. Results: The participants had a mean age of 35.6 years (SD {+/-}7.3), were predominantly female (56.5%, 214/379), and most (83.6%, 317/379) practiced at Health Centre III level facilities. While 53.8% (204/379) reported prior training, 48.3% (183/379) of these had not received an update in over 10 years. Adequate knowledge was demonstrated by 51.5% (195/379) of participants. In the multivariable analysis, practicing in Omoro (adjusted odds ratio [aOR]: 0.3, 95% CI: 0.1-0.6, p < 0.001) or Pader (aOR: 0.2, 95% CI: 0.1-0.4, p < 0.001) was associated with lower odds of adequate knowledge compared to Gulu district. Prior training significantly increased the odds of adequate knowledge (aOR: 2.3, 95% CI: 1.3-4.2, p = 0.006). A moderate positive correlation was observed between self-efficacy and objective knowledge (Spearmans {rho} = 0.33, p < 0.0001). Conclusion: Approximately half of the frontline healthcare workers in Northern Uganda lack adequate knowledge on SBE management, with significant geographic differences and outdated training. The gap between clinician self-efficacy and objective knowledge poses a risk to patient safety. Regular, mandatory refresher training and targeted educational outreach to remote districts are required to reduce SBE-related morbidity and mortality.