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Introduction: Exposure rates to Histoplasma species, the causative agent of equine epizootic lymphangitis (EL), are unknown amongst working equids in The Gambia. The primary aims of this study were to estimate anti-Histoplasma antibody seroprevalence in the equid population in rural The Gambia and to explore risk factors for seropositivity. Methods: A nationwide cross-sectional study was conducted (February-July 2022), representing baseline measurements of a longitudinal cohort study. Horses (n = 463) and donkeys (n = 92) without EL signs were recruited in 18 study sites. Following informed owner consent, equid clinical and management data were recorded. Blood samples were collected by jugular venepuncture, and sera were subject to the IMMY Latex Agglutination Histoplasma test (LAT). Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis. Study site and household variance were described using a latent-variable approach. Whole blood DNA extractions were subject to nested ITS-PCR to detect Histoplasma capsulatum var. farciminosum (HCF), and agreement with LAT results was measured using Cohen's kappa statistic. Results: Anti-Histoplasma antibody seroprevalence in horses and donkeys was 79.9% [95% confidence interval (CI) 76.0-83.5%] and 46.7% (95% CI 36.3-57.4%), respectively. In horses, two multivariable models explained the maximum amount of data variability. Model 1 demonstrated increased odds of seropositivity in mares [odds ratio (OR) = 2.90 95% CI 1.70-4.95, p < 0.001] and decreased odds in horses <2.5 years (OR = 0.46 95% CI 0.22-0.95, p = 0.04; reference: ≥4.5 years). Model 2 demonstrated increased odds in horses recruited during the rainy season (OR = 2.03 95% CI 1.08-3.84, p = 0.03) and those owned by farmers reporting previous EL in their equids (OR = 1.87 95% CI 1.04-3.37, p = 0.04). Decreased odds were measured in horses <2.5 years (OR = 0.37 95% CI 0.18-0.78, p = 0.01) and horses reported to transport firewood (OR = 0.45 95% CI 0.28-0.74, p = 0.001). On multivariable analysis of donkeys, decreased odds of seropositivity were demonstrated amongst donkeys owned by households which also owned horses (OR = 0.23 95% CI 0.06-0.85, p = 0.03). HCF infection prevalence in horses and donkeys was 22.0% (n = 102/463, 95% CI 18.3-26.1%) and 5.4% (n = 5/92, 95% CI 1.8-12.2%), respectively. No significant agreement was measured between LAT and nested ITS-PCR results (κ < 0.00). Conclusion: High Histoplasma spp. exposure was demonstrated amongst equids in The Gambia. Investigation of risk factors, including equid husbandry and management strategies, as well as geoclimatic variations, is warranted. Outcomes may inform sustainable and equitable EL control strategies in The Gambia and comparable settings worldwide. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a major cause of neonatal infections in various anatomical sites, resulting in high morbidity and mortality in The Gambia. These clinical infections are often preceded by nasal carriage of S. aureus, a known risk factor. To determine whether potential sources of newborn S. aureus infections were from carriage, and to characterize S. aureus present in different anatomical sites (blood, ear, eye, umbilical cord, skin, pus, oropharynx, breast milk and vagina), we performed whole-genome sequencing of 172 isolates from clinical sites as well as from healthy and unhealthy carriage. A random selection of mothers (n = 90) and newborns (n = 42) participating in a clinical trial and testing positive for S. aureus were considered for this study. Sequence data were analyzed to determine S. aureus multilocus sequence types and selected antimicrobial and virulence gene profiles. Our findings revealed that in The Gambia, ST15 is the dominant sequence type associated with both carriage and clinical infection. In addition, S. aureus isolates causing clinical infection among neonates were genetically similar to those colonizing their oropharynx, and the different anatomical sites were not found to be uniquely colonized by S. aureus of a single genomic profile. Furthermore, while S. aureus associated with clinical infection had similar antimicrobial resistance gene profiles to carriage isolates, only hemolysin and adhesive factor virulence genes were significantly higher among clinical isolates. In conclusion, this study confirmed S. aureus oropharyngeal colonization among neonates as a potential source of clinical infection in The Gambia. Hence, interventions aiming to reduce neonatal clinical infections in The Gambia should consider decreasing oropharyngeal S. aureus carriage. Trial registration The trial was registered at ClinicalTrials.gov NCT03199547. [ABSTRACT FROM AUTHOR]

Through qualitative analysis, the paper examined the soured relationship between Gambian chiefs and their colonial masters against the backdrop of the legal implications of the disciplinary actions the latter meted out to the former. The article commenced with the theme, before addressing the legal concept of due process, which ensures fairness in the dispensation of justice. By disregarding normal standard legal procedures, the provisions of Magna Carta, and legal precedence, the colonial administrators inflicted draconian punishments on chiefs who dared think outside the box. From archival materials, colonial correspondences, and learned journal publications, the paper advanced explanations for the highhandedness of the colonialists, which degenerated into residency restrictions imposed on the chiefs. The absence of separation of administrative powers, caused by an acute shortage of European personnel, resulted in a situation whereby colonial rule in The Gambia amounted to a situation through which rule of man took precedence over the rule of law. The compelling approach resulting from the lack of collaboration among the chiefs and the colonial administrators fomented discord. The case laws cited in the paper indicate that colonialism in The Gambia remained a case of the strong exerting control over the weak, who had no option but to put up with the inevitable consequences of colonial rule. From diverse learned sources, instances of banishments in history and how the ancient practice was applied to The Gambia received attention with the aim of elucidating how the colonial administrators adopted legal standards which compromised fair play. With primary materials derived from The Gambia National Archive, instances of chiefs who were at loggerheads with the European colonialists was addressed hence, the paper ascertained the causes and nature of the soured relationship. The findings revealed why the local administrators grappled with situations that were at variance with the normal state of affairs in England. This partly accounts for the seemingly unorthodox tactics adopted while addressing a number of issues. Consequently, the activities of overseas colonial administrators were glossed over by the colonial office and British parliament as Gambians were perceived to be a people in need of civilization. Therefore, replicating the conditions in England in a frontier territory as The Gambia would be tantamount to an exercise in futility, as they felt that they should be on higher rungs of the civilization ladder before they could comprehend European conditions. The overbearing approach of the colonialists ultimately exacerbated the lack of cooperation from the colonial subjects leading to the bone of contention. [ABSTRACT FROM AUTHOR]

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high‐income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3–5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low‐income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet‐based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend‐level association between caregiver education and CF. Patterns were similar in GM, where there was a trend‐level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low‐income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. Research Highlights: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre‐school aged children (aged 3–5 years) in two African settings (The Gambia and South Africa).On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks.There was little evidence of any association between socioeconomic variables and EFs in either site.Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend‐level significance. [ABSTRACT FROM AUTHOR]

Background and Aim: Globally, over 180,000 children develop cancers yearly, with about 80% residing in low‐ or middle‐income countries where cancer‐associated mortality is also high. In The Gambia, cumulative incidence rate of 27.6 childhood cancers/million population was reported between 2002 and 2011. The current study appraised newly‐established pediatric oncological services in The Gambia. Methods: In this prospective registry study, children with cancer who presented at the pediatric units, Edward Francis Small Teaching Hospital, Banjul, between November 2022 and October 2023 were assessed. Data on sociodemographic variables, mode of admission and presentation, tumor type, diagnostic methods, and challenges such as laboratory support, treatment, use of blood/blood products; and eventual outcome were analyzed. Results: The median (interquartile range, IQR) age at presentation of the 44 children was 36.0 (22.3–117.0) months. Wilms tumor was the most common tumor 12 (27.3%); followed by leukemia 11 (25.0%); germ cell tumor 8 (18.2%); lymphoma 6 (13.6%); retinoblastoma 4 (9.1%); rhabdomyosarcoma 2 (4.5%) and one central nervous system tumor (2.3%). The median(IQR) duration of symptoms before presentation was 48 (21–90) days, presentation to diagnosis 7.5 (3–20.8) days, and first symptom to diagnosis 62.5 (32–126.8) days. Treatment refusal and abandonment rates were 20.5% and 13.6%, respectively. Families of 93.8% of children could not procure cytotoxic drugs due to nonavailability, high cost, or both. Adequate laboratory monitoring was only available in 6.8%, and none had platelet concentrate transfusion or radiotherapy. The nine (20.5%) who completed treatment are currently being followed up, 10(22.7%) are still receiving chemotherapy, while 2(4.5%) were referred. Eight (18.2%) died, predominantly from metastasis (75%) and severe drug toxicities (25%). Conclusion: Late presentation and diagnosis, poverty, unavailability of drugs, suboptimal or lack of laboratory testing, blood product, adjuvant medications, and psychosocial supports contributed to high treatment refusal, abandonment, and mortality. These daunting challenges can be ameliorated with regular community sensitization, frequent cancer auditing, and strong political will. [ABSTRACT FROM AUTHOR]

Abstract Background Rural communities in low- and middle-income countries, such as The Gambia, often experience water insecurity periodically due to climate drivers such as heavy rainfall and reduced rainfall, as well as non-climate drivers such as infrastructural issues and seasonal workloads. When facing these challenges households use a variety of coping mechanisms that could pose a risk to health. We aimed to understand the drivers of water insecurity (climate and non-climate), the behavioural responses to water insecurity and the risks these responses pose to the health of communities in rural Gambia and map these findings onto a conceptual framework. Methods We interviewed 46 participants using multiple qualitative methods. This included in-depth interviews and transect walks. A subset of 27 participants took part in three participatory pile-sorting activities. In these activities participants were asked to rank water-related activities, intrahousehold prioritisation of water, and the coping strategies utilised when facing water insecurity. Results Multiple strategies were identified that people used to cope with water shortages, including: reductions in hygiene, changes to food consumption, and storing water for long periods. Many of these could inadvertently introduce risks for health. For example, limiting handwashing increases the risk of water-washed diseases. Deprioritising cooking foods such as millet, which is a nutrient-dense staple food, due to the high water requirements during preparation, could impact nutritional status. Additionally, storing water for long periods could erode water quality. Social factors appeared to play an important role in the prioritisation of domestic water-use when faced with water shortages. For example, face-washing was often maintained for social reasons. Health and religion were also key influencing factors. People often tried to protect children from the effects of water insecurity, particularly school-aged children, but given the communal nature of many activities this was not always possible. Many people associated water insecurity with poor health. Conclusions To reduce the risks to health, interventions need to address the drivers of water insecurity to reduce the need for these risky coping behaviours. In the short term, the promotion of behavioural adaptations that can help buffer health risks, such as water treatment, may be beneficial.

Introduction: The Gambia, West Africa, has made recent progress on infertility, a component of sexual and reproductive health that is lagging behind others. Since 2016, there is favourable policy environment stemming from infertility research and partnership building with national stakeholders and local civil society organisations focussing on infertility. Here, we report outcomes from a participatory workshop on infertility policy implementation in The Gambia and provide insights on setting national priorities for fertility care in resource-limited settings. Methods: We conducted a participatory workshop involving 29 participants from Gambia’s public and private health sectors. Using selected participatory group work tools, stakeholders identified and prioritised key activities within the framework of five pre-defined areas of action, including (i) creating guidelines/regulations; (ii) recording/reporting data; (iii) building public–private partnerships; (iv) training health providers; and (v) raising awareness and health-seeking. Results: A total of 17 prioritised activities were proposed across the five action areas, according to short-, medium-, and long-term timeframes. Three were further prioritised from the overall pool, through group consensus. A group model building activity helped to envision the complexity by elucidating links, loops, and connections between each activity and their expected outcomes. Conclusions: The participatory workshop identified actionable interventions for fertility care in The Gambia, with stakeholders setting a clear path ahead. Despite challenges, the continued engagement of Gambian policymakers, practitioners, researchers, and activists in efforts to move beyond policy creation to its implementation is essential. Improving fertility care in The Gambia and other low- and middle-income countries is feasible with effective collaboration and financial support.

Abstract Staphylococcus aureus is a major cause of neonatal infections in various anatomical sites, resulting in high morbidity and mortality in The Gambia. These clinical infections are often preceded by nasal carriage of S. aureus, a known risk factor. To determine whether potential sources of newborn S. aureus infections were from carriage, and to characterize S. aureus present in different anatomical sites (blood, ear, eye, umbilical cord, skin, pus, oropharynx, breast milk and vagina), we performed whole-genome sequencing of 172 isolates from clinical sites as well as from healthy and unhealthy carriage. A random selection of mothers (n = 90) and newborns (n = 42) participating in a clinical trial and testing positive for S. aureus were considered for this study. Sequence data were analyzed to determine S. aureus multilocus sequence types and selected antimicrobial and virulence gene profiles. Our findings revealed that in The Gambia, ST15 is the dominant sequence type associated with both carriage and clinical infection. In addition, S. aureus isolates causing clinical infection among neonates were genetically similar to those colonizing their oropharynx, and the different anatomical sites were not found to be uniquely colonized by S. aureus of a single genomic profile. Furthermore, while S. aureus associated with clinical infection had similar antimicrobial resistance gene profiles to carriage isolates, only hemolysin and adhesive factor virulence genes were significantly higher among clinical isolates. In conclusion, this study confirmed S. aureus oropharyngeal colonization among neonates as a potential source of clinical infection in The Gambia. Hence, interventions aiming to reduce neonatal clinical infections in The Gambia should consider decreasing oropharyngeal S. aureus carriage. Trial registration The trial was registered at ClinicalTrials.gov NCT03199547.

ABSTRACT Objectives Methods Results Conclusions Human childrearing is cooperative, with women often able to achieve relatively high fertility through help from many individuals. Previous work has documented tremendous socioecological variation in who supports women in childrearing, but less is known about the intracultural correlates of variation in allomaternal support. In the highly religious, high‐fertility setting of The Gambia, we studied whether religious mothers have more children and receive more support with their children.We randomly sampled 395 mothers and 745 focal children enrolled in the Kiang West (The Gambia) Longitudinal Population Study cohort. Structured interviews asked mothers who and how often people invest in their children, and about their religious practices. Data were collected at participants' homes on electronic tablet‐based long‐form surveys and analyzed using the Bayesian hierarchical models.Religiosity was weakly associated with women's higher age‐adjusted fertility. Maternal religiosity was negatively related to maternal investment in focal children, but positively associated with total allomaternal support. Specifically, a woman's religiosity was positively associated with allomaternal support from matrilineal kin, other offspring, and affinal kin, but unrelated to paternal, patrilineal, and non‐kin investment.These results suggest that higher fertility among religious mothers may be supported by high levels of investment from biological and affinal kin. Matrilineal kin, other siblings, and affinal kin seem to be the most responsive to a woman's religiosity. Our findings cast doubt on interpretations of women's religious behaviors as signals of fidelity, and instead suggest they may be part of strategies to enable collective allomaternal resources and higher relative fertility. [ABSTRACT FROM AUTHOR]

This article analyses the narratives of young people in the Gambia and of Afghan migrants in Turkey on the themes of migration and Europe as a place of destination. Based on extensive focus group and interview data, we show that these narratives (1) have a high degree of similarities across different contexts and (2) appear incongruent with, and largely unaffected by, the EU's messages of deterrence in information campaigns. We explain this misalignment by referring to a classic sociological distinction between impressions 'given' and those 'given off'. When the EU seeks to give an 'impression' in third countries (such as to be an unattractive place for irregular migrants), their messages compete with positive images of Europe provided through a myriad of other channels and information sources. To a large extent, perceptions of Europe among migrant communities are defined by positive impressions 'given off' through Europe's history as a destination area and social media accounts of individual 'success stories' of diaspora members. The social and material rewards associated with migration further inform migrants' narratives, as do the circumstances of both groups, which often push them towards leaving regardless of the risks this step involves. [ABSTRACT FROM AUTHOR]

Food security is the most critical issue to address in The Gambia, and cashew production and its respective value chain provide opportunities to improve the quality of livelihood for many families. This study conducts value chain and SWOT analyses to provide information that could improve development opportunities and strengthen linkages to food security within the cashew industry in The Gambia's Kombo East district, West Coast region. The results show that the cashew value chain in the study site is characterized by a large number of producers and relatively few intermediaries working through five marketing channels. The results demonstrate that farmers received 66% of the final market value, but there is a lack of farmer organizations, which severely affected farmers' free and fair access to markets to sell their products. So, there is an immediate need to establish farmers' cooperatives to reduce intermediaries in the value chain and obtain fair product prices. Moreover, the result of SWOT analysis revealed that the strategic position of the cashew industry is an advantageous 'holds and maintains' position, indicating a market penetration, product development, or modifying existing products, and a vertical integration strategy could increase revenue, alleviate poverty, and reduce food insecurity. Adopting the recommended market-based approaches will result in higher producer prices and incomes, thereby reducing poverty and food insecurity. The study contributes to the literature by focusing on the cashew chain value in The Gambia, added value opportunities through transformation, better markets, improved products, and other alternatives to promote global value creation, and the dynamics of the food system, which can promote food security and sustainable rural development. [ABSTRACT FROM AUTHOR]

Objective of this study was to determine the prevalence and factors that influence diabetic therapeutic non-adherence behavior among patients with type 2 diabetes in The Gambia. Methods: A cross-sectional study design was used, and participants were recruited from Edward Francis Small Teaching Hospital (EFSTH) and Kanifing General Hospital (KGH). The sample size of 145 patients with type 2 diabetes was included and data was collected using a structured questionnaire. Adherence to anti-diabetic medications was measured using the Morisky Medications Adherence Scale (MMAS-8). Logistic regression was used to determine the factors associated with diabetic therapeutic non-adherence. Results: The prevalence of non-adherence to anti-diabetic treatment was 27.6%. Perceived barrier (forgetfulness, long-term medication use, and medication side effects) to diabetic treatment (OR = 0.265, 95% CI: 0.113– 0.621, p = 0.041) was statistically significantly associated with non-adherence to anti-diabetic treatment. However, the frequency of doctor's visits (OR = 0.310, 95% CI: 0.046– 2.111) was not significantly associated with non-adherence to anti-diabetic treatment. Conclusion: The rate of non-adherence to antidiabetic treatment in this study was high. Perceived barriers to antidiabetic treatment such as forgetfulness, long-term medication use, and medication side effects influenced therapeutic non-adherence to antidiabetic treatment. While interventions should focus on how to eliminate these barriers, health education on diabetic self-care may help reinforce the importance of medication adherence to prevent complications. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is the most common complication causing lots of admissions among diabetic patients. Understanding patients' level of foot self‐care knowledge, practice and associated factors is important for planning interventions to control and prevent diabetic foot complications. This study aimed to assess the level of knowledge and practice of foot self‐care among diabetic patients attending diabetic clinics in The Gambia. Two hundred and seventeen patients attending diabetic clinics in two public hospitals were selected using a successive sampling technique. Data were collected using a validated interviewer‐administered questionnaire. Descriptive statistics were used to summarize the demographic and clinical data. Multivariate logistic regression was used to identify factors associated with foot self‐care knowledge and practice. The findings showed a poor level of foot self‐care knowledge (n = 114; 52.5%) and practice (n = 149; 68.7%). Patients' educational level was statistically significantly association with diabetic foot self‐care knowledge (p = 0.02). Diabetic foot ulcer history (aOR = 0.23, 95% CI: 0.08–0.63; p < 0.001), diabetic hospitalization (aOR = 2.41, 95% CI: 1.23–4.75, p = 0.01) and diabetic foot care education (aOR = 2.65, 95% CI: 1.39–5.06, p < 0.001) were statistically significantly associated with foot self‐care practice. The poor diabetic foot self‐care knowledge and practice among these patients emphasize the need for a diabetic health education program in these clinics. [ABSTRACT FROM AUTHOR]

Abstract Background and Aim Globally, over 180,000 children develop cancers yearly, with about 80% residing in low‐ or middle‐income countries where cancer‐associated mortality is also high. In The Gambia, cumulative incidence rate of 27.6 childhood cancers/million population was reported between 2002 and 2011. The current study appraised newly‐established pediatric oncological services in The Gambia. Methods In this prospective registry study, children with cancer who presented at the pediatric units, Edward Francis Small Teaching Hospital, Banjul, between November 2022 and October 2023 were assessed. Data on sociodemographic variables, mode of admission and presentation, tumor type, diagnostic methods, and challenges such as laboratory support, treatment, use of blood/blood products; and eventual outcome were analyzed. Results The median (interquartile range, IQR) age at presentation of the 44 children was 36.0 (22.3–117.0) months. Wilms tumor was the most common tumor 12 (27.3%); followed by leukemia 11 (25.0%); germ cell tumor 8 (18.2%); lymphoma 6 (13.6%); retinoblastoma 4 (9.1%); rhabdomyosarcoma 2 (4.5%) and one central nervous system tumor (2.3%). The median(IQR) duration of symptoms before presentation was 48 (21–90) days, presentation to diagnosis 7.5 (3–20.8) days, and first symptom to diagnosis 62.5 (32–126.8) days. Treatment refusal and abandonment rates were 20.5% and 13.6%, respectively. Families of 93.8% of children could not procure cytotoxic drugs due to nonavailability, high cost, or both. Adequate laboratory monitoring was only available in 6.8%, and none had platelet concentrate transfusion or radiotherapy. The nine (20.5%) who completed treatment are currently being followed up, 10(22.7%) are still receiving chemotherapy, while 2(4.5%) were referred. Eight (18.2%) died, predominantly from metastasis (75%) and severe drug toxicities (25%). Conclusion Late presentation and diagnosis, poverty, unavailability of drugs, suboptimal or lack of laboratory testing, blood product, adjuvant medications, and psychosocial supports contributed to high treatment refusal, abandonment, and mortality. These daunting challenges can be ameliorated with regular community sensitization, frequent cancer auditing, and strong political will.

IntroductionExposure rates to Histoplasma species, the causative agent of equine epizootic lymphangitis (EL), are unknown amongst working equids in The Gambia. The primary aims of this study were to estimate anti-Histoplasma antibody seroprevalence in the equid population in rural The Gambia and to explore risk factors for seropositivity.MethodsA nationwide cross-sectional study was conducted (February–July 2022), representing baseline measurements of a longitudinal cohort study. Horses (n = 463) and donkeys (n = 92) without EL signs were recruited in 18 study sites. Following informed owner consent, equid clinical and management data were recorded. Blood samples were collected by jugular venepuncture, and sera were subject to the IMMY Latex Agglutination Histoplasma test (LAT). Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis. Study site and household variance were described using a latent-variable approach. Whole blood DNA extractions were subject to nested ITS-PCR to detect Histoplasma capsulatum var. farciminosum (HCF), and agreement with LAT results was measured using Cohen’s kappa statistic.ResultsAnti-Histoplasma antibody seroprevalence in horses and donkeys was 79.9% [95% confidence interval (CI) 76.0–83.5%] and 46.7% (95% CI 36.3–57.4%), respectively. In horses, two multivariable models explained the maximum amount of data variability. Model 1 demonstrated increased odds of seropositivity in mares [odds ratio (OR) = 2.90 95% CI 1.70–4.95, p

Abstract Background A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. Methods A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019–2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p

The world's multiple landscape crises have placed agroforestry among the cost-effective nature-based solutions with numerous ecological, social, and economic benefits. This study examined the farmer and land factors influencing the adoption of agroforestry practices in the Gambia's Central River Region. Stratified random sampling was used to collect primary data from 377 households using semi-structured questionnaires and farm-level walkabout observations. The study used purposive and snowball sampling methods to engage different key informants. The results indicated that the agroforestry adoption rate in the study area was 52.3 %. Significant differences between the means of agroforestry adopters and non-adopters were observed. Adopters held more land size 0.66ha vs. 0.55ha, owned more livelihood assets (private land and livestock), and had significantly more fenced lands. The binary regression model established that livelihood assets, land size, land fencing, and gender were positively associated with agroforestry adoption in the study area. Conclusively, land-related factors emerged as more predictable determinants of agroforestry adoption than farmer-related factors. Notably, age and education, though important socioeconomic attributes, remained relatively the same between adopters and non-adopters, and were not statistically significant. The study recommends cross-cutting farmer and land-related policies, as well as other interventions to boost agroforestry adoption. It further suggests a follow-up study to quantify the actual cost and benefits associated with agroforestry adoption in the area.

Background: A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. Methods: A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019–2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05. Results: The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30–34 [aOR = 1.79, 95% CI = 1.30–2.47], those who were married [aOR = 2.69, 95% CI = 1.85–3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas. Conclusion: Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) contributes significantly to childhood morbidity and mortality in sub-Saharan Africa. Early diagnosis through newborn screening (NBS) and subsequent comprehensive follow-up care will reduce the burden. Up till now, the prevalence of SCD among newborns remains unknown in The Gambia and there is no national NBS programme to address this significant public health issue. We assessed the real-time frequency of SCD in the country and determined differences in the pattern of SCD phenotypes among different ethnic groups. A preliminary prospective feasibility study was done in eight purposively selected hospitals in the seven Health Administrative Regions and Banjul. Consecutive newborn babies delivered or managed in these facilities were screened using HemoTypeSC, a sensitive and specific ELISA-based point-of-care test (POCT). Babies identified as SCD with HemoTypeSC were retested at age ≥6 months using alkaline cellulose acetate hemoglobin electrophoresis (ACAE). Head-to-head comparison between HemoType screening and gold standard HPLC could not be done. 1,168 newborn babies were screened from April 14 to August 12, 2023. Fifteen (1.3%) had homozygous HbS (HbSS), two (0.2%) heterozygous for HbS and HbC (HbSC), 204 (17.5%) had sickle cell trait (HbAS), four (0.3%) heterozygous for HbA and HbC (HbAC), and 943 (80.7%) had normal hemoglobin (HbAA). The 17 with SCD (HbSS and HbSC) comprised of 7 (2.2%) of 324 Fula; 6 (1.4%) of 426 Mandinka; 2 (1.6%) of 125 Jola and 2 (1.3%) of 150 Wolof. Fourteen (82.4%) of the 17 accepted the diagnosis and were enrolled into the SCD program. For these 14, HemoTypeSC had 100% sensitivity with ACAE when repeated at age ≥6 months. In addition to determining the real-time newborn prevalence of SCD and trait in The Gambia for the first time, this pilot study showed that SCD-POCT is feasible in Gambian health facilities. [ABSTRACT FROM AUTHOR]

This paper considers the implications of migration to Europe for West African governments in relation to other forms of politically relevant mobilities. This helps to understand what governments in West Africa prioritize when it comes to migration policy. No doubt, there is an increasing European influence on the migration agenda. However, despite this influence, there are still other West African interests when it comes to migration governance. These are diverse, covering development and humanitarian concerns, and include pro-active diaspora policies, restrictive immigration regimes due to economic protectionism and security concerns, as well as protecting migrants and displaced people. Thus, different countries in the region have varying sets of political priorities, though underlined by a broader unpolitical nature of migration of the everyday. The paper is based on over 130 interviews with policymakers, politicians, civil society activists, and academic experts in Niger, Nigeria, Senegal, and the Gambia in 2019. It adds to the literature on the agency of migration states in the Global South. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease (COVID-19) heralded a dreadful global disaster that had a collateral effect on many businesses. It affected people, information, and global economies. However, its impact on public records and archives management is under-researched in Africa, particularly in The Gambia. Hence, the purpose of this study was to assess the impact of the COVID-19 pandemic on public records and archives management in The Gambia. Adopted for the survey is pragmatic research paradigm, which employs mixed methods using a purposive sample of 65, constituting 31% of a population of 211, comprising heads of Public Records and Archives staff and National Records Advisory Committee members. The ISO 31000:2018 Risk Assessment tool was employed as the theoretical framework. A questionnaire and telephone-based interview were administered to collect data. Quantitative data was analysed descriptively using IBM Statistical Packages for Social Science (IBM SPSS), while qualitative data was analysed based on the study objectives. The research shows that a significant minority confirmed information leakage during the COVID-19 pandemic, primarily through social media, phone, and email. Most records and archives are in physical format, as established by 59.1% of respondents. The records sector responded poorly due to inadequate capacity, emergency policies, and interventions. Most respondents claimed a lack a disaster plan, with 67.7% of respondents finding it ineffective in mitigating COVID-19's impact on records and archives, and 82.4% confirming inadequate documentation during the pandemic. Although the COVID-19 pandemic has moderately impacted Public Records and Archives Management in The Gambia, with staff being protected more than information, the effect severely affected archival services. The study recommends robust risk plans, digitalisation, professional capacity building, adequate resources, effective monitoring, and decentralisation, among others. [ABSTRACT FROM AUTHOR]

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The 'politics of voice' of awareness-raising bends returnees' stories towards moral tropes against illegalised migration. These stories are commodified, bringing awareness-raising within the migration industries. We address this commodification using data from an ethnographic study of the Migrants as Messengers (MaM) project run by the International Organization for Migration (IOM) in The Gambia since 2019 and through the concept that we call 'moral economy of voice'. Its constituting dimensions are outlined in our analysis of vignettes on how the clashes between IOM and the returnees over awareness-raising industry's capitalist logics are cast in moral terms. We show that the returnees orally complained at IOM's mis-categorisation, mis-compensation and appropriation of their products. When acting as members of an independent group, however, they rejected IOM's conditional support for their communication projects altogether. This all engenders an evasive paternalism whereby returnees' survival partly depends on IOM, but the latter affords them neither full vulnerability nor maturity status. As such, returnee stories' commodification mechanisms are as contentious as their discursive bending. We therefore hint at returnee groups' potential for withstanding exploitative dynamics as well as advocate for a fairer engagement of returnees in awareness-raising. [ABSTRACT FROM AUTHOR]

Background: Infertility is a major health issue worldwide, yet very few examples of interventions addressing infertility in the Global South have been documented to date. In The Gambia, West Africa, infertility is recognised as a burden and the health authorities have included it in several health policies and the new National Reproductive Health Strategy however, a detailed operationalisation plan for fertility care has not yet been established. Here, we aim to understand and document the factors that influence the implementation of fertility care in The Gambia. Methods: We conducted 46 semi-structured interviews with policymakers, implementers, and health practitioners in both the public and private sectors from July to November 2021. The interviews were transcribed, anonymised and analysed with NVivo Pro version 1.6.1. The analysis was initially inductive, with themes arising from the coding categorised according to the WHO health systems building blocks framework. Results: This study identified several barriers to a successful implementation of fertility care in The Gambia, including (i) a lack of routinely collected infertility data; (ii) an absence of financial protection mechanisms for patients, and/or a specific budget for infertility; (iii) limited cooperation between the public and private sectors in the provision of fertility care; and (iv) gaps in fertility care training among health practitioners. Conversely, enablers included: (i) strong national infertility leadership; and (ii) the integration of infertility care within public reproductive health services. Conclusion: The Gambian health system is not yet in the position to support a comprehensive fertility care package in its public health facilities. Several aspects of the implementation of fertility care must be considered in operationalising the health strategy including the systematic collection of infertility data, fertility awareness, and the provision of specialised fertility care training. Furthermore, a stronger partnership between the public and private sectors must be developed. Given the increasing availability of assisted reproductive technologies in the sub-Saharan Africa region, and the tendency to locate these technologies in the private sector, further research is needed to understand and identify the processes underlying the implementation of fertility care and to foster better integration with the existing health system. [ABSTRACT FROM AUTHOR]

Robust surveillance of Histoplasma species is warranted in endemic regions, including investigation of community-level transmission dynamics. This cross-sectional study explored anti-Histoplasma antibody seroprevalence and risk factors for exposure in a general population in Upper River Region (URR), The Gambia.Study participants were recruited (December 2022–March 2023) by random household sampling across 12 Enumeration Areas (EAs) of URR. A questionnaire and clinical examination were performed; exploring demographic, clinical and environmental risk factors for Histoplasma exposure. One venous blood sample per participant was subject to IMMY Latex Agglutination Histoplasma test to determine presence of a recent IgM response to Histoplasma. Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis.The study population (n = 298) aged 5–83 years, demonstrated a positively skewed age distribution and comprised 55.4% females. An apparent seroprevalence of 18.8% (n = 56/298, 95% CI 14.5–23.7%) was measured using the LAT. A multivariable model demonstrated increased odds of Histoplasma seropositivity amongst female participants (OR = 2.41 95% CI 1.14–5.10); and participants reporting involvement in animal manure management (OR = 4.21 95% CI 1.38–12.90), and management of domestic animals inside the compound at night during the dry season (OR = 10.72 95% CI 2.02–56.83). Increasing age (OR = 0.96 95% CI 0.93–0.98) was associated with decreased odds of seropositivity. Clustering at EA level was responsible for 17.2% of seropositivity variance.The study indicates frequent recent Histoplasma exposure and presents plausible demographic and environmental risk factors for seropositivity. Histoplasma spp. characterisation at this human-animal-environment interface is warranted, to determine public health implications of environmental reservoirs in The Gambia.The study was supported by Wellcome Trust (206,638/Z/17/Z to CES) and a University of Liverpool-funded PhD studentship (to TRC).

Abstract Background Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited making it challenging to appropriately prioritize the ideal next steps for expanding care. This study aims to describe the current services available for the prevention, screening, and treatment of cervical cancer in The Gambia and provide suggestions for expanding geographic access to care. Methods A survey aimed at assessing the availability of key cervical cancer-related services was developed and then administered in person by research assistants to all secondary and tertiary health facilities (HFs) in The Gambia. ArcGIS Pro Software and 2020 LandScan population density raster were used to visualize and quantify geographic access to care. Survey results were compared with published targets outlined by the Gambian Ministry of Health in the “Strategic Plan for the Prevention and Control of Cervical Cancer in The Gambia: 2016–2020.” Results One hundred and two HFs were surveyed including 12 hospitals, 3 major health centers, 56 minor health centers, and 31 medical centers/clinics. Seventy-eight of these HFs provided some form of cervical cancer-related service. HPV vaccination was available in all health regions. Two-thirds of the population lived within 10 km of a HF that offered screening for cervical cancer and half lived within 10 km of a HF that offered treatment for precancerous lesions. Ten HFs offered hysterectomy, but nine were located in the same region. Two HFs offered limited chemotherapy. Radiotherapy was not available. If all major health centers and hospitals started offering visual inspection with acetic acid and cryotherapy, 86.1% of the population would live within 25 km of a HF with both services. Conclusions Geographic access to cervical cancer screening, and precancer treatment is relatively widespread across The Gambia, but targeted expansion in line with the country’s “Strategic Plan” would improve access for central and eastern Gambia. The availability of treatment services for invasive cancer is limited, and establishing radiotherapy in the country should continue to be prioritized.

The Gambia has experienced three significant political crises in its history: the attempted coup of 1981, the successful coup of 1994, and the latest events in 2016–2017 when President Yahya Jammeh, having exercised semi-authoritarian power since 1994, was defeated at the ballot box but refused to step down until he was finally forced to do so. Using academic, media, social media and interview material, this article examines all three processes and their aftermaths, in particular the latter, through the lens of 'small state' politics. The article demonstrates that the small size of the population, elite, and landmass indeed matters in driving Gambian political processes. In 2023, several post-2017 processes, including constitutional change, transitional justice and elections, are playing out within the confines of the small state. This article then assesses to what extent a 'New Gambia', to use current President Adama Barrow's phrase, has emerged. [ABSTRACT FROM AUTHOR]

Although African regional interventions have tangible effects on politics and order in African states, we know little about how people living in the countries concerned experience and evaluate these interventions. The assumption in the literature is that African interventions are generally perceived as legitimate due to the interveners' cultural proximity to the contexts of intervention. Based on interview and focus group research, we present firsthand and systematically generated empirical data on local perceptions of AU and ECOWAS interventions in two African states: Burkina Faso (2014/15) and The Gambia (2016/17). Contrary to the assumption in the literature, we demonstrate that (1) AU and ECOWAS interventions are locally more contested than often assumed, but that (2) local perceptions are at the same time multiplex. In both countries, we find (3) a marked difference between elite perceptions on the one hand and those of 'everyday citizens' on the other, which reflects variegated experiences with and exposures to the regional interventions resulting from different social, political, and spatial positionalities. These findings extend existing research on local perceptions of interventions by a perspective on non-Western interveners; and they have important implications for understanding both the legitimacy and effectiveness of African regional interventions. [ABSTRACT FROM AUTHOR]

The emergence of Extinction Rebellion (XR) in 2018 as a global movement led to the establishment of chapters all around the world. Much existing work has focused on cases located in the UK, Western Europe and the Anglosphere. This profile presents a case study of the formation of XR in The Gambia as an example of further diffusion of the movement. We examine how partial democratisation opened up space for contention, which in turn led to the adoption of the XR brand in the country. In turn, becoming a chapter of XR has opened up new opportunities for the transnationalisation of Gambian environmental activism. The profile concludes by reflecting on the potential future of the group. [ABSTRACT FROM AUTHOR]

For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6–18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and immunogenic doses for children, and the possible benefit of a mucosal adjuvant, double mutant labile toxin (dmLT). Considering the promising but still underexplored potential of inactivated whole cells in oral vaccination, we present a perspective compiling key observations from past ETVAX® trials that informed The Gambian trial design. This report will update the trial's status and explore future directions for ETEC vaccine trials. Our aim is to provide not only an update on the most advanced ETEC vaccine candidate but also to offer insights beneficial for the development of other much-needed oral whole-cell vaccines against enteric and other pathogens. [ABSTRACT FROM AUTHOR]

The Gambia and the United Kingdom (UK) had cordial relations from 1965 until 1994 when a military coup led by Yahya AJJ Jammeh resulted in sanctions, accusations of misrule and the expulsion of British diplomats. When Jammeh lost the December 2016 presidential elections to Adama Barrow, the UK declared a new era of cordial relationship with the Gambia. Barrow in turn promised the Gambia's return to the Commonwealth. This article provides an analysis of the Gambia's relations with the UK and the Commonwealth, arguing that these relationships can be divided into three eras, each reflecting the nature of Gambian politics under different presidents; 1965–1994 is referred to as the golden era of relations, followed by the tumultuous years of 1994–2016, and then the years since 2017, characterised as a 'normalising' period. [ABSTRACT FROM AUTHOR]

Background Sub-Saharan Africa (SSA) has one of the highest prevalences of hypertension worldwide. The impact of hypertension is of particular concern in rural SSA, where access to clinics and hospitals is limited. Improvements in the management of people with hypertension in rural SSA could be achieved by sharing diagnosis and care tasks between the clinic and the community. To develop such a community-centred programme we need optimal approaches to identify and risk stratify patients with elevated blood pressure. The aim of the study is to improve the evidence base for diagnosis and risk estimation for a community-centred hypertension programme in two rural settings in SSA. Methods We will conduct a cross-sectional study of 1250 adult participants in Kilifi, Kenya and Kiang West, The Gambia. The study has five objectives which will determine the: (1) accuracy of three blood pressure (BP) measurement methods performed by community health workers in identifying people with hypertension in rural SSA, compared to the reference standard method; (2) relationship between systolic BP and cardiovascular risk factors; (3) prevalence of hypertension-mediated organ damage (HMOD); (4) accuracy of innovative point-of-care (POC) technologies to identify patients with HMOD; and (5) cost-effectiveness of different combinations of BP and HMOD measurements for directing hypertension treatment initiation. Expected findings This study will determine the accuracy of three methods for community BP measurement and POC technologies for HMOD assessment. Using the optimal methods in this setting it will estimate the prevalence of hypertension and provide the best estimate to date of HMOD prevalence in SSA populations. The cost-effectiveness of decision-making approaches for initiating treatment of hypertension will be modelled. These results will inform the development of a community-centred programme to improve care for hypertensive patients living in rural SSA. Existing community engagement networks will be used to disseminated within the research setting.

Non-typhoidal Salmonella associated with multidrug resistance cause invasive disease in sub-Saharan Africa. Specific lineages of serovars Typhimurium and Enteritidis have been implicated. Here we characterized the genomic diversity of 100 clinical non-typhoidal Salmonella collected from 93 patients in 2001 from the eastern, and in 2006-2018 from the western regions of The Gambia respectively. A total of 93 isolates (64 invasive, 23 gastroenteritis and six other sites) representing a single infection episode were phenotypically tested for antimicrobial susceptibility using the Kirby-Bauer disc diffusion technique. Whole genome sequencing of 100 isolates was performed using Illumina, and the reads were assembled and analysed using SPAdes. The Salmonella in Silico Typing Resource (SISTR) was used for serotyping. SNP differences among the 93 isolates were determined using Roary, and phylogenetic analysis was performed in the context of 495 African strains from the European Nucleotide Archive. Salmonella serovars Typhimurium (26/64; 30.6 %) and Enteritidis (13/64; 20.3 %) were associated with invasive disease, whilst other serovars were mainly responsible for gastroenteritis (17/23; 73.9 %). The presence of three major serovar Enteritidis clades was confirmed, including the invasive West African clade, which made up more than half (11/16; 68.8 %) of the genomes. Multidrug resistance was confined among the serovar Enteritidis West African clade. The presence of this epidemic virulent clade has potential for spread of resistance and thus important implications for systematic patient management. Surveillance and epidemiological investigations to inform control are warranted.

Abstract Background Antimicrobial resistance poses a public health threat for the treatment of community-acquired urinary tract infections. This study determined the susceptibility patterns of uropathogens and associated risk factors among outpatients diagnosed with urinary tract infections at the Kanifing General Hospital in the Gambia. Methods A cross-sectional analytic study was conducted among patients with suspected urinary tract infections at Kanifing General Hospital from March to May 2021. Data on socio-demographic and other risk factors were collected from the study participants using a structured pre-tested questionnaire. Mid-stream urine samples were collected, and bacteria identification and antimicrobial susceptibility testing done using standard microbiological methods. Descriptive and inferential statistical analysis were done to determine factors associated with urinary tract infection at 95% confidence level and a p -value

Objectives: SARS-CoV-2 transmission in sub-Saharan Africa has probably been underestimated. Population-based seroprevalence studies are needed to determine the extent of transmission in the continent. Methods: Blood samples from a cohort of Gambian pregnant women were tested for SARS-CoV-2 total receptor binding domain (RBD) immunoglobulin (Ig) M/IgG before (Pre-pandemic: October-December 2019) and during the pandemic (Pre-wave 1: February-June 2020; Post-wave 1: October-December 2020, Post-wave 2: May-June 2021; and Post-wave 3: October-December 2021). Samples reactive for SARS-CoV-2 total RBD IgM/IgG were tested in specific S1- and nucleocapsid (NCP) IgG assays. Results: SARS-CoV-2 total RBD IgM/IgG seroprevalence was 0.9% 95% confidence interval (0.2, 4.9) in Pre-pandemic; 4.1% (1.4, 11.4) in Pre-wave 1; 31.1% (25.2, 37.7) in Post-wave 1; 62.5% (55.8, 68.8) in Post-wave 2 and 90.0% (85.1, 93.5) in Post-wave 3. S-protein IgG and NCP-protein IgG seroprevalence also increased at each Post-wave period. Although S-protein IgG and NCP-protein IgG seroprevalence was similar at Post-wave 1, S-protein IgG seroprevalence was higher at Post-wave 2 and Post-wave 3, (prevalence difference 13.5 [0.1, 26.8] and prevalence ratio 1.5 [1.0, 2.3] in Post-wave 2; and 22.9 [9.2, 36.6] and 1.4 [1.1, 1.8] in Post-wave 3 respectively, P

Abstract Background Poor infant and young child feeding (IYCF) practices are a significant issue both globally and in developing nations, and they have a significant role in undernutrition, healthy growth, and development, particularly in the first 2 years of life. Improving children's general health and wellbeing requires recognizing and decreasing preventable drivers of malnutrition. Hence, this study aimed to assess the prevalence and possible determinants of minimum dietary diversity among 6–23 months old babies in the Gambia. Methods Data from the 2019–2020 Gambia demographic and health survey were used. The study included a total of 2100 weighted 6–23 months old children. To identify characteristics significantly linked with minimum dietary diversity among infants, a multilevel fixed-effect analysis approach was used. After adjusting other confounding variables, variables with a p value of 0.25 were incorporated into a multivariable multilevel regression analysis to determine associated variables. An adjusted odds ratio with a 95% confidence interval was then applied. Results Only 22.22% (95% CI 18.55, 21.99) of infants had received the minimum dietary diversity. Mothers, who had mass media exposure (aOR = 2.71, CI = (1.02, 6.21), wealthier (aOR = 1.70, CI = 1.02, 2.85), child age of (aOR = 4.14, CI = 2.98, 5.76), and (aOR = 4.97, CI = 3.54, 6.98), have shown a positive statistical association with the outcome variable, respectively. Regarding regions mothers who came from Kanifing (aOR = 0.49, CI = 0.25, 0.94), Janjanbureh (aOR = 0.38, CI = 0.18, 0.82), and Basse (aOR = 0.51, CI = 0.26, 0.99) had showed less likelihood odds to provide the minimum dietary diversity (MDD) for their babies compared to Banjul local government area, respectively. Conclusion The World Health Organization dietary evaluation tool suggests that the MDD value be extremely low, even though it might be slightly higher than the numbers for some nations. The country may need to take drastic measures to tackle child malnutrition.

Abstract Background Early initiation of breastfeeding within the first hour of life prevents neonatal and infant mortality. Sustainable Development Goals (SDGs) Target 3.2 aims to reduce neonatal mortality and under 5 mortality globally. The decline in the early initiation of breastfeeding in The Gambia coincides with deviations from the SDGs, due to poor indicators of child survival. Our work studied the determinants of early initiation of breastfeeding in The Gambia. Methods We used the 2019–2020 Gambia Demographic Health Survey (GDHS) conducted across all regions of the country. Since our population of interest was children born two years preceding the study, we only included children less than 24 months of age, living with an eligible respondent. Thus, a weighted sample of 5691 mother-child pairs was applied in the analysis. We reported summary statistics of individuals’ sociodemographic, obstetrics and antenatal, household, and community-level factors. A logistic regression model was used to determine associations between early initiation of breastfeeding and covariates. Results The prevalence of early initiation of breastfeeding was 64.3% (n = 3659). Mothers who had secondary education or higher educational level had higher odds of early initiation of breastfeeding (AOR 1.22; 95% CI 1.07, 1.40). Regions with rural population notably Lower and Central and Upper River Region had lower odds of early initiation of breastfeeding [Mansakonko (AOR 0.37; 95% CI 0.26, 0.15), Kerewan (AOR 0.26; 95% CI 0.19, 0.36), Kuntaur (AOR 0.39; 95% CI 0.28, 0.54), Janjanbureh (AOR 0.48; 95% CI 0.35, 0.66) and Basse (AOR 0.64; 95%CI 0.49, 0.85)]. Also, women in the high quintile of the wealth index were more likely to initiate breastfeeding early (AOR 1.29; 95% CI 1.06, 1.57). Four or more antenatal care visits did not increase early initiation of breastfeeding. Conclusions The results of the analyses demand affirmative action to improve maternal education, reduce poverty and inequality and empower rural communities in The Gambia. The IYCF component in antenatal care needs to be strengthened. Programs and policies on IYCF must resonate to address determinants of timely breastfeeding initiation to chart progress towards the SDG.

Abstract Glossina species are known to transmit African Trypanosomiasis, one of the most important infectious diseases for both livestock and humans in sub-Saharan Africa. Therefore, the aim of this study was to characterize trapped Glossina spp. from The Gambia using morphological and molecular techniques in relation to the vegetation cover types. A line transect survey was carried out in all the administrative regions of The Gambia. Tsetse fly trapping was carried out for 14 days during each season using line transect. A total of 220 Glossina spp. specimens (117 F and 103 M) were captured, and DNA was extracted from the legs of 100 randomly selected Glossina spp. Further, DNA samples were tested by a conventional PCR assay. A total of 135/220 (61%; 95% CI: 54.6-67.8%) and 85/220 (39%; 95% CI: 32.2-45.4%) flies were identified as Glossina morsitans submorsitans and Glossina palpalis gambiensis, respectively, with most caught during wet season (53.6%) and more females (53.2%) than males. Results of the morphological identification agreed with those of molecular identification. The type of vegetation cover significantly influenced the caught of tsetse flies. Animals and humans at the various trapping sites are at risk of being bitten by tsetse flies.

Hepatitis B is a “silent epidemic”, fifty to a hundred (50–100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted.

The purpose of this article is to provide an overview of the sport policy landscape in the Gambia. The formation of the National Sport Council (NSC) 27 years after the Gambia National Olympic Committee (GNOC) was formed meant a significant shift of power and responsibility to the government agency. Using government documents, newspaper articles and radio outputs, this article presents the sport landscape of the Gambia in three main ways: (1) highlights the power play between the NSC and the GNOC in the quest to insert authority; (2) the role of civil society in the local sport landscape and (3) demonstrates how international sport organisations disrupts policy priorities in developing countries. This article demonstrates that powerful individuals in unitary systems of government do significantly change the course of sport policy priorities. In addition, the large dependence on state resources to build sport infrastructure and implement events renders the ambitious policy documents insolent in a poor country like the Gambia. Though some of the government institutions share similar aims in their policy documents these are hardly put into practice in reality and sometimes lead o duplication of responsibilities. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance poses a public health threat for the treatment of community-acquired urinary tract infections. This study determined the susceptibility patterns of uropathogens and associated risk factors among outpatients diagnosed with urinary tract infections at the Kanifing General Hospital in the Gambia. Methods: A cross-sectional analytic study was conducted among patients with suspected urinary tract infections at Kanifing General Hospital from March to May 2021. Data on socio-demographic and other risk factors were collected from the study participants using a structured pre-tested questionnaire. Mid-stream urine samples were collected, and bacteria identification and antimicrobial susceptibility testing done using standard microbiological methods. Descriptive and inferential statistical analysis were done to determine factors associated with urinary tract infection at 95% confidence level and a p -value < 0.05. Results: A total of 422 patients were enrolled with 82.5% (348/422) being females. The prevalence of community acquired urinary tract infection was 12.8% (54/422). Escherichia coli was the most prevalent isolate (74.1%, 40/54), followed by Klebsiella spp (8.5%, 10/54). Antimicrobial resistance was highest for Ampicillin (87.0%, 47/54), Trimethoprim/Sulfamethoxazole (77.8%, 42/54) and Tetracycline (75.9%, 41/54). Uropathogens sensitivity was 77.8% (42/54) for Nitrofurantoin and 75.9% (41/54) for Ceftazidime. Being female (aOR 5.90 95% CI = 1.48–23.67), previous history of urinary tract infection (aOR 2.34, 95% CI = 1.06–5.14), use of unprescribed antibiotics (aOR 2.0, 95% CI = 1.05–3.62) and having no formal education (aOR 8.02, 95% CI = 1.04–62.0) were significant factors associated for having uropathogenic bacterial infection. Conclusion: E. coli was the most prevalent uropathogen isolated. Ciprofloxacin, Nitrofurantoin and Ceftazidime were the most sensitive antibiotics. Routine surveillance of susceptibility of uropathogenic bacteria would be helpful to update clinicians on the choice of antibiotics. [ABSTRACT FROM AUTHOR]