Purpose: Prostate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage diagnosis, treatment delays, and poor survival among patients. We analyzed the availability and use of prostate cancer screening, diagnostic and treatment guidelines, procedures, and costs in few SSA countries to determine factors for consideration in the development of prostate cancer screening guidelines for SSA. Methods: We applied mixed methods approaches to collect data through an electronic survey administered to clinicians (oncologists, urologists, pathologists, nurses, and radiation oncologists) providing prostate cancer screening, diagnosis, and treatment services in multiple sub-Saharan countries. Results: Inconsistencies in respondents’ understanding of the availability and use of prostate cancer screening guidelines in their countries were noted. Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) were the most commonly available screening modalities. Available diagnostic procedures included a combination of prostate biopsies, transrectal ultrasonography, and DRE. Our study’s data suggest that PSA and DRE exams are available for early diagnosis and screening procedures. Availability of treatment modalities with curative intent and costs for prostate cancer related procedures varied between and within countries. Conclusions: PSA and DRE are available for detecting prostate cancer and may detect aggressive cancers early, leading to improved outcomes. However, PSA screening is also associated with overdiagnosis and over-treatment. National prostate cancer policies should consider health systems, evidence-based guidelines, population characteristics and healthcare financing to ensure access to clinically relevant and safe prostate cancer related care.

Background: Cancer is the third-leading cause of mortality in Kenya, resulting in unique challenges to the country’s health system. An increase in the number of cancer cases in Kenya over the past decade resulted in legislative actions and policies to guide delivery of cancer services. Kenya’s new national cancer control strategy and past policy efforts provide an opportunity to synergise information and enhance understanding to improve cancer diagnosis and treatment in the country. The objectives of this study are to (1) document policy-modifiable factors based on a review of policy documents and results of a key informant survey and (2) develop recommendations to improve policies affecting cancer testing and treatment services in Kenya. This study builds upon our previous study Improving Access to Cancer Testing and Treatment in Kenya (Makau Barasa et al. J Global Oncol 2(216), 2017). Methods: The study applied an in-depth systematic review of Kenya’s cancer policies and guidelines, a qualitative analysis of results from a section of a semi-structured key informant survey focused on the opinions of clinicians delivering cancer services as well as cancer support groups and advocacy leaders, and a stakeholder analysis identifying key policy-makers and implementers. Details of the complete key informant survey were published in our previous study. Results: Kenya’s cancer policies have guided progress made in providing the legal and implementation frameworks for the development and delivery of cancer services at the national and county levels. Some policy implementation gaps are noted. These include inadequate financing for cancer services, limited research and data to support policy formulation, and the concentration of cancer services in urban areas. The key informant survey identified policy-modifiable actions that can address some of the gaps and improve the delivery of and access to cancer testing and treatment services in the country. Some of these include addressing the financial barriers affecting cancer testing and treatment services; increasing stakeholder engagement in training health personnel to deliver cancer testing and treatment services; decentralising cancer services and improving cancer surveillance and research; and increasing education and awareness about cancer symptoms, screening procedures and treatment options. A set of priority policy actions were selected from the study findings and used to develop recommendations for Kenya’s policy-makers and stakeholders. Conclusions: Revisions to Kenya’s cancer policies are seeking to address gaps noted in past policies and to improve access to cancer testing and treatment in Kenya. However, based on study findings, additional actions can be taken to strengthen policy implementation. Considering the policy formulation and implementation process and costs, this study recommends focusing on three priority policy actions that can have significant impact on improving access to cancer testing and treatment services. These include addressing financing, insurance and human resources gaps; increasing stakeholder engagement; and decentralising health services for better surveillance and data to inform policies.

It is estimated that more than one billion people are affected by Neglected Tropical Diseases (NTDs). Whilst there are existing treatments to reduce morbidity, a major challenge is creating robust programs that are both country led and leverage the existing health systems. Using a systems thinking approach is a critical component for integrating NTD services, as it takes into account all aspects of what might otherwise be considered fragmented systems to create a more efficient system. This paper showcases three case studies where a systems lens was applied: (1) to examine the integration of morbidity management services into the existing health system in Sierra Leone, (2) to integrate Lymphatic Filariasis (LF) mass drug administration (MDA) in the polio campaign in Madagascar, and (3) to embed hydrocele surgeries into the services available in county health facilities in Kenya. All three cases demonstrate the importance of using a systems lens to assess the current system using a participatory approach, allowing the teams to focus on leverage points to create the highest impact and by extension holistically address population needs.

Community awareness and participation in mass screening is critical for schistosomiasis control. This study assessed the impact of sharing anonymized image-based positive test results on the uptake of screening during community mobilization outreach. We conducted an observational study to compare the population response to standard and image-based strategies in 14 communities in Abuja, Nigeria. Six hundred and ninety-one (341 females, 350 males) individuals participated in this study. We analyzed the response ratio, relative increase, and sample collection time. The potential treatment uptake and change in social behavior were determined based on a semi-structured questionnaire. The mean response ratio of the image-based strategy was 89.7% representing a significantly higher ratio than the 27.8%, which was observed under the standard mobilization approach (p ≤ 0.001). The image-based method was associated with 100% of the participants agreeing to provide urine samples, 94% willing to be treated, 89% claiming to have been invited to participate in the study by a friend, and 91% desiring to change a predisposing behavioral habit. These findings indicate that image-based community awareness campaigns may increase the population’s perception about schistosomiasis transmission and treatment. This raises new possibilities for local resource mobilization to expand services in reaching the last mile in schistosomiasis control.

As Nigeria advances toward the elimination of soil-transmitted helminthiasis (STH), updated endemicity maps are essential for guiding programmatic decisions. A cross-sectional study was conducted to update the STH endemicity maps in ten local government areas (LGAs) of Ondo State from July to August 2024. LGAs were stratified into three categories (C1–C3) based on the history of preventive chemotherapy (PC), with C1 being endemic LGAs with ≥5 effective rounds of PC, C2 being endemic LGAs with <5 effective rounds of PC, and C3 being low-endemicity (STH prevalence <20%; PC not required). A total of 4507 school-aged children (5–14 years) from 151 systematically selected communities (15 per LGA) provided fresh stool samples to assess the prevalence and intensity of STH. Stool samples were examined using the Kato-Katz technique. Prevalence of STH was aggregated at the LGA level and compared with World Health Organization thresholds. In the first category (C1), the baseline prevalence was reduced significantly by 60–96%, with specific prevalence in Akoko Southwest (from 28.2% to 0.4%, Risk Ratio (RR): 0.01), Akure North (from 39% to 1.5%, RR = 0.04), Ifedore (from 25% to 2.5%, RR = 0.10), and Ondo East (from 45.2% to 8.2%, RR = 0.18). In the second category (C2), the baseline was reduced significantly by 66–100%, with Akure South (from 29% to 1.2%, RR = 0.04), Ose (from 20% to 2.2%, RR = 0.11), Owo (~100% reduction), and Odigbo (38% to 12.8%, RR = 0.34). In the C3 LGAs, infection was significantly below the baseline threshold, with Akoko Northwest (5.2% to 0.9%, RR = 0.17) and Idanre (from 14.2% to 1.8%, RR = 0.13). Overall, significant reductions in STH prevalence were observed across the surveyed LGAs, with risk ratios ranging from 0.04 to 0.40. These findings updated the endemicity map for the ten LGAs in Ondo State, demonstrating significant progress toward STH elimination following PC implementation.

: Efforts to eliminate schistosomiasis in Africa have advanced, with most countries evaluating the impact of preventive chemotherapy (PC) on disease burden. WHO has recommended eight distinct methodologies for such assessment. We, therefore, investigated the sensitivity of three prominent methodologies—sentinel, cluster, and practical, each varying in site selection, sampling approach, and data interpretation. We conducted a cross-sectional study among 2,093 children across 45 schools in Ese-Odo, Ile-Oluiji, and Irele local government areas (LGAs) of Ondo, Nigeria. Fresh stool and urine samples were processed using Kato–Katz and urine filtration techniques to estimate prevalence, which was compared with 2014 baseline estimates. Findings showed significant prevalence reductions in Ese-Odo from 1.3% (95% CI: 0.5–3.3) at baseline to 0.1% (95% CI: 0.01–0.95) at impact (d = −92.3%, P = 0.03) and in Ile-Oluiji from 58.0% (95% CI: 53.9–62.1) to 1.8% (95% CI: 0.9–3.3; d = −97%, P = 0.00). However, it increased from 3.0% (95% CI: 1.6–5.6) to 5.3% (95% CI: 3.8–7.3) in Irele (d = 66%, P = 0.13). Higher prevalence estimates were observed with the practical method compared with cluster and sentinel across the three LGAs: 0.3% versus 0.1% versus 0.0% in Ese-Odo, 5.8% versus 5.3% versus 5.4% in Irele, and 2.2% versus 1.8% versus 1.5% in Ile-Oluiji (all P >0.05). Sentinel and cluster methodologies suggest stopping PC, whereas the practical method suggests continued PC in Irele. Our findings demonstrate that practical assessment is a sensitive method for refining PC decisions.