Victor Abiola Adepoju

Background: Artificial intelligence (AI) is increasingly used in obstetric ultrasound, cardiotocography, wearable fetal electrocardiography, and remote maternal-fetal monitoring. Evidence on real-world implementation, including feasibility, acceptability, workflow, task sharing, sustainability, equity, cost, and user experience, remains limited. This review aimed to map global real-world implementation evidence for AI-enabled obstetric monitoring and identify outcomes, determinants, gaps, and research priorities for scale-up. Methods: We conducted a scoping review using the Arksey and O’Malley framework with Levac refinements, Joanna Briggs Institute guidance, and PRISMA-ScR. PubMed/MEDLINE, Web of Science, and Dimensions were searched from January 2010 to May 2026 and Scopus from January 2010 to December 2025. We included studies on AI-enabled obstetric monitoring in clinical or community settings and primary research on implementation readiness. We classified findings as operational (Tier 1) or readiness (Tier 2), mapped outcomes to RE-AIM, and interpreted determinants using NASSS. Results: Thirteen studies met the criteria: ten on AI-enabled obstetric ultrasound, two on AI-assisted cardiotocography, and one on wearable fetal electrocardiography. Seven were Tier 1 and six Tier 2; ten were conducted in LMICs or mainly represented LMIC stakeholders. Included studies reported higher ultrasound process-quality measures, shorter expert-review time, feasible image acquisition, high acceptability, and potential for task sharing. Selection bias, confounding, short follow-up, and reliance on proximal outcomes limited inference. No randomized trial showed improved maternal or neonatal outcomes, and no complete cost-effectiveness evaluation met the criteria. Conclusions: Implementation evidence remains sparse, recent, and concentrated in AI-enabled ultrasound. Pragmatic comparative studies, long-term implementation research, economic evaluation, safety monitoring, referral completion, and equitable scale-up should be prioritized.

Despite significant biomedical advances, human immunodeficiency virus (HIV) remains a persistent global health crisis, with over 40 million people affected as of 2023, two-thirds of whom live in the World Health Organization (WHO) African Region. However, from an HIV prevention perspective, the more urgent concern is the continued occurrence of approximately 1.3 million new infections annually, particularly in sub-Saharan Africa and in settings where incidence is stable or increasing. This commentary explores the evolving landscape of HIV prevention, focusing on the trajectory of oral pre-exposure prophylaxis (PrEP), long-acting injectable cabotegravir (CAB-LA), and the newly emerging lenacapavir. While oral PrEP opened new possibilities, adherence challenges have limited its impact. CAB-LA demonstrated superior efficacy but encountered access, cost, and delivery barriers that restricted uptake. Lenacapavir, offering 6-monthly subcutaneous dosing with ≥ 99.9% efficacy in trials, holds the potential to overcome these hurdles. As of May 2026, lenacapavir had received regulatory approval in 17 countries, including several African nations, while regulatory reviews remained ongoing in multiple additional countries, reflecting the rapid global expansion of access to this long-acting HIV prevention option. However, its success depends on clinical promise, timely licensing, affordability, and integration into health systems. Drawing from real-world lessons of oral PrEP and CAB-LA, this paper argues that a proactive, coordinated rollout of lenacapavir could dramatically expand prevention reach. With global stakeholders aiming for 3 million users by 2028 and strategic licensing in 120 countries, the groundwork is in place. The recent release of WHO guidance recommending lenacapavir as an additional PrEP option further strengthens this momentum. Yet, equitable delivery, user-centred models, and strong policy backing will be critical. Ultimately, long-acting PrEP is not just a clinical breakthrough; it is a test of health systems' ability to deliver innovation at scale.

1. The global health community has long categorized antimicrobial resistance (AMR) as a slowly unfolding catastrophe [1,2]. The 2025 World Health Organization (WHO) Global Antimicrobial Resistance ...

Background and Objectives: Despite global commitment to the World Health Organization triple elimination initiative, evidence on integrated antenatal service delivery models that simultaneously address human immunodeficiency virus (HIV), syphilis, and hepatitis B virus (HBV) remains fragmented, particularly across diverse health-system contexts. Eliminating vertical transmission of HIV, syphilis, and HBV is a global priority. Pregnant women are disproportionately affected by these infections, and untreated maternal disease leads to significant infant morbidity. Integrating antenatal screening and treatment provides an opportunity to address all three conditions simultaneously. Purpose: This systematic review and meta-analysis aimed to identify and synthesise evidence on integrated antenatal service delivery models addressing HIV, syphilis, and HBV simultaneously within maternal health services. It specifically examined model characteristics, screening uptake, treatment and follow-up outcomes, implementation barriers and facilitators, and evidence on cost-effectiveness. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261342186). We searched Scopus, PubMed, Web of Science, and Dimensions for studies published between January 2007 and January 2026. Of 423 records identified, 11 met the inclusion criteria after excluding two studies that did not provide empirical results for an integrated service model addressing all three target infections simultaneously. Data on study characteristics, service delivery, diagnostics, outcomes, and implementation factors were extracted. A random-effects meta-analysis of proportions was conducted using the DerSimonian–Laird estimator with logit transformation. Results: Eleven studies covered Asia, Africa, Europe, and Latin America, mostly in low- and lower-middle-income countries. Integration ranged from rapid test packages in community clinics to comprehensive programmes including STI treatment, malaria testing, and HBV birth-dose vaccination. Pooled triple testing uptake was 97% (95% CI 92 to 100%). Large programmes achieved over 99% coverage and reduced HIV vertical transmission to below 3%. Pilot studies showed feasibility but noted stockouts, data gaps, and weak treatment linkage. Economic analyses supported cost-effectiveness. Conclusions: Integrated antenatal services appear feasible and can achieve high testing uptake, particularly in well-supported programmes. However, evidence remains uneven regarding treatment completion, infant follow-up, HBV prophylaxis, long-term transmission outcomes, and sustainability in resource-constrained settings. Key challenges include supply constraints, workforce limitations, and follow-up gaps. Future research should evaluate the full care cascade, not screening uptake alone.

Objective: This study provides the first systematic synthesis of the burden of Group B Streptococcus (GBS) colonization and invasive disease in Nigeria, with emphasis on prevalence, serotypes, and sequence types (STs). Method: This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines and was registered on PROSPERO (CRD420251155310). Searches were conducted across multiple databases, including Scopus, ScienceDirect, Web of Science, PubMed, Dimensions, and African Journals Online, as well as in Google Scholar and Google to identify relevant articles. In total, 426 records were retrieved, of which 43 studies met the inclusion criteria. A random-effects model was applied to estimate the pooled prevalence. Result: The pooled prevalence of GBS colonization in Nigeria was 12.0% (95% CI: 9.0–15.0%). Higher colonization rates were observed in Southern Nigeria (13.0%) than in Northern Nigeria (9.0%). The neonatal colonization rate was 16.0%. Colonization rates were 13.0% in pregnant women and 8.0% in non-pregnant individuals. Human immunodeficiency virus status showed no significant association with GBS colonization among pregnant women (OR = 1.47, p = 0.17). Invasive GBS disease was uncommon (3.0%) and occurred only in neonates. Across included studies, serotypes V and II were the most frequently reported, with ST19, ST182, and ST28 being the predominant STs. Conclusions: GBS colonization is common in Nigeria, with marked regional variation and heightened neonatal vulnerability to invasive GBS infections. Notably, nineteen states lacked surveillance data, highlighting substantial gaps in national monitoring. These findings highlight the importance of strengthening prevention strategies, expanding surveillance coverage, and implementing maternal screening and immunization programs to mitigate the burden of GBS.

Background: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality globally. Women with inherited or unexplained bleeding disorders such as von Willebrand disease (VWD), factor XI deficiency (FXI), platelet function disorders, or bleeding disorder of unknown cause (BDUC) face a higher risk. While tranexamic acid (TXA) is routinely used in obstetric care, its specific efficacy and safety in these populations remain unclear. Methods: A systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO: CRD420251082349). Databases searched included PubMed, Scopus, Web of Science, and Dimensions. Studies evaluating TXA for PPH prevention or treatment in women with bleeding disorders were included. Six cohort studies (2016–2024) involving 213 deliveries met the criteria. Three contributed to a meta-analysis on primary PPH; the other three were synthesised narratively. Results: TXA use was associated with a 56% reduction in primary PPH risk (risk ratio 0.44; 95% CI: 0.27–0.70; p = 0.0007), with no observed heterogeneity (I² = 0%). Because contributing cohorts were phenotypically heterogeneous (BDUC, FXI, mixed), the pooled effect reflects an average across disorders rather than disorder-specific efficacy. TXA also appeared to reduce secondary and severe PPH in some cohorts. However, bleeding occurred in 26–36% of high-risk deliveries despite prophylaxis. No maternal deaths or thromboembolic events were reported in 136 TXA-exposed cases. Attribution was complicated by concurrent use of desmopressin and platelet transfusions. Most studies had moderate to severe bias. Conclusions: TXA significantly lowers the risk of primary PPH in women with bleeding disorders and appears safe. Despite this, residual bleeding underscores the need for trials to optimise TXA use alongside disease-specific strategies. However, this conclusion is derived from only six observational studies with heterogeneous patient populations and co-interventions. The evidence remains preliminary and should be interpreted cautiously. TXA should be considered as part of a multimodal postpartum haemorrhage management algorithm rather than a stand-alone therapy.

Disrespect and abuse (D&A) during facility-based births remains widespread in low- and middle-income countries (LMICs). This disproportionately imp