Abstract: This study proposes a reproducible exploratory framework to link long-term territorial development with electricity demand in data-scarce contexts, and applies it to Ecuador’s Costa region. The pipeline combines three commonly available input streams: periodic census microdata, an official demand series, and macroeconomic aggregates. Socioeconomic heterogeneity across five non-uniform census rounds (1974, 1982, 1990, 2001, 2010) is summarized through Principal Component Analysis (PCA), and territorial indicators are projected to the demand horizon using low-order polynomial functions. Eleven regression specifications are compared on a log-transformed demand variable, and a rollingorigin backtesting scheme plus a 2020–2024 holdout are used for validation. The selected Trend OLS log model attains R2 = 0.551 and MAPE = 6.08%, and projects a regional demand of approximately 6,940 MW by 2050, equivalent to a compound annual growth rate of 3.45%. Beyond the Ecuadorian case, the results show that transparent, low-data pipelines based on harmonized census information, macroeconomic drivers and simple regression models can provide defensible medium- and long-term demand signals for planners in other emerging economies with limited high-frequency data.

Abstract: Congenital pericardial agenesis (CPA) is a rare anomaly that is often considered a benign incidental finding but may present with nonspecific symptoms and mimic structural heart disease. Its clinical relevance remains incompletely defined, particularly regarding the distinction between harmless anatomical variant and clinically significant condition. We present a retrospective two-center case series of four patients with imaging-confirmed CPA, combined with a narrative review of the literature aiming to evaluate the clinical spectrum, diagnostic challenges, and management implications of CPA. The clinical presentation of our patients was heterogeneous, ranging from incidental findings to chest discomfort and dyspnea. In all cases, initial echocardiography suggested alternative diagnoses, including right ventricular cardiomyopathy, atrial septal defect, or pericardial disease, leading to diagnostic uncertainty. Definitive diagnosis was established using multimodality imaging, particularly cardiac magnetic resonance and computed tomog-raphy, which demonstrated characteristic features such as cardiac levoposition and in-terposition of lung parenchyma. Three patients had complete left pericardial agenesis and one had a partial defect. All patients were managed conservatively, with no complications observed during follow-up.

Abstract: Background: Non-small cell lung cancer (NSCLC) is driven by distinct oncogenic al-terations with important therapeutic and prognostic implications. Noninvasive bi-omarkers that predict molecular status in surgically resectable disease may aid in their management. We investigated the association of preoperative primary-tumor SUVmax on PET/CT, smoking history, and corrected serum calcium levels with driver oncogenic alterations and PD-L1 expression in surgically resected NSCLC. Methods: We retrospectively studied 170 patients with surgically resected NSCLC at a single tertiary center. Resected tumors were assessed for EGFR, KRAS, and BRAF mu-tations, ALK and ROS1 rearrangements, and PD-L1 expression. Associations between molecular status, PD-L1 expression, and clinicometabolic parameters were evaluated using univariate analyses and multivariable regression models. Results: A driver alteration was detected in 51.2% of tumors, and 30% of evaluable cases showed high PD-L1 expression (≥50%). Corrected serum calcium was positively correlated with SUVmax and emerged as the strongest independent predictor retained in the final linear regression model, with pack-years also contributing independently. Most molecular subgroups did not show significant differences in SUVmax. EGFR-mutated tumors showed a trend toward lower SUVmax compared with EGFR wild-type tumors, although this did not reach statistical significance. Smoking history was not significantly associated with PD-L1 expression, and pack-years did not differ significantly across the molecular groups examined. Conclusions: In this cohort of surgically resected NSCLC, preoperative corrected se-rum calcium and smoking exposure were more closely associated with tumor meta-bolic activity than with specific molecular alterations. These findings suggest that simple clinical and biochemical parameters may provide complementary information, although their utility for discriminating individual molecular subgroups appears limited.

Abstract: This article develops a coherent set of outcome indicators for assessing progress in rural development in South Africa by directly linking policy objectives to measurable de-velopment outcomes. Drawing on a multidimensional conceptual framework encom-passing economic, social and environmental dimensions of rural development, the ar-ticle employs a document‑based research design analysing strategic plans of the De-partment of Rural Development and Land Reform, now known as the Department of Agriculture, Land Reform and Rural Development, for the period 2009–2025. Rural development objectives are first translated into ideal output indicators and subse-quently screened using internationally recognised indicator‑selection criteria to iden-tify outcome‑focused indicators aligned with policy intent. The analysis yields ten core indicators that capture key rural development outcomes, including employment, household income, housing quality, education, health, waste management, and sus-tainable natural resource use. These indicators strengthen the alignment between rural development policy objectives and measurable outcomes and provide a practical and replicable framework for monitoring rural development progress at both national and municipal levels. The proposed indicator set contributes to evidence‑based planning, monitoring, and accountability in efforts to promote a more inclusive and sustainable rural economy.

Abstract: Background: Autism spectrum disorder (ASD) affects approximately 1-2% of children worldwide, yet its etiology remains incompletely understood. Emerging evidence suggests that offspring of parents with autoimmune diseases show elevated autism prevalence. Notably, children of parents with psoriasis (OR 1.59), type 1 diabetes (OR 1.49-2.36), and rheumatoid arthritis (OR 1.51) demonstrate particularly strong associations.Hypothesis: I propose that autism may be conceptualized as an immune-metabolic disorder in which multiple pro-inflammatory cytokines—including TNF-α, IL-6, IL-1β, and IFN-γ—act through distinct molecular pathways yet converge on a common endpoint of mitochondrial dysfunction and cerebral energy deficiency. This convergence implies that it is the cumulative prenatal inflammatory burden, rather than any single cytokine, that drives the energy deficit. The resulting energy shortage may impair three critical processes: (1) synaptic pruning during neurodevelopment, (2) real-time social cognition including gaze processing and emotion recognition, and (3) protein synthesis of critical synaptic scaffolding molecules.The proposed mechanism is a chronic low-grade pro-inflammatory cytokine state—clinically silent, yet biologically consequential—arising from inherited inflammatory susceptibility and/or direct fetal exposure to elevated maternal inflammatory signaling during pregnancy. Unlike high-grade inflammatory states in which maternal and fetal survival are acutely threatened, low-grade cytokine elevations may proceed without conspicuous symptoms or detectable clinical signs, particularly when chronic. Although seemingly quiet, such a state may be insufficient to endanger maternal or fetal survival, yet sufficient to disrupt fetal brain bioenergetics during sensitive gestational windows—producing neonates who appear outwardly healthy at term while their neurodevelopmental trajectories have already been altered.I further propose that the well-documented "firstborn effect" in autism reflects maternal immune maladaptation during primigravid pregnancies. Additionally, for cases without parental autoimmune history, a speculative secondary mechanism is proposed: mitonuclear immune conflict, where paternal immune genes may partially recognize maternal mitochondria as non-self, generating endogenous pro-inflammatory signaling.Implications: This framework may provide an integrative account of disparate observations about autism pathophysiology and suggests that pro-inflammatory immune pathways and mitochondrial protection strategies merit further investigation for potential risk modification, particularly in pregnancies identified as high-risk through parental autoimmune or inflammatory disease. If supported by sufficient subsequent evidence, prenatal cytokine monitoring and corresponding clinical management—currently not part of routine obstetric care—may merit consideration by the medical community as a candidate strategy for autism risk reduction.

Abstract: Autoimmune diseases comprise a broad group of conditions that affect virtually any organ or tissue and share mechanisms of chronic, autoimmune-based inflammation. Once rare or unknown, they have become increasingly common in recent years, affecting individuals of all ages, including the elderly, due to the growing the number of older people. According to evolutionary medicine, if the frequency of a disease, or group of diseases, increases sharply over a few decades, the primary cause cannot be the effect of genetic alterations but rather the consequence of one or more alterations in the living conditions of the species. For autoimmune diseases, there is no environmental, dietary, or infectious factor that appears to correlate with their increased frequency. On the contrary, the epidemic of autoimmune diseases is likely correlated with serious alterations of our holobiont (i.e., our organism, the host species, plus the myriad of species coexisting with us). In particular, the critical factor appears to be the decreasing incidence of macroparasite infestations, without, however, excluding the effects of profound alterations in the bacterial ecosystems that are also part of our holobiont. The macroparasites modulate and curb the intensity of immune responses in order to survive in our bodies. In the coevolution of host organism and other species of the holobiont, a delicate balance has developed that is severely altered by the eradication of macroparasites. Therefore, it is necessary to move beyond the concept of macroparasites as harmful species by definition and therefore to be eliminated without hesitation. Alternatively, it is essential to study our holobiont as a whole and consider the balances of its ecosystems before modern alterations. Furthermore, it is essential to evaluate the effects of reintroducing macroparasite species with which we have coevolved into our holobiont.

Abstract: Explainable Artificial Intelligence (XAI) has emerged as a critical enabler for the adoption of machine learning models in high-stakes domains such as healthcare. While significant progress has been made in XAI for computer vision and natural language processing, tabular data—the predominant format of electronic health records—presents unique challenges and opportunities. This systematic review provides a comprehensive analysis of XAI methods specifically applied to tabular healthcare data for classification tasks. We examine 15 representative studies published between 2025 and 2026, covering three complementary perspectives: (1) intrinsically interpretable models such as Concept and Argumentation Models (CAM), (2) post-hoc methods including LIME, SHAP, and their variants like TransLIME, and (3) evaluation frameworks that assess both model-centered fidelity and human-centered clinical alignment. Our analysis reveals that SHAP remains the dominant post-hoc method for tabular healthcare data, achieving strong model fidelity but showing inconsistent alignment with clinical expert reasoning. Intrinsically interpretable models, such as CAM, offer transparency by design but require semantic feature descriptions. Emerging trends include integrating XAI with federated learning to preserve privacy, applying transfer learning to improve explanations in data-scarce settings, and deploying real-time XAI systems in occupational health. We identify critical gaps, including limited adoption of XAI in automated machine learning pipelines (in only 30.7% of studies), a lack of standardized evaluation metrics that combine technical fidelity with clinical utility, and the predominance of single-institution validation studies. This review provides researchers and practitioners with a structured roadmap for selecting, evaluating, and deploying XAI methods for trustworthy tabular healthcare classification.

Abstract: Background: Type 1 diabetes mellitus (T1D) is associated with chronic inflammation, platelet activation, and increased cardiovascular risk (CVR). The relationships between adipokines and platelet indices in long-standing T1D remain incompletely defined. Objective: To explore the relationships between adipokines (adiponectin and leptin), platelet indices, and inflammatory status in adults with long-standing T1D. Methods: This cross-sectional study included 124 adults with long-standing T1D and 59 non-diabetic controls. Platelet indices were obtained from automated blood count, and serum leptin (LEP), adiponectin (ADNC), and C-reactive protein (CRP) were measured using standardized assays. Associations were evaluated using correlation and multivariable regression analyses with adjustment for body mass index (BMI). Results: Platelet count (PLT) and plateletcrit (PCT) were higher in T1D compared with non-diabetic individuals (p=0.003 for both), while mean platelet volume (MPV) and platelet distribution width (PDW) showed non-significant upward trends. ADNC levels were higher in T1D (p< 0.001), whereas LEP and the leptin–adiponectin ratio (LAR) did not differ between groups. In T1D, LEP correlated with PLT (rho=0.235), PCT (rho=0.263), and CRP (rho=0.474), all p< 0.05. Similar associations were observed for LAR. No significant associations were found in non-diabetic controls. In multivariable analyses, PCT remained associated with LEP in T1D after adjustment for BMI, whereas in the control group LEP was associated with BMI only. Conclusion: LEP and platelet-related indices were associated in individuals with long-standing T1D, whereas ADNC showed no such relationships. These findings suggest a distinct pattern of adipokine–platelet associations in long-standing T1D.

Abstract: The Developmental Origins of Health and Disease framework proposes that environmental exposures during critical periods of development can shape physiological systems and influence the risk of chronic diseases later in life, including diabetes and metabolic syndrome. Most research on metabolic programming has focused on classical metabolic organs such as the liver, pancreas, and adipose tissue. However, skeletal muscle plays a central role in systemic glucose homeostasis and metabolic flexibility, accounting for the majority of insulin-stimulated glucose uptake in the body. Because muscle metabolism is closely regulated by neural activity through the organization of motor units, the development of the motor neuromuscular axis may represent an underexplored dimension of metabolic programming. This review examines evidence linking early-life metabolic environments to neuromuscular development and discusses how alterations in the maturation of motor neurons, neuromuscular junctions, and muscle fiber phenotype may influence long-term metabolic outcomes. Evidence from epidemiological studies, experimental models, and mechanistic research suggests that maternal metabolic disturbances, including hyperglycemia, obesity, and systemic inflammation, can influence fetal development through metabolic and inflammatory pathways affecting both neural and muscular components of the motor system. These findings support the hypothesis that the motor neuromuscular axis may represent a structural interface linking early developmental exposures to long-term metabolic regulation and risk of metabolic syndrome.

Abstract: Congenital Cytomegalovirus (cCMV) infection is the leading non-genetic cause of sensorineural hearing loss in newborns. Systematic nationwide screening programs are lacking. Antiviral valganciclovir therapy could improve auditory outcomes if initiated within the first 30 days of life, making timely diagnosis crucial. To address this, we investigated whether a hearing screening-based protocol is suitable. Between 2015 and 2019, newborns ≤21 days of age with repeated abnormal Newborn Hearing Screening (NHS) were prospectively enrolled at University Hospital Frankfurt. Oral mucosal swabs were tested for CMV DNA by real-time PCR, with confirmatory urine and blood-diagnostics in positive cases. Of 2,741 infants presenting for repeat NHS, 2,059 (75.1%) showed normal bilateral findings. Of the 682 (24.9%) with abnormal results, 575 (84.3%) were >21 days and thus ineligible. 107 infants (3.9%) met both criteria — abnormal NHS and age ≤21 days — of whom 100 entered per-protocol analysis. Two (2%) were confirmed cCMV-positive and received valganciclovir. Among the 48 infants who additionally underwent DBS testing, diagnostic sensitivity and specificity were 100%. The presented NHS–driven cCMV protocol reliably identified cCMV-infected newborns timely to offer antiviral therapy. In the absence of universal cCMV screening, this targeted approach offers a challenging, but WHO-screening-criteria-compliant strategy to enable timely antiviral intervention.

Abstract: Background: Good Pharmacy Practice (GPP) provides a globally recognized framework to promote the safe, effective, and rational use of medicines while strengthening the role of pharmacists in patient-centered health care. To enhance awareness and practical understanding of GPP principles in the local context, a one-day workshop titled “GPP: Strengthening the Role of Pharmacists in Health Care Delivery” was conducted. Methods: The workshop was facilitated by subject experts and faculty members and included focused presentations and interactive discussions addressing key components of GPP, such as rational use of medicines, medication counseling, professional ethics, and the evolving responsibilities of pharmacists. Particular emphasis was placed on the current status, challenges, and opportunities for GPP implementation in Nepal in comparison with international standards. Participant feedback was collected at the end of the program. Results: Participants reported a high level of satisfaction with the workshop, highlighting the relevance and clarity of the content as well as its perceived professional and career-related benefits. Interactive discussions enabled participants to identify context-specific challenges and opportunities in pharmacy practice in Nepal. Minor logistical limitations, including sound system and internet connectivity issues, were noted but did not significantly affect overall engagement. Conclusion: The workshop underscored the importance of continuous professional development initiatives to strengthen the implementation of GPP and enhance pharmacists’ contributions to health care delivery. Conducting similar capacity-building programs, particularly in remote and underserved regions, may support the promotion of standardized pharmacy practice and contribute to improved health care outcomes in Nepal.

Abstract: Numerous adverse effects caused by oxidative stress are commonly observed in preterm infants. This stress is caused by the oxidative burden resulting mainly from supplemental oxygen and parenteral nutrition (PN), and by their precarious antioxidant defense system. The natural antioxidant defense against these oxidant molecules relies on glutathione, levels of which are low in preterm infants. Given that several short- and long-term biological complications, including lung damage, are associated with this oxidative stress, the aim of this review was to discuss possible methods for reducing it. Consequently, after briefly discussing the effectiveness of reducing oxidative stress-related effects achieved through adequate photoprotection of PN, it is proposed to correct glutathione deficiency by adding glutathione to PN intended for premature infants. This article addresses the 1) importance and efficacy of parenteral glutathione in preventing oxidative stress, 2) causes of glutathione deficiency and ways to prevent it, 3) reasons why the disulfide form (GSSG) is recommended over the reduced form (GSH) for enriching PN, and 4) safety profile of glutathione infusion. In conclusion, we believe that the time has come to improve the health of premature infants by providing them with GSSG supplemented PN that is adequately photoprotected.

Abstract: We develop a unified first-order framework for relativistic fields of different spin, in which the dynamics are governed by a common operator-based equation. This formulation provides a coherent description of scalar, spinor, vector, and tensor fields within a single structure and reproduces the corresponding second-order wave equations in appropriate limits. A central result is the emergence of a consistent spin-2 sector from the same underlying dynamics. By constructing the tensor field as a bilinear combination of internal spacetime degrees of freedom, we obtain a symmetric rank-2 field with the correct number of independent components. In the massless limit, the resulting equation matches the structure of linearized gravity, while source-like terms arise naturally from quadratic combinations of field derivatives, providing an intrinsic origin for an effective energy–momentum tensor. The Lagrangian formulation yields conserved quantities via Noether’s theorem and reproduces derivative structures consistent with the weak-field Einstein–Hilbert action. These results suggest that gravitational dynamics may emerge from a more fundamental first-order field theory.

Abstract: During atmospheric reentry, a spacecraft is enveloped by a turbulent plasma sheath that induces severe signal degradation and communication blackout. Conventional mitigation strategies primarily focus on reducing average attenuation but fail to address the dynamic fluctuations in plasma density (typically 20%–40%), which cause significant group velocity dispersion (GVD), pulse broadening, and intersymbol interference. To overcome this limitation, this paper proposes an active decoupling framework that dynamically tunes an external magnetic field to suppress turbulence-induced signal distortion in the reentry plasma sheath. By establishing a wave propagation model for right-hand circularly polarized (RCP) waves in magnetized collisional plasma and introducing a sensitivity analysis of propagation parameters with respect to plasma density fluctuations, we derive the condition under which the first-order sensitivity of GVD vanishes. Under this condition, a dynamic balance between collisional effects and frequency detuning renders the system immune to density perturbations, effectively decoupling signal transmission from plasma turbulence. Numerical simulations demonstrate that, under optimal parameter matching, pulse broadening is suppressed by several orders of magnitude, and the broadening factor remains near unity over extended propagation distances. Furthermore, reentry trajectory analysis reveals that static matching is insufficient in dynamically evolving environments, motivating the necessity of adaptive magnetic field control. This work provides a novel physical-layer paradigm for mitigating reentry blackout by actively decoupling signals from turbulence via dynamically tuned magnetic fields.

Abstract: Background: Heme oxygenase (HO) is an antioxidant enzyme ubiquitously present in the body. Oxidative stress is one of the main causes of male infertility. Here, we aimed to analyze the correlation between serum heme oxygenase-1 (HO-1) level and sperm count, motility, normal morphology, and sperm DNA fragmentation index (DFI) in infertile male patients. Methods: In this retrospective cross-sectional study, serum HO-1 concentrations, routine semen parameters, sperm morphology, and DFI were analyzed in 178 patients. Subjects were stratified into high-HO-1 (≥278 ng/L; n=77) and control (<278 ng/L; n=101) groups. Intergroup comparisons and Spearman's correlation analyses were performed. Results: The high-HO-1 group demonstrated significantly increased normal sperm morphology (P<0.05) and reduced sperm DFI (P<0.05) versus controls. No significant intergroup differences existed in sperm concentration or progressive motility (P>0.05). Correlation analysis revealed positive associations between HO-1 levels and normal morphology (r=0.190, P<0.05), and negative correlations with DFI (r= -0.195, P<0.05).Conclusions: We first identified significant correlations between serum HO-1 levels and both sperm DFI and normal morphology in infertile men, suggesting HO-1's protective role in spermatogenesis. Serum HO-1 quantification may offer a novel strategy for male fertility assessment.

Abstract: In this paper, we are concerned with the existence of crossing periodic solutions for a class of second order discontinuous undamped Duffing equations. By applying the Poincaré-Bohl theorem, we obtain several existence results of 2π crossing periodic solutions.

Abstract: Healthy and sustainable food consumption implies not only making conscious food choices but also limiting waste. In fact, interventions targeting choices are effective only if the healthier food selected is not wasted on the plate. The aims of the study were: to quantify plate and service waste in hospital canteens; to characterize plate waste (PW) composition and environmental indicators; to compare PW before and after an intervention to improve food choices. Trays of users who gave consent were photographed (N=1,624) in three hospital canteens in Italy. PW was quantified visually, and energy, nutrients, and environmental indicators were estimated using portion sizes and recipes provided by canteen staff. PW was 4.7% (2.0-6.1% by canteen), corresponding on average to 33.1 g/tray, 43.6 kcal/tray, 69.6 gCO2 eq./tray and 61.8 LH2O/tray. Side dishes contributed the most to total PW (30%). The canteen where PW had decreased significantly (median among wasters: -48.9 g/tray) was the one with the poorest result in food choices. PW increased, though not significantly, in the other two canteens. Service waste analysis revealed considerable variability, probably driven by canteen management. In conclusion, the present study highlights the importance of including plate and service waste in public health campaigns.

Abstract: In the context of SDG 7 and SDG 13 of the 2030 sustainable development agenda, a new performance indicator started to gain momentum in scientific research: the renewable energy productivity. Understanding the drivers and the challenges of green energy productivity could help add on to the classical focus of renewable energy research on infrastructure, technical and economic feasibility, environmental and social impacts, by considering more the performance indicators in this field. Only very few studies explored the influencing factors of the renewable energy productivity. Thus, this research aims to reveal the impact of social, economic, energy, and environmental variables on the green energy productivity. The methodological approach involves bibliometric analyses of the literature on green energy productivity (GEP), and panel data regression models involving 16 independent variables. The main findings indicate positive effects of green taxes, female participation in the workforce, and highly educated people on GEP, pointing out the importance of green taxation, education, and gender equality in sustainable development. On the other side, negative relationships of green energy productivity with economic growth, traditional energy variables, and air pollution were found for the European Union’s member states over 2007 and 2023. The results suggest that the analyzed European countries based their economic growth on traditional resources, with less importance provided to the renewable resources and green technologies, as the share of renewable resources of GDP was also negatively correlated. While private financial resources increases the green energy productivity, questions about research and development investments, urbanization, and diversity index are still debatable.

Abstract: Achieving carbon neutrality has become a central policy objective for emerging economies, particularly the BRICS countries-BRICS (Brazil, Russia, India, China, and South Africa) which collectively account for a substantial share of global carbon emissions and energy consumption. The transition toward green energy, rapid technological innovation, and the expansion of green finance mechanisms are increasingly viewed as critical drivers of sustainable development and environmental improvement. However, empirical evidence integrating these three dimensions within a unified analytical framework for BRICS remains limited. This study examines the contribution of green energy transition, technological innovation, and green finance to achieving carbon neutrality in BRICS countries using a Pooled mean group auto regressive distributed Lag (PMG ARDL) framework and Dumitrescu–Hurlin panel causality analysis. The results indicate that green energy transition significantly reduces carbon emissions in both the long run (−0.45) and short run (−5.65), emphasizing the importance of shifting toward renewable energy sources. Technological innovation exerts a significant negative effect in the long run (−0.17), reflecting efficiency gains and cleaner production, although its short-run impact remains insignificant. Similarly, green finance improves environmental quality in the long run (−0.10) by supporting low-carbon investments, while short-run effects are statistically insignificant due to adjustment frictions. Economic growth increases emissions in the long run (0.43), confirming the scale effect, whereas trade openness reduces emissions (−0.87), indicating the role of technology diffusion. The error correction term (−0.76) confirms a strong convergence toward long-run equilibrium. The causality analysis reveals unidirectional causality from green energy transition, technological innovation, and green finance to carbon emissions, while bidirectional causality exists between economic growth and emissions, highlighting a feedback mechanism. Policy implications suggest that BRICS economies should strengthen green financial systems, accelerate renewable energy adoption, promote innovation-driven sustainability, and design growth strategies that decouple economic expansion from environmental degradation.

Abstract: Sanitation knowledge, attitudes, and practices (KAP) among primary school learners can aid in disease prevention through sanitation as well as in improving learner academic achievement. Despite this, evidence regarding sanitation KAP among rural South African primary school learners is inadequate. In this study, sanitation KAP among grade 6 learners in Sekhukhune District, Limpopo Province, were investigated. The study adopted a quantitative cross-sectional design among 249 learners chosen randomly from nine primary schools. Data were collected utilizing a structured questionnaire which was pre-tested prior to the study. Analysis was performed using SPSS version 29 with the help of the Pearson chi-square test at a significance level of 5%. Of the total sample size, 59.0% exhibited adequate knowledge about sanitation (≥80% correct answers). Nonetheless, 41% held erroneous views regarding hand washing that it was enough for hands to look clean even without the use of soap, while only 41.0% used soap always after defecating. Open defecation was noted by 12.4% of the learners, where non-functional toilets accounted for 73% of these cases. Over half (45.8%) of the respondents were embarrassed about using school toilets. Knowledge about ill effects of poor hygiene on one's health correlated significantly with the age of learners.