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Plasmablast, memory B cell and T follicular helper cell responses after human papillomavirus vaccination: effect of dose number and age.
No full textMultiple doses of HPV vaccines induce durable, antibody-mediated protection against HPV infections and HPV-associated diseases. Although actual protection against disease by a single HPV vaccination dose has not been confirmed in randomised trials, this regimen induces protection against incident and persistent HPV infection, similar to multi-dose schedules. However, the cellular mechanisms driving durable antibody responses to subunit vaccines remain poorly understood. B cells and T follicular helper (Tfh) cells play central roles in long-term antibody-mediated immunity. We characterised plasmablast, memory B cell (Bmem), and Tfh cell responses to assess the effects of dose number and age following HPV vaccination in Gambian females aged 4-26 years. A significant induction of HPV16/18-specific IgM plasmablasts occurred after the first dose, while robust HPV16/18-specific IgG plasmablast, Bmem, and Tfh responses were observed after two or three doses. Activation within the total Tfh pool increased with decreasing age, whereas HPV16/18-specific Tfh activation was higher in older vaccinees. These findings demonstrate the potential of multi-dose HPV vaccination schedules to sustain antibody protection through coordinated B cell and Tfh responses and highlight the need for continued monitoring of single-dose regimen. Exploring HPV vaccination in children under nine years may improve delivery and uptake
The tuberculogenic environment.
Full text linkTuberculosis persists as the world's deadliest infectious disease, despite improved diagnostics and effective treatment. The tuberculogenic environment describes the sum of influences, vulnerabilities, policies, life conditions, and health factors that sustain the tuberculosis pandemic in vulnerable communities. The persistence of these environments is attributable to challenges upstream of the health system, involving sectors such as trade, taxation, finance, agriculture, employment, social services, and education. The availability, affordability, access, and acceptability of safe infrastructure (including housing), nutritious foods, protection against harmful consumption (tobacco, alcohol, sugar, etc), and adequately resourced health services are all linked to tuberculosis risk. Yet people affected by tuberculosis and national tuberculosis control programmes continue to bear almost the sole responsibility for a problem that is largely beyond their control. Reframing tuberculosis through the lens of complex systems science highlights the array of decision makers who, by action or inaction, have a shared responsibility to end tuberculosis as a global pandemic
"It left me burnt": Traditional treatment and stigma experiences of cutaneous leishmaniasis in Kalu district, Ethiopia.
Full text linkBACKGROUND: Cutaneous leishmaniasis (CL) is a major public health issue in Ethiopia, often causing lesions on the cheeks, nose, and lips that take months to heal, and leave permanent scars. Data on the lived experiences of people with CL in Ethiopia is needed to support design of interventions that could respond to their needs. METHODS: We interviewed 18 people with active or healed CL to understand their experiences of the disease in Kalu district, South Wollo, Ethiopia. Interviews were audio recorded, transcribed and translated for content analysis which focused on experiences of symptoms, treatment and the consequences of living with CL. RESULTS: Experiences of CL symptoms and treatments used by people with CL in Kalu were associated with physical discomfort and significant emotional distress. CL began with pain, pruritus, bleeding and ulceration. Most people with CL used painful treatments such as plant-based traditional medicines which irritated the skin or heat to cauterize lesions at home or by traditional healers and expressed dissatisfaction at being left "burnt" but not healed. During treatment, individuals reported abstaining from sexual intercourse as this was believed to worsen CL; people also avoided contact with others who'd recently had sex. Individuals with CL experienced psychological distress, reduced self-worth, and self-exclusion from social participation due to anticipated or experienced stigma, fear of spreading the disease and worsening their own disease. CONCLUSIONS: Community engagement strategies to promote early case detection and treatment at health facilities should acknowledge the specific fears, informational needs and challenges that shape existing care-related behaviours of people with CL. Providing information about the safety of common traditional treatments and correct information about contagiousness are key areas that public health programmes could address to reduce some of the disease's impacts. Existing cultural attitudes that emphasize shared vulnerability to CL and underlie non-stigmatizing behaviors could also inform stigma interventions
'We should be focusing on why we eat, what we eat and how it makes us feel, not how many calories it has': a photovoice study exploring young people's views on the out-of-home calorie labelling policy in England and their priorities for changing the local food environment.
Full text linkBackground: Obesity is a complex problem, a perpetual challenge for governments to address. In 2022 as part of a government obesity strategy, a mandatory calorie labelling policy for out-of-home food sectors was implemented in England. Little is known about the impact of this policy on young people; therefore, this study explored young people views on the policy and their priorities for change in their local food environments.
Methods: We conducted a participatory, qualitative study using Photovoice with 20 young people (12–17 years old) living in two communities in areas of high deprivation in England, a coastal town and an inner-city neighbourhood. Young people were involved in photography-led focus groups, a photo ‘walkabout’ in their local highstreets, and a local community photography exhibition. A textual-visual thematic analysis framework was used to analyse textual and visual data.
Results: Young people described challenges with navigating complex out-of-home food environments and reflected on whether the policy was effective in addressing these challenges. Three themes were identified: (1) Relevance of calories for informing healthy eating. Few found calories alone helpful to gauge whether something was healthy. However, some expressed surprise at the energy content of drinks and found calorie information useful for understanding ‘liquid calories’. (2) Commercial influences on food choices. Participants were aware of how commercial activities shaped their food environments, often in unequal ways, and how targeted marketing/advertising for young people can be more influential than calorie information on menus and food labels. (3) Value placed on the relational aspects of food. Young people recognised food as more than fuel, valuing its social and cultural significance and believing it should be produced and sold ethically and sustainably.
Conclusion: Young people viewed calorie labelling as unhelpful for making healthy eating choices, emphasising instead the need to address structural barriers and support for them to navigate increasingly complex and inequitable food systems. They demonstrated their role as informed food citizens by exercising social responsibility to shape their food environments. It is therefore vital to amplify their voices in public discourse and support their participation in shaping food policy and governance
Implementing effective cataract surgical coverage: a comparative qualitative study in Kenya and Nepal.
Full text linkINTRODUCTION: The WHO has set a 2030 target to raise effective cataract surgical coverage (eCSC) by 30 percentage points in every country, requiring gains in surgical access and quality. Despite this mandate, evidence on how low- and middle-income health systems are implementing eCSC remains limited. METHODS: We conducted a qualitative comparative case study in Kenya and Nepal. 20 interviews were held with senior stakeholders from government, non-governmental organisations, academic institutions and clinical networks. Transcripts were thematically analysed using the consolidated framework for implementation research, adapted into a growing systems framework to capture national-level dynamics. RESULTS: Implementation unfolds within the inherent structures of each cataract system rather than through centrally imposed directives. In Kenya, cataract services operate within devolved county structures supported by non-governmental organization (NGO) partnerships and national technical coordination. In Nepal, vertically organised NGO networks deliver care through a hub-and-spoke outreach model with limited government oversight. Both systems incorporate context-specific adaptations to overcome barriers in access and postoperative quality. Public-private partnerships expand reach but are weakened by fragmented financing, reliance on donors and high out-of-pocket costs. Outcome monitoring is sporadic and seldom informs planning, limiting system-wide learning. CONCLUSION: The eCSC target prompts change less by prescribing reform than by revealing the features that enable or constrain implementation. Sustained progress will require embedding outcome monitoring within routine information systems, strengthening public stewardship of mixed provider networks, mobilising domestic financing and designing services attuned to geographic and sociocultural realities
Comparison of portable devices with standard glaucoma diagnostic testing for the detection of glaucoma for the purposes of glaucoma case finding in low-and middle- income countries.
Full text linkBACKGROUND/OBJECTIVES: Glaucoma is a leading cause of blindness worldwide, with the greatest burden in low- and middle-income countries (LMICs) where access to diagnostic services is limited. Portable devices, which are simple to use and comparable to standard tests, may strengthen early detection and referral. This study evaluated selected portable glaucoma assessment devices against standard reference tools in Nigeria and identified which tests or combinations most closely matched a glaucoma diagnosis. SUBJECTS/METHODS: In this cross-sectional study at the University of Abuja Teaching Hospital, 312 participants (524 eyes) underwent both portable and conventional testing: Peek CS vs. Pelli-Robson (contrast sensitivity), Peek Acuity vs. LogMAR (visual acuity), iCare vs. Goldmann Applanation Tonometry (GAT) (intraocular pressure), Eyecatcher vs. Humphrey Field Analyzer (visual fields), and Remedio handheld fundus camera vs. slit lamp (optic discs). Agreement, diagnostic accuracy (AUC), completion rates, and patient preference were assessed. RESULTS: Strong correlations were observed between iCare and GAT IOP (r = 0.96), Peek and LogMAR acuity (r = 0.82), and Remedio handheld fundus camera and slit lamp CDR (r = 0.82). The Remedio handheld fundus camera achieved the highest diagnostic accuracy (AUC = 0.91; sensitivity 82.4%, specificity 99.8%). Combining Remedio with Eyecatcher MD (AUC = 0.86) or iCare IOP (AUC = 0.83) also performed well. Portable devices were faster, had higher completion rates, and were strongly preferred by participants, particularly iCare and Eyecatcher. CONCLUSIONS: Portable devices showed good agreement with standard tools and high acceptability, supporting their potential role in glaucoma screening in resource-limited settings. Further community-based validation is recommended
Versatility, value and limitations of using health and demographic surveillance system data for secondary analyses: guidance for researchers, using examples from existing analyses
No full textHealth and Demographic Surveillance Systems (HDSS) are geographic open cohorts operating in countries with absent/incomplete vital registration. Data on demographic events, socio-demographic indicators, and certain health conditions are regularly gathered on the whole population of a small area, sometimes for decades. In the same countries there are often also nationally-representative demographic data available from roughly quinquennial Demographic and Health Surveys (DHS). This paper uses a comparison with DHS data, and an in-depth review of complex HDSS analyses to demonstrate the utility of using HDSS data for secondary analyses, and to provide guidance on the conduct and reporting of these analyses. DHS data has advantages in terms of representativeness and data access, and HDSS in terms of scope for complex longitudinal analyses which may take household and familial contexts into account. HDSS also have issues which make interpretation of data and conclusions challenging: lack of data on in- and out-migrants when they are outside of the area, and repeatedly collected data may result in inconsistencies and/or more reliable data for longer-term residents. Despite these challenges, the reviewed HDSS data analyses demonstrate the flexibility and unique strengths of HDSS data. HDSS data users are recommended to clearly state their methods, particularly how they approached the issues specific to HDSS analyses of handling repeated data, migration and missing data: while there were interesting ways used to approach these issues, they were often not discussed. HDSS data producers are further encouraged to ensure that the data are being used to their full potential
Impact of an electronic clinical decision support algorithm (eCDSA) on antibiotic prescribing in primary care in Cambodia: A cluster randomised controlled trial.
No full textOBJECTIVES: Poorly targeted antibiotic use in primary care is a driver of antimicrobial resistance. Electronic clinical decision support algorithms (eCDSAs) integrating point-of-care tests may improve prescribing. We evaluated the impact of an eCDSA on antibiotic prescriptions among febrile patients attending primary health centres in Cambodia.
METHODS: In this cluster randomised controlled trial, 30 PHCs in Battambang Province were randomised (1:1) to either adopt the eCDSA or routine care. The eCDSA integrated clinical assessment with pulse oximetry and C-reactive protein tests. Patients aged ≥1 year with acute febrile illness were eligible. The primary outcome was the proportion of patients prescribed antibiotics, using an age- and sex-adjusted generalised linear mixed model, incorporating PHC as a random effect. Secondary outcomes included hospital referral rates and self-reported recovery at 7 and 14 days.
RESULTS: Between May 2024 and January 2025, 4752 patients were enrolled (2324 intervention; 2428 control). Crude proportions of patients prescribed antibiotics were 56.1% and 60.5% in intervention and control arms, respectively. No difference in prescribing rates between the arms was detected (adjusted odds ratio [aOR] 0.64; 95% CI: 0.20-1.99; P = 0.44). Among patients for whom the eCDSA did not recommend antibiotics, almost half (45.6%) received a prescription. Hospital referral was rare (2.0%) and most patients reported full recovery within 7 days (94.3%).
CONCLUSION: This eCDSA did not reduce antibiotic prescription in this setting. Relatively low adherence to the eCDSA's recommendations suggests that, to support a change in prescribing behaviour, future iterations of this intervention should incorporate enhanced training, greater adaptation to local health sector, and deeper engagement with frontline healthcare workers
Stakeholder Perspectives on Evaluating Emergency Medical Teams Deployments.
Full text linkOBJECTIVE: A standardized framework for evaluating Emergency Medical Teams (EMT) deployments is currently lacking. This study aimed to identify evaluation practices and elucidate stakeholder perspectives on evaluating EMT deployments.
METHODS: Qualitative interviews were conducted with seventeen participants from all World Health Organization regions, including EMT members, researchers, funders, EMT deploying organizations, and host governments. Thematic analysis using Braun and Clarke's 6-step process was applied to generate data-driven codes and themes.
RESULTS: Participants generally agreed on the importance of evaluating EMT deployments and sharing lessons learned to establish best practices. Participants recommended that evaluations be carried out externally for objectivity, incorporating both qualitative and quantitative data. They highlighted that voices of local stakeholders are essential but often overlooked. Participants identified evaluation areas which could be used to develop a comprehensive evaluation framework, which included leadership, partner coordination, information management and planning, health operations and technical expertise, operations support and logistics, and finance and administration.
CONCLUSIONS: Stakeholders generally recognized the value of establishing a standardized evaluation framework for EMT deployments to enable sharing of best practices and learning for improvement. Further research should prioritize identifying evaluation priorities, with next steps being piloting in both training and deployment settings
Retention and longitudinal change in Insight 46, an intensive neuroscience sub-study of the 1946 British birth cohort.
Full text linkOBJECTIVES: Participant retention is a significant challenge in ageing and dementia research. This analysis investigated (a) factors associated with retention in Insight 46, a neuroscience sub-study of the 1946 British birth cohort, and (b) clinical and cognitive changes over 2.5 years of follow-up. RESULTS: Of 502 participants assessed at baseline (mean[SD] age: 70.5[0.7] years), 442 returned for follow-up (mean[SD] interval: 2.5[0.3] years), representing a retention rate of 88%. Being β-amyloid positive (measures using positron emission tomography), female sex, and older age at baseline associated with lower odds of retention, while completion of neuroimaging and better cognitive performance at baseline- particularly on memory testing- related to higher odds of retention. By the time of follow-up, 14 participants were deceased, 12 of whom were female. Over follow-up, improvements were noted in certain cognitive tests (face-name test, logical memory delayed recall) with declines seen in others (mini-mental state examination, digit-symbol substitution test). Increases in self- and informant-reported cognitive complaints, cognitive disorder diagnoses, and motor abnormalities were also observed, alongside declines in blood pressure. These results have implications for the interpretation and generalisability of Insight 46 data and may be relevant to the planning of other longitudinal studies in this field