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Children's Caregiving and Growth in Northwestern Tanzania: Limited Evidence That Support From Specific Caregivers Is Associated With Better Growth.
Get PDFReceiving care from individuals other than one's mother (i.e., allomothering) is a universal aspect of raising children, but whether and how such care impacts children's health remains subject to debate. Existing studies in low-income societies largely use broad proxies for caregiving behaviors rather than measuring childcare activities, which may mask variation in allomothering and, thus, its impact on children's health. Using data collected to address these limitations we measure, for 808 children under 5 years in Northwestern Tanzania: (a) Maternal residence, (b) receipt of two childcare types from seven caregivers; and (c) children's growth (height-for-age and weight-for-height). We predict that (1) allomothering will be beneficial for children's growth and (2) benefits of allomothering will be most evident within mother nonresident households. We demonstrate that children receive care from a range of allomothers, even when mothers co-reside; and there are associations between care from different relatives. Receiving care from relatives of the same lineage tends to be positively associated, whereas care from fathers is negatively associated with care from maternal relatives. Maternal residence is not associated with child growth. We find little support for our predictions, with few and inconsistent associations between allomothering and child growth. Our findings suggest that our measures of care, while more nuanced than previous proxies, do not fully capture the complexity of caregiving. Pathways between allomothering and child growth may be further elucidated through more comprehensive care indicators, which specifically measure maternal need for help, and whether allomothering is in addition to, or substitutive of, maternal care
Primary healthcare readiness for nutritionally at-risk infants aged under 6 months: a facility-based survey in Senegal.
Get PDFBACKGROUND: Malnutrition in infants aged <6 mo (u6m) is poorly identified and managed in many countries, increasing the risk of poor growth and development. Addressing this gap, 2023 WHO malnutrition guidelines recommend assessment, classification and treatment at primary care level. This study aimed to assess primary healthcare facility readiness for nutritional care in infants u6m. METHODS: We adapted the Harmonized Health Facility Assessment (HHFA), adding items for Management of small and nutritionally At-risk Infants u6m and their Mothers (MAMI) at five care contact points. Our HHFA-MAMI tool captured 342 items using healthcare provider interviews, observations and registers data to calculate mean scores per area and median patient visits. RESULTS: We surveyed 15 facilities in Senegal. General readiness scored 69.5%, MAMI availability and readiness 37.7%. Infrastructure (72.0%) and health workforce (60.7%) were available, while equipment (32.5%) and training (22.3%) scored low. Infants were frequently assessed (53.6%), not often classified (15.2%) as at risk, nor adequately treated (38.2%). Comparing contact points, delivery and sick child clinic scored highest in readiness, immunization in utilization. CONCLUSIONS: Primary care readiness gaps exist in classifying and treating at-risk infants u6m, equipment and training. We found opportunities at each of the five contact points to implement WHO-recommended care
Opportunities and challenges for the adoption of novel platform technologies to develop veterinary bacterial vaccines.
Get PDFVaccine platform technologies provide standardised vehicles for the delivery of diverse antigens to elicit specific immune responses. The deployment of these platforms for novel vaccine development is influenced by a wide range of factors that must meet end-user needs for uptake, which includes cost, frequency of delivery and dependency on cold-chain storage. These factors can be identified by constructing a vaccine target product profile (TPP) that helps to direct the research effort towards the desired goal. The COVID-19 pandemic has exemplified how viral vectored and nucleic acid-based platforms can be rapidly deployed for population disease control. While successful for viral vaccines, the applicability of these platforms for bacteria is less well defined. Bacteria present different challenges to vaccine design from viruses due to their diversity and complexity. Other platform technologies are under development to address these challenges. The more we understand about vaccine platforms, the more adaptable they become, particularly for deployment across species with benefits for One Health. A Workshop was held at the 13th International Veterinary Immunology Symposium (IVIS) in South Africa in November 2023 to discuss the opportunities and challenges in deploying novel platform technologies for vaccine development against bacteria, particularly those that are affordable to low-middle income countries (LMICs). We report here on the outcomes of the presentations and discussions at the Workshop, highlighting the gaps and potential solutions through collaborative global efforts
Documentation of the monthly validation of malaria rapid diagnostic test (RDTs) results in Benin
Get PDFSince January 2023, the Ministry of Health (MoH) of Benin has implemented a nationwide, decentralised monthly malaria RDT validation program at the district level. Early results indicate improved data accuracy, reduced false-positive diagnoses, and decreased antimalarial drug use—despite stable testing volumes—suggesting better alignment between reported cases and clinical reality. The Centre de Recherche Entomologique de Cotonou (CREC) was engaged by PMI Insights to document and share the MoH’s procedures, experiences, and lessons learned over the first 18 months of implementation. This included document reviews, key informant interviews, and observation of validation sessions.
The program builds on earlier efforts dating back to 2012, addressing shortcomings of previous quarterly validation strategies—such as delays and poor adherence to RDT results—by introducing monthly district-level sessions involving both public and private facilities. A successful pilot in 2018–2019 showed significant improvements in data consistency and health worker motivation. The validation sessions are chaired by district statisticians and involve peer data checks using primary tools like registers and used RDT cassettes. Funded by PMI, the program runs on a monthly national budget of approximately 21.4 million FCFA. Despite strong structure and stakeholder engagement, key challenges remain, including administrative delays, limited private sector participation, and a need for digital tools to enhance efficiency. Sustainability concerns highlight the need to explore more targeted and government-led funding approaches
Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case-control study in the extra-Amazon Region from 2011 to 2019.
No full textBACKGROUND: Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths. METHODS: A case-control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level. RESULTS: The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04-1.43), low education (elementary school OR = 2.21; 95% CI 1.78-2.75 or high school OR = 1.72; 95% CI 1.39-2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15-1.96 or abroad OR = 1.72; 95% CI 1.28-2.32), high parasite count (501 to 10,000/mm3 OR = 1.51; 95% CI 1.27-1.80, 10,001 to 100,000/mm3 OR = 1.77; 95% CI 2.87-1.96 or higher than 100,000/mm3 OR = 3.15; 95% CI 2.20-4.50) and delayed treatment (after 3-7 days symptoms onset OR = 1.74; 95% CI 1.36-2.24 or 8 days or more OR = 2.08; 95% CI 1.62-2.66). Active case detection was a protective factor (OR = 0.65; 95% CI 0.54-0.78). CONCLUSIONS: Delayed treatment remains a key factor in the occurrence of severe malaria, leading to high parasitaemia and revealing inequalities in access to healthcare based on socioeconomic differences. Travel to the Amazon Region or other countries also poses a challenge, requiring strengthened traveller health strategies and increased surveillance awareness to promptly suspect and identify cases
Governance of national public health agencies: a crucial yet neglected aspect of health emergency preparedness and response.
Get PDFPPE50 variants as novel phylogeographic signatures of host-pathogen co-evolution in tuberculosis.
Get PDFWhile evidence supports co-evolution between Mycobacterium tuberculosis and humans, underlying mechanisms remain unclear. We identified PPE50 as a novel subfamily of PE/PPE proteins comprising eight variants. Surveying 387 M. tuberculosis complex (MTBC) strains representing global phylogeography, we found PPE50 variants are lineage-specific and stably associated with geographic regions, defining them as phylogeographically-associated proteins (PAPs). PPE50-381 is the ancestral variant (present in early-branching M. canettii) and the only variant observed in both Ancient and Modern MTBC lineages. Transcriptomic analysis confirmed that ppe50 variant genes are expressed in strains from respective MTBC lineages, but not in all L1 strains and sub-lineages L2.1 and L4.1 where the gene was deleted. In silico analysis revealed significant structural diversity among variants, particularly in C-terminal regions. This strong association of M. tuberculosis protein diversity with phylogeography suggests PPE50 may contribute to MTBC adaptation to different host populations. Further characterization of PPE50 and other PAPs may facilitate improved targeted diagnostics, therapeutics and vaccines
Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes
Get PDFIn randomized controlled clinical trials, composite outcomes are often used to study treatment effects. This approach is popular because it increases the number of observed events, enhancing statistical power while reducing the required patient sample size. However, composite outcomes do not provide insight into the effect of individual endpoints. This becomes particularly relevant when mortality is combined with less critical but clinically relevant endpoints or when the clinical importance of individual endpoints varies significantly. As a result, interpreting composite outcomes can be challenging.
This narrative review introduces the win ratio (WR), a method for prioritizing individual endpoints within a composite outcome. The WR offers an alternative to composite outcomes by considering the clinical importance of each component and prioritizing the most critical endpoint, such as death, over less significant events.
Despite the popularity of the WR among cardiovascular trialists, this approach has not been extensively used in other areas of clinical research. We contend, that perioperative and periprocedural researchers could consider the WR and related approaches when the outcomes of interest are not of similar clinical importance. To this end, understanding the benefits and limitations of the WR will be essential to exploit its benefits, while avoiding potential misuses of the technique
Revisiting Afghanistan's Drug Policy: A Policy Analysis of Eradication, Harm Reduction, and Economic Dependencies.
Get PDFBACKGROUND: Afghanistan's responses to illicit drugs have oscillated between punitive eradication and limited harm-reduction initiatives. Two decades of heavy external spending, entrenched conflict, and an economy intertwined with opium have blunted policy effectiveness. METHODS: Guided by Walt and Gilson's policy-triangle, we undertook a document-based review (2001-2024). Twenty-seven national laws, strategies, and analytical reports were retrieved from government and multilateral repositories. Data were coded thematically using Braun-and-Clarke's six-phase approach to map policy content, actors, context, and implementation barriers. RESULTS: Four themes emerged. First, Afghan drug policy has passed through distinct phases-post-2001 tolerance, eradication campaigns, a harm-reduction window, and the current Afghan government's prohibition-each shaped by shifting political economies. Second, a complex actor constellation spans ministries, insurgent groups, multilateral donors, and opium-dependent farming communities, often with conflicting incentives. Third, implementation is hampered by corruption, chronic insecurity, rural poverty, and a shrinking treatment infrastructure (113 centres for an estimated 1.5 million users in 2024). Fourth, persisting failures fuel cycles of addiction, rural impoverishment, and insurgent financing, while recent poppy bans have accelerated a pivot to methamphetamine production. CONCLUSION: Sustainable progress demands moving beyond short-term enforcement toward an integrated rural-development and public-health agenda. Priorities include: (i) secure livelihood alternatives for farmers; (ii) restoration and scale-up of evidence-based treatment and harm-reduction services; (iii) transparent governance mechanisms that engage local communities. A balanced, context-sensitive policy mix offers the best prospect of reducing drug-related harm while addressing the structural drivers that have long frustrated Afghan counter-narcotics efforts
Trends in net survival from cervical cancer in a Brazilian state with medium Human Development Index.
Get PDFCervical cancer remains a major public health concern in Northeast Brazil, ranking as the second most common cancer among women. This study provides the first long-term, population-based estimates of net survival from cervical cancer in Sergipe, a Brazilian state with a medium Human Development Index, using high-quality registry data subjected to rigorous quality control procedures. We analysed data for 3,977 women aged 15-99 years diagnosed with an invasive cervical cancer between 1996 and 2017 and followed up to 2022, after excluding 6,095 in situ neoplasms. Net survival was estimated using the Pohar Perme method, stratified by histological subtype and calendar period, and age-standardised with the International Cancer Survival Standard weights. We observed a substantial decline in survival over time: one-year net survival dropped from 84.6% (1996-1999) to 73.4% (2015-2017), and five-year survival from 60.8 to 49.3%. Squamous cell carcinoma and adenocarcinoma showed similar survival patterns, with five-year survival ranging from 55 to 58%. The persistent decline in net survival may reflect a shift toward more advanced or aggressive invasive cancers, as screening programmes increasingly detect and remove early-stage lesions. Delayed diagnosis and sub-optimal treatment further contribute, underscoring the need to improve screening and timely cancer care access