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Did COVID-19 vaccine enforcement work? Evidence from northwestern and northern Uganda.
Get PDFDuring the COVID-19 pandemic, vaccination programmes were shaped by diverse approaches to enforcement. Yet, little is known about how public authority influenced modes of enforcement on the ground or their ramifications for governance and public health more broadly. This article focuses on the Ugandan mandatory COVID-19 vaccination programme in two contrasting geographical and socio-political spaces: rural Dei and peri-urban Gulu. Ethnographic and survey research demonstrated that enforcement occurred in different ways and by diverse public authorities, with ostensibly contrasting results. In Dei, self-reported vaccine uptake and coverage was 77 % and 73 % respectively; while in Gulu, it was 46 % and 23 %, and below the national target of 70 %. Public authority dynamics explain these differences. In Dei, the military co-opted official political figures and side-lined other local leaders. Anxieties about the vaccine were dismissed, and people were forcibly vaccinated against a disease which they did not perceive to be a significant problem. In Gulu, the military were barely involved. Instead, government appointees and civil servants made efforts to alleviate anxieties through news media, whilst also requiring proof of vaccination to access, or remain employed at, schools, universities, health care facilities. However, some officials undermined the strategy, including health care workers who provided false vaccination certificates. Despite the apparent success of high vaccine uptake reported in Dei, available data suggests that it is unlikely that efforts to enforce vaccination at either field site shaped the course of the COVID-19 outbreaks. Instrumentally violent enforcement 'works' if resistance is not possible, as it was in Dei, but may be counterproductive. Enforcement procedures at both sites provided opportunities to entrench unaccountable modes of governance and fostered mistrust of the government's intentions, thereby weakening previously established vaccine compliance procedures. A public authority lens thus foregrounds the importance of moving beyond narrow public health metrics and engaging with broader conceptions of whether enforced vaccination is effective, and if so, for whom and what purpose
Early life exposure to economic shocks and association with childhood malnutrition: a pooled analysis of 230 nationwide surveys from 68 low-income and middle-income countries.
Get PDFBACKGROUND: The relationship between economic growth and nutrition is not yet fully understood in the context of the new nutrition reality where most low-income and middle-income countries (LMICs) face an increasing double burden of malnutrition. We aimed to investigate the association between early life exposure to economic shocks and multiple forms of childhood malnutrition in LMICs. METHODS: We pooled cross-sectional data on children younger than 5 years from the Demographic and Health Surveys from 1990 to 2022 and longitudinal income data from the World Inequality Database. An economic shock was defined as any negative income growth and was tested at intensity levels of less than -1%, -5%, and -10%. Malnutrition outcomes variables comprised stunting, wasting, overweight, obesity, concurrent wasting and stunting (WaSt), and double burden of malnutrition (child is both stunted and overweight). Adjusted associations of economic shocks, at different critical windows (year of the interview, birth, first 1000 days of life), with malnutrition outcomes were estimated by multivariable Poisson regression models with robust errors. The associations were interpreted using prevalence ratios (PRs) and 95% CIs. FINDINGS: A total of 1 643 898 children across 230 surveys in 68 LMICs were included in this study. Negative income shocks in the year of interview were associated with a 5·4% (PR 1·054 [95% CI 1·029-1·080]) increase in the prevalence of wasting and a 12·7% (1·127 [1·079-1·176]) increase in severe wasting. A dose-response association according to the intensity levels of income shock in the year of birth was found for stunting (-1%: PR 1·019 [95% CI 1·011-1·027]; -5%: 1·033 [1·025-1·042]; and -10%: 1·061 [1·051-1·072]) and severe stunting (-1%: 1·041 [1·026-1·055]; -5%: 1·059 [1·044-1·074]; and -10%: 1·099 [1·081-1·118]). In children aged 2-4 years, income shocks during the first 1000 days of life strongly increased the prevalence of double burden of malnutrition by 30·3% (PR 1·303 [95% CI 1·221-1·391]), obesity by 14·3% (1·143 [1·046-1·249]), and overweight by 13·8% (1·138 [1·090-1·188]). We also found a strong dose-response association between the intensity of income shock during the first 1000 days and double burden of malnutrition (-1%: PR 1·216 [95% CI 1·141-1·295]; -5%: 1·299 [1·192-1·416]; -10%: 1·350 [1·185-1·537]). INTERPRETATION: Exposure to negative income shocks can significantly increase the risk of various forms of malnutrition during childhood, with critical windows of vulnerability that vary based on the timing of economic instability and the specific type of malnutrition. Policymakers and public health practitioners must recognise these critical periods and develop targeted interventions to safeguard maternal and child nutrition, particularly during times of economic crises. FUNDING: Ministry of Science, Innovation and Universities of Spain; Spanish State Research Agency; Generalitat de Catalunya through the CERCA Program; and Wellcome Trust
Association between objectively assessed physical activity and kidney function among female agricultural workers in hot environments in Spain.
No full textBACKGROUND: Physical activity in hot environments has been associated with impaired kidney function. We aimed to quantify the association between occupational physical activity and kidney function over one work shift in female agricultural workers exposed to environmental heat. METHODS: We measured occupational physical activity in female berry pickers in Huelva, Spain, using movement intensity, based on vector magnitude units (VMU), and heart rate (HR). For both, we calculated the mean (VMU_mean; HR_mean), standard deviation (VMU_sd; HR_sd), and 3-min 95th percentile (VMU_p95; HR_p95). Environmental heat in greenhouses was estimated using wet bulb globe temperature (WBGT). Kidney function and injury were quantified using pre- and post-shift differences in serum creatinine (SCr_dif), Cystatin C (Cystatin C_dif) and neutrophil gelatinase associated lipocalin (NGAL_dif), respectively. Acute Kidney Injury (AKI) was defined as an increase in post-shift serum creatinine of ≥0.3 mg/dl, or ≥1.5 times pre-shift levels. Heat strain was estimated using the ISO 7933:2004 index. We used linear and logistic regressions. RESULTS: Ninety women aged 37.4 ± 5.7 years were exposed to a mean WBGT of 25.2 (±3.6)°C and light intensity physical activity (HR_mean of 94 (±9)bpm). Of those, 26 % experienced heat strain, 68 % were dehydrated, and 7 % presented with AKI at the end of the shift. Higher VMU_sd was associated with higher Scr_dif (β: 0.029 (95 % CI: 0.00; 0.058) and meeting the threshold for AKI (OR: 1.6 (95 % CI: 0.8; 3.2)). We observed higher NGAL_dif with higher VMU_mean (β: 1.944 (95 % CI: 0.139; 3.748)) per 100 VMU_mean increase. The positive association between HR_mean and SCr_dif was stronger among women with heat strain (interaction p = 0.033). CONCLUSIONS AND RELEVANCE: In female harvest workers, high means and variations in VMU over a single one shift worked under hot conditions were associated with kidney injury, as assessed by urinary biomarkers, though there is limited evidence for any change in kidney function. Precautiously, large changes in physical activity intensity over one work shift should be avoided to protect from renal injury
The 2025 report of the Lancet Countdown to 2030 for women's, children's, and adolescents' health: tracking progress on health and nutrition.
Get PDFIn line with previous progress reports by Countdown to 2030 for Women's, Children's, and Adolescents' Health, this report analyses global and regional trends and inequalities in health determinants, survival, nutritional status, intervention coverage, and quality of care in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition, as well as country health systems, policies, financing, and prioritisation. The focus is on low-income and middle-income countries (LMICs) where 99% of maternal deaths and 98% of child and adolescent deaths (individuals aged 0–19 years) occur, with special attention to sub-Saharan Africa and South Asia
Estimating the urban heat-related mortality burden due to greenness: a global modelling study.
Get PDFBACKGROUND: Heat exposure poses a substantial public health threat. Increasing greenness has been suggested as a mitigation strategy due to its cooling effect and potential to modify the heat-mortality association. This study aimed to comprehensively estimate the effects of increased greenness on heat-related deaths. METHODS: We applied a multistage meta-analytical approach to estimate the potential reduction in global heat-related deaths by increasing greenness in the warm season in 2000-19 in 11 534 urban areas. We used the enhanced vegetation index (EVI) to indicate greenness and a random forest model to predict daily temperatures in counterfactual EVI scenarios. In the factual EVI scenarios, daily mortality and weather variables from 830 locations in 53 countries were extracted from the Multi-Country Multi-City Collaborative Research Network and used to assess heat-mortality associations. These associations were then extrapolated to each urban area under both factual and counterfactual EVI scenarios based on meta-regression models. FINDINGS: We estimated that EVI increased by 10% would decrease the global population-weighted warm-season mean temperature by 0·08°C, EVI increased by 20% would decrease temperature by 0·14°C, and EVI increased by 30% would decrease temperature by 0·19°C. In the factual scenario, 3 153 225 (2·48%) of 127 179 341 total deaths could be attributed to heat exposure. The attributable fraction of heat-related deaths (as a fraction of total deaths) in 2000-19 would decrease by 0·67 (95% empirical CI 0·53-0·82) percentage points in the 10% scenario, 0·80 (0·63-0·97) percentage points in the 20% scenario, and 0·91 (0·72-1·10) percentage points in the 30% scenario, compared with the factual scenario. South Europe was modelled to have the largest decrease in attributable fraction of heat-related mortality. INTERPRETATION: This modelling study suggests that increased greenness could substantially reduce the heat-related mortality burden. Preserving and expanding greenness might be potential strategies to lower ambient temperature and reduce the health impacts of heat exposure. FUNDING: Australian Research Council and Australian National Health and Medical Research Council
Capsular immunity is necessary for protection against some but not all strains of Glaesserella parasuis.
Get PDFGlaesserella parasuis is the causative agent of Glässer's disease in pigs and results in significant losses to the swine industry annually. Due to the serovar and strain specific response associated with many bacterin vaccines, there has been difficulty generating broad heterologous protection. Here, an unencapsulated G. parasuis mutant (HS069∆cap) was assessed as a bacterin vaccine and compared to a bacterin made from the encapsulated parent strain, against challenge with the homologous, parent strain (serovar 5) as well as four heterologous challenge strains (serovar 1, 4, 5, and 14). Both the HS069 and HS069∆cap bacterins generated high titers to the homologous and heterologous strains. The HS069∆cap bacterin was able to provide protection against the parent strain as well as 12939 (serovar 1), 2170B (serovar 4), and MN-H (serovar 13), but was unable to protect animals from challenge with Nagasaki (serovar 5). In contrast, the HS069 bacterin was able to provide protection against all challenge strains, showing the importance of serovar specific immunity against the challenge strain Nagasaki. This appears to be due to the production of a more abundant and well-organized capsule in Nagasaki as compared to HS069. This study indicates HS069∆cap is a good candidate strain for bacterin development; however, it may be less able to provide protection against highly encapsulated strains of G. parasuis
When health data go dark: the importance of the DHS Program and imagining its future.
Get PDFBACKGROUND: The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which includes nationally representative surveys of households, DHS, Malaria Indicator Surveys [MIS]) and health facilities (Service Provision Assessments [SPA]) in over 90 low- and middle-income countries. USAID co-funding and provision of technical support for these surveys has been shut down. MAIN BODY: The impact of these disruptions will reverberate across local, regional, national, and global levels and severely impact the ability to understand the levels and changes in population health outcomes and behaviours. We highlight three key impacts on (1) ongoing data collection and data processing activities; (2) future data collection and consequent lack of population-level health indicators; and (3) access to existing data and lack of support for its use. CONCLUSIONS: We call for immediate action on multiple fronts. In the short term, universal access to existing data and survey materials should be restored, and surveys which were planned or in progress should be completed. In the long term, this crisis should serve as a tipping point for transforming these vital surveys. We call on national governments, regional organisations, and international partners to develop sustainable alternatives that preserve the principles (standardised questionnaires, backward compatibility, open access data with rigorous documentation) which made the DHS Program an invaluable global health resource
Assessing the prevalence of trachoma in the East, North, Far North and Adamaoua regions of Cameroon, 2016-2022.
Get PDFBACKGROUND: Baseline prevalence surveys in Cameroon in 2010-2012 showed that trachoma was endemic primarily in the north of the country, with 23 evaluation units (EUs) requiring interventions against active (inflammatory) trachoma. This study presents data from prevalence surveys conducted in 2016-2022 following interventions against trachoma in the East, North, Far North and Adamaoua regions of Cameroon. METHODS: EUs were created based on health district boundaries. Within each EU, clusters were selected using probability of selection proportional to population size. Participants were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT). RESULTS: A total of 151 800 people were examined in 45 surveys across 35 EUs. Based on the most recent survey results, TF prevalence was greater than the 5% TF elimination threshold in two EUs. Ten EUs had TT prevalence estimates greater than the 0.2% elimination threshold. CONCLUSIONS: Trachoma remains a public health problem in Cameroon. Continued interventions are needed in EUs with prevalence estimates greater than elimination thresholds, including antibiotic mass drug administration and improved access to TT surgery. Future surveys will be needed to determine when national elimination of trachoma as a public health problem has been achieved
Effectiveness of the BNT162b2 and mRNA-1273 JN.1-adapted vaccines against COVID-19-associated hospitalisation and death: a Danish, nationwide, register-based, cohort study.
Get PDFBACKGROUND: Little epidemiological evidence exists on the protective effects of the JN.1-adapted mRNA vaccines against COVD-19 hospitalisation and death. In this study, we estimated vaccine effectiveness against COVID-19 hospitalisation and death. METHODS: This nationwide, register-based, cohort study included all Danish residents older than 65 years on Oct 1, 2024. We used Denmark's national COVID-19 surveillance system and comprehensive population-based registers, which are updated daily and linked via the unique civil registration number assigned to all residents. To minimise differences between the comparison groups with regard to vaccination history, participants were required to have completed a primary vaccination course in 2021 and have received the 2023-24 XBB.1.5-adapted vaccine between Oct 1, 2023, and Jan 15, 2024. Participants with a recent recorded infection, or a vaccine dose since the previous season and prior to study start, were excluded. COVID-19 hospitalisation was defined as hospital admissions lasting more than 12 h, with associated ICD-10 primary diagnosis codes B342 or B972 (indicating that COVID-19 was the primary reason for admission) and occurring no earlier than 2 days before, and no later than 14 days after, a positive PCR test. Since cause-of-death data were unavailable, a COVID-19 death was defined as a death due to any cause occurring within 30 days of a positive SARS-CoV-2 PCR test. Participants were followed up from study start on Oct 1, 2024, until Jan 31, 2025, or, if earlier, until their date of death, emigration, first positive SARS-CoV-2 PCR test during follow-up, or further vaccination, whichever occurred first. Hazard ratios comparing event rates among those with and without a JN.1 booster dose during follow-up were derived using Cox regression. Vaccine effectiveness was estimated separately by vaccine brand, time since vaccination, and for the predominant circulating variants KP.3.1.1 and XEC. We used a case-only analysis to assess comparative vaccine effectiveness between the two variants. FINDINGS: Of nearly 6 million people resident in Denmark on Oct 1, 2024, 1 247 315 were older than 65 years and 894 560 met inclusion criteria and were included in the study. Median age was 76 years (IQR 70-81); 484 735 (54·2%) of 894 560 people were female and 409 825 (45·8%) were male. Among those without JN.1 vaccination, 278 COVID-19 hospitalisations and 84 deaths were observed during 25·6 million person-days compared with 197 COVID-19 hospitalisations and 56 deaths observed during 62·9 million person-days in those vaccinated with BNT162b2 JN.1 and ten COVID-19 hospitalisations and one death observed during 9·2 million person-days in those vaccinated with mRNA-1273 JN.1. Vaccine effectiveness for BNT162b2 JN.1 was 70·2% (95% CI 62·0-76·6) against hospitalisation and 76·2% (63·4-84·5) against death. We found little evidence of waning effectiveness 4 months after vaccination. For mRNA-1273 JN.1, vaccine effectiveness was 84·9% (70·9-92·2%) against hospitalisation and 95·8% (69·2-99·4%) against death; however those vaccinated with mRNA-1273 JN.1 were younger and healthier. The BNT162b2 JN.1 vaccine effectiveness against hospitalisation was 71·7% (44·4-85·6) after infection with KP.3.1.1 and 76·8% (59·0-86·9) after infection with XEC. BNT162b2 JN.1 vaccine effectiveness against death from these variants was 90·9% (67·4-97·5) for KP.3.1.1 and 76·3% (24·7-92·6) for XEC. The case-only analysis found no differential protection. INTERPRETATION: Both JN.1-adapted vaccines offered high levels of sustained protection for 4 months against hospitalisation and death. These findings support continued use of regularly updated variant-adapted mRNA vaccines in older adults as an effective strategy to reduce severe COVID-19 outcomes. FUNDING: None
Mapping the geography of violence against children in Namibia: A Geographically Weighted Regression Approach
Get PDFThis study investigated the geospatial patterns and determinants of violence against children and young people in Namibia using data from 5,191 individuals aged 13–24 years, interviewed across 79 constituencies in the 2019 Violence Against Children and Youth Survey. We employed Global Moran’s I and Local Indicators of Spatial Autocorrelation to identify global spatial autocorrelation and hotspots. Ordinary least squares regression was used to identify significant area-level risk factors, whereas Geographically Weighted Regression was used to model local variations. We found significant regional variations in the prevalence of past-year sexual(SV), physical (PV), and emotional violence (EV), with the highest rates observed in constituencies in central and northern Namibia. Global spatial autocorrelation was evident for SV and EV but not for PV, suggesting distinct spatial patterns for each form of violence in the study area.Our findings also revealed notable spatial variations in risk factors, with area-level factors showing strong influences in certain areas, while being less impactful or negligible in others. These findings emphasise the need for geographically targeted interventions and policies to address localised risk factors and reduce violence against children and young people in Namibia