69832 research outputs found
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Predicting risk of inadequate micronutrient intake with transferable machine learning models.
Full text linkIdentifying populations at risk of inadequate micronutrient intake is necessary for governments and development partners in low- and middle-income countries to make informed and timely decisions on nutrition-relevant policies and programmes. In this study, we propose a machine learning methodological approach using data on household dietary diversity, socioeconomic status, and climate indicators to predict the risk of inadequate micronutrient intake. Using case studies from Ethiopia and Nigeria, we demonstrate that the models effectively predict risk, with key predictors showing consistency in terms of importance and direction. We also illustrate the feasibility of transferring models between countries, offering a short-term, practical solution for contexts lacking nationally representative micronutrient data. Our results show that this machine learning methodological approach can generate geographically and socioeconomically disaggregated risk estimates that reflect expected patterns of nutritional vulnerability, supporting more targeted and data-driven nutrition interventions
CSF Hypo-Inflammation Drives Mortality in HIV-Associated Tuberculous Meningitis.
Full text linkBACKGROUND: Outcomes in tuberculous meningitis (TBM) are closely linked to host inflammation. Anti-inflammatory corticosteroid therapy improves survival in HIV-negative TBM, but not in people with HIV. In people with HIV, TBM is fatal in 40-50% of cases. Therefore, we investigated how mortality is associated with the local immune response in people with HIV-associated TBM. METHODS: We measured baseline concentrations of immune signalling mediators in cerebrospinal fluid (CSF) of 149 adults with HIV in Uganda, who presented with definite or probable TBM. Participants received both antimycobacterial and corticosteroid therapy. RESULTS: At baseline, non-survivors had more severe TBM disease and lower blood CD4 T cells than survivors. Mortality at 90 days was strongly associated with CSF hypo-inflammation. CSF interferon gamma (IFN-γ) was most differentially expressed by survivors (2.2 log2-fold change higher, p=.003), and 90-day mortality was lower with increasing concentrations (Tertile-1=50%, Tertile-2=41%, Tertile-3=18%; p=.006). Even among people who successfully mounted a CSF cellular immune response (>5 white cells/μL CSF), those with low CSF IFN-γ had higher risk of death (Hazard Ratio =3.10 (1.44-6.68). Interleukin-13 had a more complex relationship, with lower mortality among people with intermediate CSF interleukin-13 concentrations but higher at the two extremes (Tertile-1=45%, Tertile-2=22%, Tertile-3=40%; p=.017). Of all sub-groups, those with both peripheral CD4 depletion and low CSF IFN-γ had the highest mortality (63%). CONCLUSIONS: In adults with HIV-associated TBM receiving dexamethasone, mortality was strongly associated with CSF hypo-inflammation. Although steroids may be appropriate in those with high inflammation, personalized approaches to immunotherapy are likely necessary to improve outcomes
Global perspectives on Klebsiella epidemiology and biology: conference report on the KLEBS 2024 symposium.
Full text linkThe inaugural Klebsiella Epidemiology and Biology Symposium (KLEBS) took place in November 20-22, 2024, at the Institut Pasteur in Paris. It covered a broad multidisciplinary range of topics from fundamental biology to public health aspects, including epidemiology and public health burden, One Health and clinical aspects, genomics, host-pathogen interactions, vaccines, and therapeutics. This report describes research presented during keynote presentations, plenary sessions and a panel discussion. A recording of the conference is available at: https://www.klebs-2024.conferences-pasteur.org/replay
Antimicrobial stewardship interventions currently implemented at primary healthcare settings across low- and lower-middle-income countries (LLMICS).
Full text linkBACKGROUND: Antimicrobial resistance (AMR) is a top global public health and development threat. Antimicrobial stewardship programs (AMSPs) are one of the most cost-effective interventions to optimize the use of antimicrobials. This study reviews AMSPs that have been implemented in low- and lower middle-income countries.
METHODS: A systematic search was conducted on electronic databases including MEDLINE, PubMed, Embase, OVID, Web of Science and Cochrane Library on 18 July 2024 for published papers from 2014 to 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Relevant published literature was then selected based on the established inclusion/exclusion criteria. Each article was screened by two independent reviewers. Data were extracted and synthesized in the review.
RESULTS: Of the 425 articles screened, only 13 were eligible for review and included in this study. Two studies were multinationals. Five studies were randomized controlled trials. Among the three key focuses of AMSPs, most of the interventions focused on optimizing antibiotic use (n=8), followed by improving diagnostics and monitoring (n=3) and education and training (n=2). The most commonly reported barriers to implementing AMSPs was a lack of resources (n=9). Facilitators reported included knowledge of AMS (n=8), availability of educational and training resources (n=8), adequate funding (n=6), accountable and transparent procedures (n=5) and positive communication within healthcare facilities (n=4).
CONCLUSIONS: All included studies show improvement in AMS through innovative programs. However, only a few have been adopted nationwide and influence policy formulation in the country. We recommend adoption of effective AMSPs into the national strategic planning and implementation across primary health settings
Seroprevalence and risk factors for Brucella species and Coxiella burnetii exposure in a cross-sectional serosurvey of occupationally exposed groups in peri-urban Lomé, Togo.
Full text linkBACKGROUND: Brucella species and Coxiella burnetii have been detected in livestock populations in Togo. Populations exposed to livestock ruminants through their occupation may be at increased risk of infection. METHODS/PRINCIPAL FINDINGS: A cross-sectional serosurvey was conducted in 108 abattoir and 81 dairy farm workers (from 52 dairy farms) in peri-urban Lomé, Togo in 2019-2020. Structured questionnaires were used to collect data on participant livestock contact and dairy product consumption. Sera were tested using the Rose Bengal plate agglutination test (RBT) and the indirect Brucella IgG Enzyme-Linked Immunosorbent Assay (ELISA) for Brucella, and the IgG ELISA for Coxiella burnetii in Phase 1 and in Phase 2. Fresh bulk milk samples from farms were tested using an indirect milk ELISA for Brucella IgG. The association between seropositivity and exposure variables was examined using logistic regression with robust standard errors to account for site-level clustering. Eighteen workers (9.5%, 95% CI 5.5-16.0) were Brucella seropositive. Twenty-eight percent (95% CI 22.5-34.3) of workers were seropositive for C. burnetii. Twenty of fifty-one farms which gave milk samples tested positive for Brucella antibodies (39.2%, 95% CI 26.6 - 53.4%). Farmworkers had nearly twice the crude odds of being Brucella seropositive compared to abattoir workers (OR 1.93, 95% CI: 0.94-3.93, p = 0.07). After adjusting for age, working on farms with animal ill health, a positive milk test, participating in small ruminant husbandry and assisting with cattle abortion were all associated with increased odds of seropositivity. Farm and abattoir workers who consumed raw milk at least every month were more likely to be seropositive for Brucella species (OR 3.79, 95% CI: 2.34-6.13, p < 0.001) while participants who consumed fermented milk and cheese had greater odds of being seropositive for C. burnetii (OR 1.59, 95% CI: 1.26-2.00, p < 0.001 and OR 1.70, 95% CI: 0.97-2.98, p = 0.07 respectively). CONCLUSIONS: Livestock workers in peri-urban Lomé have been exposed to both Brucella and Coxiella burnetii bacteria. The widespread consumption of raw dairy products and lack of personal protective equipment (PPE) use is of concern as both dairy consumption and participation in animal husbandry activities have been seen to increase odds of seropositivity for both pathogens. A One Health prioritization of zoonotic disease would help to bring together the relevant sectors to adequately resource prevention and control of zoonoses of public health concern in Togo, which may particularly impact workers in close contact with animals
Global Surgery and Health Equity: Integrating Education, Research, and Policy-A Perspective Review.
Full text linkBACKGROUND: Global surgery is intended to guarantee that all people can access safe, timely, and affordable surgical, obstetric, and anesthesia care, but wide disparities remain, mostly in low- and middle-income countries (LMICs). When the 17.9 million annual preventable deaths from surgical conditions are considered, the LDCS face a debilitating deficit of personnel, infrastructure, and policy-required backing. Mitigating these disparities calls for a comprehensive approach, which includes education, research, and policy.
METHODS: This perspective article reviews findings distilled from the global health literature, policy papers and reports, and leading initiatives such as the Lancet Commission on Global Surgery, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), and academic partnerships. It reviews pressing issues and solutions aimed at workforce development, research equity, and systems-level policy change.
RESULTS: Despite emerging awareness of the importance of surgery in universal health coverage, major gaps remain. Over 20% of public health practitioners lack fundamental knowledge of global surgery, and LMICs produce a minority of surgical research, reinforcing dependence on high-income country (HIC) frameworks. Successful interventions include integrating global surgery into public health curricula, fostering academic "twinning" partnerships, supporting South-South collaborations, and leveraging digital innovations like tele-mentoring and AI-based tools. NSOAPs have shown promise in driving national reforms but remain underfunded and unevenly implemented. However, integrated approaches also face practical challenges, including variable political commitment, competing health priorities, and limited absorptive capacity within under-resourced systems.
CONCLUSION: Bridging global surgical inequities demands a coordinated, decolonial approach linking education, research, and policy. Building local capacity, prioritizing LMIC leadership, and embedding surgical care within broader health systems are essential to achieving sustainable, equitable progress. Global surgery must evolve from fragmented efforts into a cohesive movement that views surgical care as a fundamental human right. Future work should articulate clearer stakeholder-specific strategies, particularly for governments, academic institutions, NGOs, and funders, to ensure that integrated approaches translate into actionable, context-appropriate reforms
Sub-national modelling of surveillance sensitivity to inform declaration of disease elimination: A retrospective validation against the elimination of wild poliovirus in Nigeria.
Full text linkA fundamental question in the global commitment to polio eradication is how long a period of absence would be consistent with regional elimination, and the safe withdrawal of the oral polio vaccine is contingent on the answer. We present a statistical framework to model the time-varying sensitivity of two key components of polio surveillance - environmental sampling and clinical cases of acute flaccid paralysis - for detecting infection on a monthly basis at the local government authority level. We use this to estimate the probability of freedom from infection (FFI) at a critical prevalence level that is consistent with interruption of transmission, given the absence of virus in collected samples. We validated this framework against two periods of poliovirus absence in Nigeria (2014-2016 and 2016-2020). Our model highlights substantial heterogeneity in surveillance sensitivity over time and space and, given this, concluded an 85% probability (95% uncertainty interval: 77.1-90.0%) of the country being free from WPV1 infection after 23 months without detection from July 2014. Detection of WPV1 in July 2016 demonstrated that circulation had indeed persisted during this time. In contrast, we conclude a probability of 98% (97.5-98.5%) by the time elimination of the serotype was officially declared in 2020. The inferred probability of FFI during both time periods was found to be consistent with the retrospectively known status of regional elimination. This supports the validity of applying this framework prospectively to inform the certification of wild poliovirus elimination from remaining endemic regions, and to determine the resolution of cVDPV2 outbreaks
In-utero exposure to chikungunya and child morbimortality: a population-based study using linked routine data
Full text linkAbstract
Chikungunya exposure in-utero is linked to neonatal morbidity and neurodevelopmental effects. We examined the long-term morbidity associated with in-utero Chikungunya. This registry-based cohort study linked records of infants born in Brazil between 2015 and 2018, with all-cause first hospitalization and death as outcome. Infants were followed until the outcome, their third birthday, or the end of the study. Adjusted stratified Cox models were used to estimate hazard ratios (HR), 95% confidence intervals (95% CIs), and absolute risk differences. A total of 1,821 exposed and 18,210 unexposed infants were included. The HR for hospitalization was 1.21 (95% CI: 1.11–1.36), corresponding to 37 excess hospitalizations per 1000 exposed (95% CI: 16-64). The risk was twofold for intrapartum exposure (HR 2.08, 95% CI: 1.33–3.44) and elevated for first- and second-trimester exposure. Evidence for risk of death was limited. Here we show an elevated hospitalization risk associated with in-utero Chikungunya exposure
Variation in reporting of heatstroke mortality: evidence from a multi-country study.
Full text linkBACKGROUND: Heatstroke represents the most severe manifestation of heat exposure. Heatstroke is rare and under-reported, resulting in limited empirical data on its global incidence and burden. This study aimed to examine geographical variations and temporal trends in reported heatstroke mortality across multiple countries. METHODS: We collected annual heatstroke mortality data from 34 countries participating in the Multi-Country Multi-City Collaborative Research Network between 2000 and 2022, using the ICD-10 code X30. Country-specific mortality rates were estimated using Poisson regression, alongside analyses of annual trends and associations with mean warm-season temperature. We also assessed the proportion of heatstroke deaths relative to both overall heat and extreme heat-attributable all-cause mortality. FINDINGS: Heatstroke mortality rates varied widely across countries, with Japan reporting the highest rate (5·81 per 1 million population; 95% CI 4·43-7·62), followed by Cyprus (2·51; 1·36-4·61), and China (2·42; 1·21-4·85). By contrast, most countries in Europe, South America, and southeast Asia reported rates of less than one death per 1 million population. Heatstroke mortality increased over time in several countries and was associated with warm-season temperatures in most regions. The proportion of heatstroke deaths relative to overall heat-attributable mortality ranged from less than 1% in many countries to as close to 24% in Japan. When analyses were restricted to deaths attributable to extreme heat, the proportion of heatstroke deaths increased substantially. INTERPRETATION: Our broad international assessment of heatstroke mortality highlights its distinct patterns compared with overall heat-attributable mortality. The observed variability likely reflects differences in recognition, reporting, and diagnostic practices, while climate exposure and health system capacity influence whether heat-related deaths are identified and recorded as heatstroke. FUNDING: The Japan Society for the Promotion of Science and the Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency provided by the Japanese Ministry of the Environment
Artificial intelligence to improve the detection and risk stratification of acute pulmonary embolism (AID-PE): protocol for a pragmatic quasi-experimental comparator study.
Full text linkINTRODUCTION: Pulmonary embolism (PE) is a potentially fatal condition requiring timely diagnosis and treatment. CT pulmonary angiography (CTPA) is the gold standard for diagnosis and indicates PE severity through radiological markers of right heart strain. However, accurate interpretation and communication of these findings is often suboptimal in real-world practice. Artificial intelligence (AI) could alleviate pressure on radiology services by supporting PE identification, risk stratification and worklist prioritisation. Before widespread adoption, AI tools must be rigorously validated for diagnostic accuracy, safety and clinical impact. METHODS AND ANALYSIS: This pragmatic single-centre, non-randomised quasi-experimental study will evaluate the diagnostic accuracy, feasibility, and clinical-cost impact of AI-assisted PE detection and risk stratification using AIDOC and IMBIO software. We will recruit two consecutive cohorts of adult patients undergoing CTPAs for suspected PE: a comparator cohort (12 months pre-AI implementation) and an intervention cohort (12 months post-AI implementation). AI will be applied retrospectively to the comparator cohort, while in the intervention cohort, radiologists will have contemporaneous access to the AI's interpretation of CTPA images.A subset of retrospective scans, both PE-positive and PE-negative, will undergo expert thoracic radiologist review to establish a reference standard. Data on patient demographics, clinical management and outcomes will be collected. Clinical management pathways and patient outcomes will be compared between cohorts to assess AI's influence on acute PE management. Health economic modelling will assess the cost-effectiveness of integrating AI technology within the diagnostic workflow of acute PE. ETHICS AND DISSEMINATION: This study was approved by the UK Healthcare Research authority (IRAS 311735, 10 May 2023). Ethical approval was granted by West of Scotland Research Ethics Service (23/WS/0067, 3 May 2023). Results will be shared with stakeholders, presented at national and international conferences, and published in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT06093217