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Improving nutrition outcomes through enhanced allocative efficiency of investments in 24 high risk counties in Kenya: An Optima Nutrition modelling study.
Get PDFINTRODUCTION: Undernutrition remains a significant global challenge, severely impacting children's development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up evidence-based nutrition interventions and (2) determine how existing resources could be optimized to reduce stunting, wasting, and anemia in children under five and anemia in pregnant women across 24 counties with the poorest nutrition outcomes. METHODS: Utilizing the Optima Nutrition model, we analyzed demographic and intervention data to assess the impact and allocation of interventions. Scenario analyses and optimization techniques were employed to reallocate resources and evaluate their potential impact on reducing undernutrition. RESULTS: When scaled up to 95% coverage and maintained until 2030, across the counties the interventions resulted in median relative reductions of 14.6% in stunting prevalence, 23% in wasting prevalence, 20.6% in anaemia prevalence among children and 64.2% in anaemia prevalence among pregnant women. For stunting, the optimized scenarios prioritized infant and young child feeding education, vitamin A supplementation, lipid-based nutrition supplements for children, and balanced energy-protein supplementation and multiple micronutrient supplementation for pregnant women. For wasting, cash transfers was prioritized. For anaemia in children, long-lasting insecticide treated bednets and IFA fortification of maize were prioritized. For anaemia in pregnant women, multiple micronutrient supplementation, iron and folic acid supplementation and long-lasting insecticide-treated bed nets were prioritized. CONCLUSION: This study provided a comprehensive assessment of the prevalence of stunting, wasting, and anemia among children under five years in 24 counties in Kenya. The Optima model suggested that scaling up nutrition-specific interventions under the same baseline budgets could lead to significant reductions in stunting, wasting, and anemia in Kenya. Additionally, the study identified interventions that should be prioritized during nutrition intervention resource allocation
Planning for scale: analysis of adaptations and contextual factors influencing scale-up of the QUALI-DEC intervention to optimize caesarean section use.
Get PDFBACKGROUND: Researchers are encouraged to plan for scale through purposeful and guided assessment of scalability of an intervention. This study analysed factors potentially influencing scale-up and synthesised early adaptations of the QUALI-DEC intervention aiming to improve the appropriate use of caesarean section. The intervention consists of opinion leader engagement, audit and feedback for caesarean section, a tool to help women make an informed decision on the mode of birth, and labour companionship. METHODS: We conducted a framework analysis, which was guided by the scalability assessment framework by Zamboni et al., a 34-item checklist with a three-point scale. We used data from the formative research including a document review, hospital readiness assessment and qualitative interviews conducted between March 2019 and May 2020 in 32 facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. Data were deductively coded based on the four dimensions of the scalability framework. Our findings were validated with implementing partners across countries. RESULTS: We identified the perceived relevance of the intervention by women and providers and the presence of relevant key clinical guidelines as factors that may ease scalability of QUALI-DEC. Labour companionship and the decision-analysis tool were perceived as harder to scale-up and requiring additional changes to existing healthcare structures. Most of the study facilities reported high workload and time constraints as implementation barriers. Thailand was the only country with a national policy to reduce unnecessary caesarean sections. Legal disputes were common and followed a structured process in Thailand and Argentina, which may support preference of caesarean section due to fear of litigation. Early adaptations included development, revision and translation of educational material, monetary compensation of opinion leaders and reaching consensus on clinical guidelines to be used across hospitals, most of which are deemed conducive to scale up. CONCLUSIONS: Planning for scale-up is a key feature of the QUALI-DEC intervention. Scale-up may not be guaranteed at this point of the intervention since effectiveness and cost-effectiveness are not demonstrated yet. However, the investment in studying scale-up opportunities is a core contribution to implementation research. This exercise informed implementation and scale-up strategies of the QUALI-DEC intervention
Integrating infectious diseases into life course epidemiology.
Get PDFThe term “life course epidemiology” was coined over two decades ago, proposing a framework to investigate the effect of long-term biological, behavioral, and psychosocial processes that link adult health across generations to exposures acting during gestation, childhood, adolescence, and earlier adult life [1, 2]. It is a powerful approach and the recent literature has emphasized the relevance of life course epidemiology in reproductive health [3], women and child health [4], noncommunicable diseases [5], and public health policy prevention strategies [6]. One notable gap in the life course literature is research on the role of infectious diseases—a topic that has often been overlooked, as its importance was highlighted by Hall et al. in 2002 [7]. This commentary advocates for including exposure to infectious diseases in life course epidemiolog
Smoking status and voting behaviour and intentions in countries of the former Soviet Union.
Get PDFSmokers experience multiple disadvantages throughout their lives, yet there is another disadvantage, political, that is less widely recognised. Smokers are less likely to vote but only so far in studies conducted in Western democratic regimes. This cross-sectional study aimed to examine the association between current smoking and voting behaviour and intentions in nine countries of the former Soviet Union (FSU). Data were analysed from 18,000 individuals aged ≥ 18 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine, collected in the Health in Times of Transition (HITT) survey in 2010/11. Information was obtained on smoking status and voting behaviour and intentions. In a fully adjusted logistic regression analysis, current smoking was associated with significantly higher odds of 'never voting' (not having voted in the past or intending to vote in future) in the pooled sample (OR: 1.29, 95% CI 1.13-1.47). In stratified analyses, smoking was associated with never voting in women but not men and in young but not middle-aged or older adults. The smoking-never voting association was observed in flawed democracies (OR: 1.57, 95% CI 1.07-2.32) and hybrid regimes (OR: 1.31, 95% CI 1.08-1.59) but not in authoritarian regimes (OR: 1.02, 95% CI 0.81-1.29). Smoking is associated with never voting in these FSU countries although not in all population subgroups or types of political regime. A necessary task for future research will be determining the factors associated with not voting among smokers in these countries
Safety and efficacy of single-dose primaquine to interrupt Plasmodium falciparum malaria transmission in children compared with adults: a systematic review and individual patient data meta-analysis.
Get PDFBACKGROUND: Adding a single dose of primaquine to artemisinin-based combination therapy (ACT) for the treatment of falciparum malaria can reduce the transmission of Plasmodium falciparum and could limit the spread of artemisinin partial resistance, including in Africa, where the disease burden is greatest. We aimed to compare the safety and efficacy of single-dose primaquine plus ACT between young children (aged 25%) in haemoglobin concentration associated with anaemia, and adverse events until day 28 using regression analyses, with random study-site intercepts to account for clustered data. These analyses were registered with PROSPERO, CRD42021279363 (safety) and CRD42021279369 (efficacy). FINDINGS: Of 5697 records identified by the search, 30 studies were eligible for analysis. Of these, individual patient data were shared for 23 studies, including 6056 patients from 16 countries: 1171 (19·3%) young children (aged 25%) at a primaquine dose of 0·25 mg/kg, regardless of age group, transmission setting, and glucose-6-phosphate dehydrogenase status. The risks of adverse events of grade 2 or higher and of serious adverse events were similar between primaquine and no-primaquine groups, including in young children. INTERPRETATION: Regardless of malaria transmission intensity and age group, a single dose of 0·25 mg/kg primaquine is safe and efficacious for reducing P falciparum transmission. These findings underscore the need for primaquine formulations suitable for young children, and also provide supportive evidence to expand the use of single low-dose primaquine in regions with a moderate-to-high transmission rate that are threatened by artemisinin partial resistance. FUNDING: The EU and the Bill & Melinda Gates Foundation
Artificial Intelligence and Corruption: Opportunities and Challenges in the Health Sector.
No full textCorruption in health systems diverts resources, erodes trust, and reduces service quality. Traditional oversight methods struggle to detect fraudulent patterns, but Artificial Intelligence (AI) offers new possibilities. AI can analyse large datasets to predict corruption risks and detect irregularities in procurement, insurance claims, and counterfeit medicines. Successful applications include AI-powered tools that flag suspicious transactions, expose bid-rigging in procurement, and identify fraudulent medical billing. AI can also complement other analytical tools to help track counterfeit drug supply chains through image recognition and network analysis. However, AI's impact depends on how it is deployed. Government-led AI initiatives may enhance transparency but risk reinforcing power imbalances or enabling authoritarian control. In contrast, civil society-driven efforts can empower citizens to hold authorities accountable but face challenges like limited data access and misinformation risks. Moreover, AI can also facilitate corruption in the health system through biased algorithms, deepfake propaganda, or manipulated AI-driven decision-making in resource allocation. Maximising AI's anti-corruption potential in healthcare requires investments in skilled personnel and data systems. AI should complement human oversight, with transparent auditing mechanisms to mitigate biases. Integrating blockchain and AI technologies may enhance accountability by securing procurement records and preventing data manipulation. While AI presents significant opportunities, its application to anti-corruption remains a political issue as much as a technological one. Careful governance, ethical and legal safeguards, and balanced implementation will determine whether AI combats corruption or exacerbates abuses
Pathways to Reducing Dating and Relationship Violence and Gender-based Violence in School-based Interventions: Systematic Review Using Qualitative Comparative Analysis
Get PDFThis paper uses qualitative comparative analysis to understand why some school-based interventions for dating and relationship violence and gender-based violence are more effective than others. Results indicate that a central condition for the reduction of victimization is the reduction of perpetration. However, a number of other pathways to the reduction of victimization exist, generally characterized by the implementation of single-gender components or a critical mass of girls. Absence of parental involvement and of narrative components was important as well. These findings underscore the importance of both simple content (clearly connecting victimization to perpetration) and complex influences (such as the role that participant gender and single-gender activities may play) in understanding pathways through which interventions effectively reduce all forms of DRV and GBV
How does policy modelling work in practice? A global analysis on the use of epidemiological modelling in health crises.
Get PDFThis study examines the use and translation of epidemiological modelling by policy and decision makers in response to the COVID-19 outbreak. Prior to COVID-19, there was little readiness for global health systems, and many science-policy networks were assembled ad-hoc. Moreover, in the field of epidemiological modelling, one with significant sudden influence, there is still no international guidance or standard of practice on how modelled evidence should guide policy during major health crises. Here we use a multi-country case study on the use of epidemiological modelling in emergency COVID-19 response, to examine the effective integration of crisis science and policy in different countries. We investigated COVID-19 modelling-policy systems and practices in 13 countries, spanning all six UN geographic regions. Data collection took the form of expert interviews with a range of national policy/ decision makers, scientific advisors, and modellers. We examined the current use of epidemiological modelling, introduced a classification framework for outbreak modelling and policy on which best practice can be structured, and provided preliminary recommendations for future practice. Full analysis and interpretation of the breadth of interview responses is presented, providing evidence for the current and future use of modelling in disease outbreaks. We found that interviewees in countries with a similar size and type of modelling infrastructure, and similar level of government interaction with modelling reported similar experiences and recommendations on using modelling in outbreak response. From this, we introduced a helpful grouping of country experience upon which a tailored future best practice could be structured. We concluded the article by outlining context-specific activities that modellers and policy actors could consider implementing in their own countries. This article serves as a first evidence base for the current use of modelling in a recent major health crisis and provides a robust framework for developing epidemiological modelling-to-policy best practice
Understanding sexual violence: Perspectives from an adolescent HIV prevention study.
Get PDFBACKGROUND: Sub-Saharan Africa has a high prevalence of sexual violence in young women, with less data on young men. AIM: We investigated the prevalence of forced sex among adolescents and young people and described factors putting them at risk of sexual violence. SETTING: The study was conducted in South Africa, Uganda and Zimbabwe. METHODS: We conducted a cross-sectional, structured survey among 1330 13-24-year-old male and female participants. Logistic regression models were used to estimate odds ratios for associations with forced sex, adjusting for site, sex and age. Sixty in-depth interviews and 24 group discussions were also conducted. Data were transcribed, translated and analysed using thematic framework analysis. RESULTS: Seventy-six out of 1326 participants (6%) reported forced sex in the last 6 months. Forced sex was most commonly reported in Entebbe versus other sites, female than male participants, and 18-24 years than 13-18 years. Associations were seen with younger sexual debut (adjusted odds ratio [aOR]: 0.89; 95% confidence interval [CI]: 0.81, 0.98), ever having transactional sex (aOR: 2.18; 95% CI: 1.19, 4.02), risk-taking (aOR: 3.51; 95% CI: 1.99, 6.19), depression (aOR: 3.20; 95% CI: 1.69, 6.06), anxiety (aOR: 2.07; 95% CI: 1.08, 3.96) and binge drinking (aOR: 2.66; 95% CI: 1.33, 5.36), and strong association with forcing someone to have sex (aOR: 7.54; 95% CI: 3.68, 15.46). Qualitative data support these results. CONCLUSION: Our findings identify risks similar to those for sexual violence. CONTRIBUTION: We suggest protection strategies to police times and places of risk are developed, and addressed in economic and legal country specific guidance
Neurosyphilis in 2025
Get PDFPURPOSE OF REVIEW: Syphilis continues to be a major global health problem. In recent years epidemics of syphilis have also been reported in many high-income countries. In this review, we aim to highlight varied presentations, including recent guidelines on diagnosis and treatment, including in people with HIV (PWH).
RECENT FINDINGS: Neurosyphilis is increasingly being diagnosed and presentations are varied in both the immunocompetent and immunocompromised host. An appropriate history, examination and diagnostic work-up is central to identification of neurosyphilis and to enable appropriate treatment. Clear criteria for indication and interpretation of results from lumbar punctures, neuroimaging and treatment protocols have been outlined by the British association for sexual health and HIV (BASHH) in 2024.
SUMMARY: The increase in overall cases of syphilis has been accompanied by increases in the number of cases with neurological involvement. The presentation of neurosyphilis is variable and may occur early or late in the disease course. It is important to be aware of the varied presentations, diagnostic and treatment criteria to limit the late sequelae of disease and address the global health challenge it poses and measures being taken to help reduce this global burden