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Toward ‘planetary health security’? Critical scoping review of conceptual linkages between ‘health security’ and ‘planetary health’
Get PDF‘Health security’ — the subjection of health to ‘security’ frameworks — and ‘planetary health’— the study of human health impacts of the degradation of planetary ecosystems — have emerged in the last decades as prominent global health fields. However, limited literature connects them, particularly incorporating critical perspectives. We explored interactions between these approaches conceptually, institutionally, and empirically, aiming to chart a conceptual genealogy of these interactions. To this end, we conducted a scoping review using Arksey and O’Malley’s method and Levac’s revisions, exploring health, security, and ecology literatures. We identified 75 eligible sources of 10,352 screened and synthesised findings inductively using Braun and Clarke’s thematic approach. Based on our findings, we synthesised five themes relating to how environmental degradation is framed as a security threat, the role of biosecurity and broader ‘non-traditional’ security threats, institutional ties between health and environmental governance, environmental costs of militarised health responses, and the rise of new technologies for managing planetary health risks. We found multiple descriptions of environmental health as ‘crisis’ and ‘security’ issue, yet health security’s scope remained limited to containment of emerging infectious diseases, rather than prevention or broader health concerns. This initial exploration across disciplinary literatures of conceptual interactions between planetary health and health security showed both mobilising the language of ‘security’ to frame health issues yet raised concerns over inequitable experiences resulting from this framing. An overt emphasis on containment over prevention and tacit commitments to the protection of some lives over others could result in asymmetrical health experiences, rendering some geographies and populations ‘sacrificial’ in their health risks
Challenges and opportunities in achieving sustainable development goal 3 in KwaZulu-Natal: reflections from a research institute, South Africa.
Get PDFBACKGROUND: South Africa is committed to achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure health and well-being for all. However, in rural provinces like KwaZulu-Natal, structural inequalities, socio-cultural challenges, and environmental stressors hinder progress. This study synthesises findings from qualitative research conducted at the Africa Health Research Institute (AHRI) to explore the challenges and opportunities in meeting SDG 3 targets. METHODS: An integrative literature review was conducted, analysing studies from 2015 to 2024 that focused on SDG 3related topics, including HIV/AIDS, tuberculosis, maternal and child health, sexual and reproductive health, and the impact of climate change. A framework analysis approach was applied to identify common themes, opportunities and challenges to achieving SDG 3 in rural KwaZulu-Natal. RESULTS AND DISCUSSION: Key challenges to achieving SDG 3 include limited access to healthcare, socio-cultural norms that influence health-seeking behaviours, climate-related stressors, and gender disparities. Studies highlighted poor maternal immunisation uptake due to traditional beliefs, stigma-related challenges in HIV prevention, and climate-induced economic hardships affecting treatment adherence. Gendered challenges were prominent, with men’s healthcare engagement being hindered by masculinity norms and adolescent girls facing restricted access to sexual health services. The COVID-19 pandemic further disrupted access to healthcare, particularly for older adults. Despite these challenges, opportunities exist for progress. Community-driven interventions such as DREAMS and MTV-Shuga improved adolescent engagement with sexual health education. Male-focused interventions like Stepping Stones and Creating Futures increased men’s involvement in HIV care. Additionally, integration of climate adaptation strategies into health systems could mitigate environmental health risks. CONCLUSION: This study provides critical insights for policymakers to enhance the progress towards achieving SDG 3. To do so policymakers should focus on addressing systemic healthcare challenges, integrating gender-responsive interventions, and strengthening community-based health initiatives. Climate-resilient healthcare infrastructure and policies are crucial to ensuring sustained progress. Future efforts should focus on expanding youth-friendly services, enhancing male engagement in healthcare, and leveraging local partnerships to improve health outcomes in rural communities
Prevalence and risk factors of viral hepatitis and HIV among people experiencing homelessness in Germany based on a nationwide study
Get PDFPeople experiencing homelessness (PEH) are at risk of contracting and transmitting infectious diseases. Data on PEH blood-transmitted virus prevalence and vaccination coverage is needed to design targeted interventions. A nationwide multicentre cross-sectional study of PEH was conducted. Clinical data were collected through questionnaire-based interviews, and blood samples were tested by serology and qPCR. Latent class analysis (LCA) identified subgroups of PEH, while univariable regressions identified risk factors of viral hepatitis. 643 PEH from four metropolitan areas in Germany were included. LCA revealed national short-term, long-term and international short-term PEH subgroups. The prevalence of anti-HAV-IgG, anti-HBc, anti-HBsAg, anti-HCV, anti-HEV and anti-HIV was 44% (95%CI: 39-48%), 17% (95%CI: 14-21%), 25% (95%CI: 21-29%), 18% (95%CI: 15-22%), 29% (95%CI: 25-33%) and 0.7% (95%CI: 0.2-1.7%), respectively. Active HBV and HCV infection was detected in 1.4% (95%CI: 0.7-2.7%) and 12% (95%CI: 9.6-14%), respectively. Univariable logistic regression revealed PEH with former imprisonment had 13.24 times the odds of active or past HCV infection (95%CI: 6.28-27.90) that individuals without had. This study shows the high acquisition and transmission risks for HCV/HIV among PEH. Low vaccination coverage for HAV/HBV calls for revising vaccine recommendations. High HCV infection risk associated with imprisonment highlights the need to address health disparities faced by incarcerated individuals
Managing insecticide resistance in malaria vectors in Africa: case studies from Cameroon, Côte d'Ivoire and Tanzania.
Get PDFBACKGROUND: Malaria remains a significant public health challenge in sub-Saharan Africa (SSA), where vector control strategies, particularly insecticide-treated nets (ITNs) and indoor residual spraying (IRS), have played a critical role in reducing transmission. However, the emergence and spread of insecticide resistance among malaria vectors threatens to undermine these gains. In response, many countries in the region have developed national insecticide resistance management (IRM) plans. This study evaluates the adequacy and implementation of these plans in Cameroon, Côte d'Ivoire, and mainland Tanzania, aiming to identify key challenges and best practices, and to develop actionable recommendations applicable to these and other countries with similar contexts. METHODS: A mixed-methods approach was employed, incorporating document reviews, epidemiological and entomological data analysis, and discussions with stakeholders and experts in 2023. The evaluation focused on the alignment of national IRM plans with national malaria control strategies, their operational effectiveness, and the ability to guide effective monitoring and management of insecticide resistance. The assessment was conducted before changes in the global aid funding landscape. RESULTS: Each country has developed a 5-year IRM plan; however, the plans for Côte d'Ivoire and mainland Tanzania were found to be outdated. While the plans align well with national malaria strategies and international guidelines, implementation has been hindered by inadequate domestic funding and heavy reliance on external donors. Sentinel site coverage for resistance monitoring remains limited, though ITN campaigns have increasingly adopted targeted approaches using varied net types based on local data. IRS is sparsely deployed, but where it is used, rotation of insecticides with differing modes of action is practiced. Despite existing strengths, such as subnational tailoring of interventions, major challenges persist, including inactive monitoring sites and limited data availability due to financial and logistical constraints. The assessment identified important recommended actions, including increased mobilization of domestic financing of resistance monitoring and management to offset shortfalls in external funding, updating of national IRM plans regularly by realistically aligning with available resources, and improved tailoring of effective vector control through high-quality and localized resistance and malaria risk data. CONCLUSION: Insecticide resistance remains a significant threat to malaria control efforts across sub-Saharan Africa. Robust, adaptable IRM plans are essential to address this challenge. Case studies from Cameroon, Côte d'Ivoire, and mainland Tanzania reveal that such policy plans exist but implementation gaps, largely driven by funding shortages (a challenge that has increased since the study was completed), undermine the effectiveness of existing strategies. Strengthening domestic resource mobilization, enhancing multisectoral coordination, and investing in systematic entomological surveillance are critical to ensure evidence-based, sustainable vector control programmes
A cost analysis comparing seasonal malaria chemoprevention with and without Vitamin A supplementation among under-5 children in Nigeria.
Get PDFBackground:
Child mortality in Nigeria, significantly affected by malaria and malnutrition, remains a public health concern in the country. Seasonal Malaria Chemoprevention (SMC) and Vitamin A supplementation (VAS) are effective interventions that can be delivered through integrated health campaigns to reduce this mortality. This study assesses the cost implications of integrating these two interventions among under-5 children in Northeast Nigeria.
Methods: A cost analysis compared standalone SMC (Cycle 1 in July 2021) with SMC-VAS integrated campaign (Cycle 4 in October 2023) in two Local Government Areas (LGAs) in Bauchi State. The number of children reached by the SMC-only campaign was 168,820 and for the SMC + Vit A campaign, the number was 170,681. Data collection utilized a mixed-methods approach, drawing from primary and secondary sources, including programmatic, financial, and coverage records. Costs were categorized into distribution, Sulphadoxine-Pyrimethamine plus Amodaiquine (SPAQ) for SMC, Vitamin A, training, supplies, meetings, labor, supervision, and social mobilization costs. Sensitivity analyses evaluated the effect of a 10% fluctuation in the costs of distribution, labor, SPAQ, and supplies on the cost per child.
Results: The total cost for the SMC standalone campaign was US186,426. Distribution and drug costs were the largest contributors in the integrated and SMC-only campaign. The SMC-only cost per child was 1.18 when eligible children received both SMC and VAS. The integration of VAS into the SMC campaign cycle incurred an additional US186,426 - US0.24 per child, a modest increment considering the potential health benefits. The results support the feasibility of this integration, in terms of cost, to combat child mortality from malaria and malnutrition in Nigeria. Further research is recommended to explore the cost-effectiveness of this integrated distribution model
Assessing early detection ability through spatial arrangements in environmental surveillance for poliovirus: A simulation-based study.
Get PDFDetecting the circulation of poliovirus in its early stages is paramount for swift public health action. While environmental surveillance (ES) is promising for enhancing early pathogen detection, the influence of spatial arrangement of ES sites on early detection remains unclear. Here, we aim to assess the early detection ability of ES by varying the number and location of ES sites using the simulation-based approach utilising geographic and demographic characteristics of South Africa as a case study of a non-endemic country. We developed a stochastic meta-population model among unimmunised children aged under 5 years old, assuming a single introduction of wild poliovirus serotype 1. We constructed six scenarios by combining three importation risk distributions (predicated on population size, approximations of international inbound travel volume and border crossing volume) with two ES site layout strategies (proportionate to population size and importation risks via land border crossings). We showed a modest number of strategically positioned ES sites can achieve a high early detection ability given assumed importation risks were geographically confined while dispersed importation risks reduced the effectiveness of ES. Our sensitivity analysis suggested that implementing the ES across large areas with low sampling frequency consistently resulted in a better early detection ability against various importation scenarios than implementing the ES in limited areas with high sampling frequency. Although we acknowledge the challenges of translating our simulated outcomes for real-world situations, our study has implications for deciding the scale and site selection of ES
Post-treatment life-trajectories among people who inject drugs who completed hepatitis C treatment with direct acting antivirals: A thematic analysis.
Get PDFBACKGROUND: Hepatitis C Virus is a global health burden, particularly affecting people who inject drugs. Direct-acting antiviral treatment can cure almost all people infected with hepatitis C. However, the longer-term impacts on within people's life trajectories are unknown, although some suggest it may lead to fundamental behavioural changes. DESIGN: A cross-sectional exploratory retrospective qualitative design. METHODS: We interviewed 30 people who inject(ed) drugs and who had previously been treated with direct-acting antivirals on average 18 months before the interview (range: 12-24 months). Most were male, aged 36-55 years, and had been treated in urban community-based needle and syringe programmes in Scotland. All interviews were semi-structured, conducted over the phone by either peer or academic researchers, and analysed thematically. RESULTS: We present three discernible post-treatment life-trajectories. Firstly, 'A cure that was like totally new life' involved identity transformation, often associated with controlled or zero drug use, and improved physical and mental health. Secondly, 'There isn't much afterwards' comprised poor quality of life and social isolation, often due to participants' disengagement from former drug use and support networks. Thirdly, 'I'm getting tested every year now' detailed a few life changes but normalized hepatitis C testing and treatment. CONCLUSION: Our thematic analysis reinforces the positive impacts on mental well-being, physical health and self-transformation of direct-acting antiviral treatment in the short- and long-term. However, there is an urgent need for psychosocial interventions to maintain health behaviour changes and self-management, and social support for individuals post hepatitis C treatment
HIV Testing Uptake in a Sexual and Reproductive Health Service for Youth and Impact on Population-Level Prevalence of Undiagnosed HIV in Zimbabwe.
Get PDFPURPOSE: High rates of undiagnosed HIV persist among youth. We investigated the uptake of HIV testing within community-based integrated HIV and sexual and reproductive health (SRH) services, and the impact on population-level prevalence of undiagnosed HIV in Zimbabwe. METHODS: A cluster randomized trial (CHIEDZA) was conducted in three provinces (Harare, Bulawayo, and Mashonaland East) with 8 clusters/province randomized 1:1 to integrated HIV/SRH services for youth aged 16-24 years or to routine existing services for 30 months, followed by a population-level outcome survey. HIV testing uptake within CHIEDZA services, prevalence of population-level undiagnosed HIV, and individual- and community-level factors associated with undiagnosed HIV were assessed. RESULTS: Overall, 29,827/35,446 (84%) youth who accessed CHIEDZA took up HIV testing, with 92% (27,339/29,827) testing at their first eligible visit. Notably, 98% and 93% of females and males took up another service alongside HIV testing. In the outcome survey, HIV prevalence was 7% (n = 1,226/17,554), of whom 576 (47%) were undiagnosed. There was no difference in prevalence of undiagnosed HIV by trial arm (49% intervention; 45% control). Individual-level factors associated with being undiagnosed were male sex, higher education, no HIV testing history, and inconsistent condom use. Community-level factors associated with undiagnosed HIV were unavailability of SRH services and testing drives, and harmful social norms. DISCUSSION: Although community-based integrated HIV/SRH achieved high HIV testing uptake, there was no impact on population-level prevalence of undiagnosed HIV. Concerted efforts are needed to identify and reach those at highest risk, and to address structural factors and prevalent social norms
Cross-sectional study of maternal iodine nutrition and salt iodization in Kyrgyzstan: urban-rural and socioeconomic factors.
Get PDFBACKGROUND: Iodine deficiency remains a public health concern, especially among vulnerable populations such as pregnant women. Despite global efforts to address iodine deficiency disorders (IDDs) through universal salt iodization programs, gaps in coverage and effectiveness persist in countries like Kyrgyzstan. This study evaluated the iodine status of pregnant women and the effectiveness of Kyrgyzstan's national salt iodization program. We investigated sociodemographic factors associated with iodine deficiency. METHODS: A cross-sectional study was conducted in Kyrgyzstan. Urine and salt samples were collected from a stratified random sample of 388 pregnant women to measure urinary iodine concentration (UIC) and iodine concentration in salt (ICS). Descriptive statistics, t tests and logistic regression were used. RESULTS: Most salt samples had adequate ICS levels. Median UIC levels were adequate, but a significant share of insufficient UIC levels indicated widespread iodine deficiency. Urban residents showed higher UIC and ICS levels. Higher education and income levels were associated with better iodine status. Ethnic differences in UIC and ICS levels were observed. CONCLUSIONS: Despite Kyrgyzstan's salt iodization program's success, iodine deficiency remains prevalent among pregnant women, particularly in rural and lower-income groups. Targeted public health interventions, monitoring and tailored strategies are essential to improve iodine intake and reduce IDDs in these populations
‘The medicine sellers have become the hospital now': Health service responses to violence against women during the Ebola and COVID-19 outbreaks in Sierra Leone
Get PDFIntroduction: Outbreaks and violence against women (VAW) are interlinked public health challenges, yet health system responses for VAW during outbreaks remain poorly understood. We sought to understand how and to what extent health services for VAW in Sierra Leone were delivered by health providers and communities during the 2014-2016 Ebola outbreak and the COVID-19 pandemic.
Methods: Thirty-seven in-depth interviews and four focus group discussions were conducted in Freetown and Kambia in Sierra Leone in 2022 with health service providers, outbreak actors, community members, and women who had experienced physical or sexual violence during the Ebola or COVID-19 outbreaks. Data were analysed thematically.
Findings: Many participants described the exacerbation of long-term health system challenges during the outbreaks, with survivors of violence facing under-resourced, broken or corrupt government health services. Especially during the Ebola outbreak, systems of care for VAW survivors were reconfigured with the role of informal health actors such as medicine sellers and traditional healers amplified. VAW providers described adaptations to health service delivery and ways that they tried to cope with difficult working conditions: plugging gaps in commodity supplies, adopting infection prevention and control protocols or making personal sacrifices so that systems functioned. Whilst VAW health services faced significant challenges continuing to provide care, they were overlooked by the outbreak response.
Conclusions: The outbreaks, especially Ebola, meant ‘normal’ service delivery challenges for VAW were heightened. These findings highlight the need to integrate VAW services into outbreak preparedness and response efforts, including through leveraging informal actors