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Food Insecurity and Loneliness in the Former Soviet Countries
Get PDFOBJECTIVES: To examine the association between food insecurity (FI) and loneliness in countries of the former Soviet Union (FSU).
METHODS: Data were analysed from 15,568 adults in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine, collected in the Health in Times of Transition (HITT) survey in 2010-2011. Information was obtained on both FI and loneliness with single-item measures. Logistic regression was used to examine associations.
RESULTS: In a fully adjusted analysis, moderate (OR: 1.35, 95% CI: 1.16-1.57) and severe FI (OR: 1.94, 95% CI: 1.58-2.38) were associated with significantly higher odds of loneliness in the pooled sample. In sex- and age-stratified analyses, severe FI was associated with loneliness in all population subgroups, with odds ratios ranging from 1.69 to 1.99. However, moderate FI was linked to loneliness in only three of the five subgroups. In further analyses, FI was associated with loneliness in six of the nine countries.
CONCLUSION: FI is associated with loneliness in FSU countries. Efforts to increase food security in these countries may be important for improving physical and psychological well-being among adults in the general population
Announcing the Lancet Global Health Commission on anti-corruption in health: a call for a novel approach
Get PDFLife Expectancy Loss and Recovery by Age and Sex Following Catastrophic Events in Europe during the 19th and 20th Centuries
Get PDFFollowing catastrophic events such as pandemics or wars, a systematic loss in life expectancy at birth () can be observed. This study aims to estimate the time required for to recover after mortality crises and to identify which age groups contribute to the decline and assist in restoring pre-crisis levels. Focusing on major European pandemics and wars of the 19th and 20th centuries, we used data from the Human Mortality Database (HMD). Arriaga’s decomposition was applied to analyze values before the sharpest decline and at the recovery point. Events were categorized into pandemics and non-pandemics, and further stratified by sex. Various statistical tests were used to ensure valid comparisons. The analysis is grounded in demographic resilience, understood as the capacity of a population to return to previous levels after a mortality shock. This approach enables comparison between events of different types and historical contexts. Our findings show that the largest declines occurred during the World Wars. No significant differences were found by event type or sex. Youth and children emerged as the main contributors to the decline and recovery of following catastrophic events
Building resilience against the growing threat of arboviruses: a scoping review of Aedes vector surveillance, control strategies and insecticide resistance in Africa.
Get PDFBACKGROUND: The number of reports of arboviral outbreaks is increasing and, consequently, the need for effective surveillance and vector control plans for Aedes-borne diseases is becoming more urgent. To explore the current state of knowledge of Aedes arbovirus vectors in Africa, we reviewed studies published between 1980 and 2023 that involved Aedes vector surveillance, vector control or insecticide resistance, with the aim to synthesize information and identify knowledge gaps to guide future Aedes research and control in Africa. METHODS: Studies conducted in Africa and published between 1980 and 2023 were retrieved from twelve electronic databases using search strings designed to capture relevant concepts. Articles that did not meet the eligibility criteria were excluded during relevance screening. RESULTS: Out of 17,337 publications identified, 877 full-text articles were reviewed, of which seven included information on vector surveillance, 56 on vector control and 57 on insecticide resistance. Publications reporting longitudinal data from sustained Aedes vector surveillance systems were only available for Senegal and La Réunion. Aedes vector control studies were principally controlled bioassays or small-scale studies conducted before and after entomological studies which lacked epidemiological outcomes. The most studied methods were larval control (n = 21 publications), integrated control combining different interventions (n = 7), topical repellents (n = 6), environmental management (n = 5) and spatial repellents (n = 3). Four publications described typical vector control responses during arbovirus epidemics in Africa: these often combined larviciding, ultra-low volume (ULV) space spraying and community engagement to reduce larval sites, alongside active source reduction. There was a lack of high-quality evidence generated through rigorous study design on the effectiveness of control measures in reducing arbovirus transmission in the African context. As a consequence, the scientific basis for evidence-informed decisions in Africa, both for routine Aedes vector control or for outbreak response, remains weak. Insecticide resistance studies focused on adulticides using WHO tube tests (n = 43 publications), with larval bioassays relatively less common (n = 13). Aedes aegypti (n = 53) and Aedes albopictus (n = 12) were the only Aedes species tested. The most commonly tested adulticides were permethrin and deltamethrin (pyrethroids); bendiocarb (carbamate); and dichlorodiphenyltrichloroethane (DDT; organochlorine), although the results were rarely reported in connection with decision-making about Aedes control. Results of the most relevant adulticides indicated that Ae. aegypti populations were generally susceptible to malathion (organophosphate), but resistance to permethrin and deltamethrin was detected in West and Central Africa. Most studies pre-dated the revised WHO guidance, and insecticide concentrations were mostly those recommended for Anopheles susceptibility testing that use relatively higher discriminating doses, and thus likely underestimate true Aedes resistance levels. Larval susceptibility bioassays were conducted with temephos (n = 12) and Bacillus thuringiensis israelensis (n = 6). Temephos resistance was only detected in Cabo Verde following several decades of use. CONCLUSIONS: Given the increasing frequency of arbovirus epidemics in Africa, countries urgently need to develop plans for emergency response and robust control strategies that make use of evidence from good-quality studies to strengthen resilience
A demographic assessment of the impact of the war in the Gaza Strip on the mortality of children and their parents in 2023.
Get PDFBACKGROUND: Following Hamas's 7 October attack, Israel launched extensive aerial bombardments in the Gaza Strip, followed by a large-scale ground invasion. During the first 3 months of the conflict, up to December 31, 2023, the Palestinian Ministry of Health reported that 21,822 Palestinians were killed in Israeli strikes. This study estimates the number of excess deaths in children due to the war in the Gaza Strip in 2023 and assesses how the conflict has impacted the experience of parental loss among children. METHODS: We reconstructed background life tables for the Gaza Strip based on under-five mortality estimates from sample surveys and accounted for casualties due to the 2023 conflict, using the age distribution of deaths from an individual list of 13,101 fatalities reported by the Palestinian Ministry of Health. We employed a kinship matrix model to estimate the number of new orphans in 2023 and the prevalence of maternal and paternal orphanhood. RESULTS: From October 8 to December 31, 2023, our estimates indicate that 8120 children under 18 years of age were killed due to the conflict (with a range of 7099 to 9196 excess deaths). Additionally, 15,127 children (14,716-15,553) lost a father, and 9886 children (9564-10,216) lost a mother due to the conflict. Between 2022 and 2023, the probability of dying in childhood (ages 0-17) increased nearly sixfold for both males and females. The war increased the risk of losing a mother and a father by nine-fold and six-fold, respectively. Compared to the situation in 2022, the proportion of paternal orphans among children aged 0-17 rose by 1.5 times, while the proportion of maternal orphans doubled. CONCLUSIONS: The dramatic number of excess deaths among children and the sharp increases in orphanhood underscores the urgent need to prioritize the well-being and rights of children caught up in the war in Gaza
An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma: A Pilot Cluster Randomized Control Trial.
Get PDFBACKGROUND: Consistent evidence shows stigma impedes healthcare access in people living with HIV (PLWH) and men who have sex with men (MSM). We evaluated the impact of a stigma reduction training for providers whose design was informed by direct observation of their clinical behaviors obtained through visits by incognito standardized patient (SP). SETTING: We conducted this study in in sexually transmitted infection clinics in Guangzhou, China. METHODS: This pilot cluster randomized control trial assessed the feasibility, acceptability, and preliminary efficacy of an intervention whose design was informed by a baseline round of incognito visits in which SPs presented standardized cases to consenting doctors. By randomly varying the HIV status and sexual orientation of each case, we could quantify stigma as differences in care quality across scenarios. We then conducted a follow-up round of SP visits and assessed impact using linear fixed effects regression. RESULTS: Feasibility and acceptability among the 55 provider participants was high, with no adverse visit events. The training improved testing for HIV negative MSM (0.05 percentage points [PP], 95% CI,-0.24, 0.33) and diagnostic effort in HIV positive MSM (0.23 standard deviation [SD] improvement, 95% CI, -0.92, 1.37). Patient-centered care only improved for HIV positive straight cases (SD, 0.57; 95% CI, -0.39, 1.53). All estimates lacked statistical precision, an expected outcome of a pilot RCT. CONCLUSIONS: Our training reduced stigma in in several domains of care, but least of all for PLWH, suggesting that future trainings should include more clinical content to strengthen clinical skills in PLWH management
Prenatal Exposure to Zika Virus and Risk of Epilepsy-Related Hospitalization During Early Childhood.
Get PDFIMPORTANCE: Epilepsy is a major clinical concern in children with congenital Zika syndrome (CZS). However, whether in utero exposure to Zika virus (ZIKV) without development of CZS is associated with increased epilepsy risk compared with unexposed children remains unclear. OBJECTIVE: To compare the risk of epilepsy-related hospitalizations during the first 4 years of life among children exposed to ZIKV during pregnancy (with and without CZS) vs an unexposed group. DESIGN, SETTING, AND PARTICIPANTS: This was a population-based cohort study conducted in Brazil among live-born singleton children with 22 or more weeks' gestation born from January 2015 to November 2018. Data analysis was conducted from December 2024 to March 2025. EXPOSURE: In utero exposure to ZIKV by maternal notification during pregnancy. MAIN OUTCOMES AND MEASURES: The primary outcome was the time from birth to the first epilepsy-related hospitalization. Hazard ratios (HRs) and 95% CIs were estimated using a cause-specific Cox regression model, adjusting for maternal education level, maternal self-reported race and ethnicity, maternal age, year of child birth, and adequacy of the number of antenatal appointments. All-cause deaths were also considered as competing events. RESULTS: Among 10 828 887 children (5 275 628 [48.7%] female; mean [SD] gestational age, 38.5 [2.0] weeks), 2780 (0.03%) had CZS and 8361 (0.08%) were exposed to ZIKV during pregnancy without developing CZS. After adjusting for confounders, CZS was associated with an increased risk of epilepsy-related hospital admission (adjusted HR [aHR], 34.22 [95% CI, 29.16-40.16]). Age-specific aHRs peaked at age 7 to 18 months (aHR [95% CI], 33.72 [24.70-46.04] for 0-6 months, 44.58 [35.89-55.36] for 7-18 months, and 20.62 [14.31-29.72] for 19-48 months). Children with CZS who were microcephalic, normocephalic, or macrocephalic showed similar associations with epilepsy-related admissions. Children exposed to ZIKV without CZS did not show increased risk compared with unexposed peers (aHR, 0.66 [95% CI, 0.34-1.27]). CONCLUSIONS AND RELEVANCE: In this population-based cohort study, CZS was associated with elevated risk of epilepsy-related hospitalization in early childhood in Brazil. In contrast, children exposed to ZIKV during pregnancy without CZS did not appear to have higher risk of epilepsy-related admission compared with unexposed children
A systematised review of seasonal influenza case-fatality risk.
Get PDFCase-fatality risk (CFR) is an important indicator of disease severity for influenza infection and an input to estimates of influenza burden and vaccination impact. However, CRF estimates based on laboratory-confirmed cases (cCFR) are more-highly sensitive to features of the local health-care system and surveillance. Estimates based on diagnosed-symptomatic cases (sCFR) are likely to be more consistent across health systems but are less commonly reported. We present a systematised review of sCFR for seasonal influenza to determine the availability of studies, variation across their sCFR estimates, and factors driving this variation. We identified 10 studies reporting sCFR, or primary data for its direct estimation, resulting in 40 location and season-specific point estimates (range 0.3-908 per 100,000 cases). There is considerable variation in sCFR across geographies, which was not linearly related to key socio-economic factors, but the variation can be even larger across seasons in a geography. The wide variation across studies and the lack of studies in many world regions point to the need for standardised protocols and more data collection
Gender and food systems: Are global recommendations for sustainable food systems transformation also gender transformative?
No full textThe globally dominant industrialised food system, which encompasses the interrelated actors and activities involved in producing, processing, distributing, preparing and consuming food, in its current form contributes to the global burden of food insecurity and malnutrition, and to environmental degradation and social inequities. Women are critical actors across all aspects of this food system, yet food systems also drive gender inequality, negatively impacting the health and wellbeing of women and girls globally. Addressing these systemic gender inequities is essential for food systems transformation, which requires the adoption of gender-transformative approaches (GTAs) in policymaking. This study assessed the level of gender inclusion in existing global-level food systems policy recommendations to identify gaps in the achievement of GTAs within sustainable food systems policymaking. We undertook a three‑step methodological approach: (i) identification and adaptation of a gender inclusion assessment tool through a scoping review; (ii) identification of global-level policies addressing food systems challenges; and (iii) gender inclusion policy analysis using the adapted assessment tool. The analysis revealed that most food systems policies recommended at the global level fail to integrate GTAs. Policies that were assessed showed limited consideration for gender equality and did not effectively address systemic gender inequities. The findings suggest that GTAs should be prioritised in food systems policymaking to address gender inequalities. There is scope for considerable gender inclusion assessment tool and framework development, but the gender inclusion assessment tool used in this study provides a foundational framework for future gender inclusion analysis in global food systems policy development
Home-Based Care for Hypertension in Rural South Africa.
No full textBACKGROUND: Poorly controlled hypertension is a common problem worldwide, particularly in low-resource settings. METHODS: We conducted an open-label, randomized, controlled trial of a home-based model of hypertension care in South Africa. Adults with hypertension were assigned to receive home-based care, which consisted of patient monitoring of blood pressure, home visits from a community health worker (CHW) for data collection and medication delivery, and remote nurse-led decision making supported by a mobile application (CHW group); enhanced home-based care, which consisted of the same intervention but with blood-pressure machines transmitting readings automatically (enhanced CHW group); or standard care with clinic-based management (standard-care group). The primary outcome was the systolic blood pressure at 6 months. Secondary outcomes were the systolic blood pressure at 12 months and hypertension control at 6 and 12 months. Safety outcomes included adverse events, deaths, and retention in care. RESULTS: A total of 774 adults underwent randomization. The mean age was 62 years; 76.0% of the participants were women, 13.6% had diabetes mellitus, and 46.5% had human immunodeficiency virus infection. The mean systolic blood pressure at 6 months was lower in the CHW group than in the standard-care group (difference, -7.9 mm Hg; 95% confidence interval [CI], -10.5 to -5.3; P<0.001) and was also lower in the enhanced CHW group than in the standard-care group (difference, -9.1 mm Hg; 95% CI, -11.7 to -6.4; P<0.001). The percentage of participants with hypertension control at 6 months was 32.5% in the standard-care group, as compared with 57.4% in the CHW group (relative risk, 1.76; 95% CI, 1.40 to 2.13) and 61.3% in the enhanced CHW group (relative risk, 1.89; 95% CI, 1.51 to 2.27). The improvements in systolic blood pressure and hypertension control with home-based care appeared to persist at 12 months. Severe adverse events and deaths occurred in 2.7% and 1.0% of the participants, respectively, and occurred in a similar percentage of participants across trial groups. Retention in care was observed in more than 95% of the participants in the CHW and enhanced CHW groups. CONCLUSIONS: In South Africa, home-based hypertension care led to a significantly lower mean systolic blood pressure at 6 months than standard, clinic-based care. (Supported by the National Institutes of Health and others; IMPACT-BP ClinicalTrials.gov number, NCT05492955; South African National Clinical Trials Register number, DOH-27-112022-4895.)