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Fostering leadership and gender equality in climate action among underserved, rural and Indigenous women: a qualitative exploration of opportunities and limitations in Peru.
Get PDFBACKGROUND: Climate change has profound impacts on women's health and wellbeing, particularly in the Global South, which is disproportionately affected by environmental threats. Peru, one of the most biodiverse and culturally rich countries worldwide, is uniquely vulnerable to these effects due to its diverse ecosystems each facing distinct climate challenges. Yet research on the lived experiences of rural and Indigenous Peruvian women facing these impacts is scarce. We aim to explore the perspectives and experiences of underserved Peruvian women regarding the effects of climate change, and the needs, assets, and community responses to these threats. METHODS: Between April and May 2022, we conducted 48 in-depth walking interviews with adult women from the Peruvian north coast, Amazon rainforest, and central and southern Andes regions. Using purposive and iterative snowball sampling, we recruited community key informants. We analysed the data thematically. FINDINGS: Our analysis identified four main themes: (1) Local understanding of environmental changes, (2) Gendered impacts of climate change, (3) Women's participation in environmental governance, and (4) Pathways for gender-responsive climate action. Participants described vivid observations of environmental shifts, often attributing these to local human activities. Women reported increased caregiving responsibilities and economic vulnerabilities due to climate-related events. Barriers to women's participation in environmental decision-making were identified, including traditional gender roles and lack of voice in community forums. Participants highlighted the need for capacity building, leadership development, and integration of indigenous knowledge in climate action. INTERPRETATION: This study underscores the imperative of centring gender equity and social justice in climate change adaptation and environmental governance. Findings highlight the urgent need to address systemic barriers, rebuild institutional trust, and adopt an intersectional, community-centric approach responsive to marginalised women's realities and priorities. Health systems should prepare for the mental health impacts of climate-related events on women, particularly increased anxiety and depression linked to resource insecurity and caregiving burdens. Policymakers should develop gender-responsive disaster preparedness plans, strengthen women's representation in environmental decision-making bodies, and create culturally appropriate climate communication strategies that integrate Indigenous knowledge systems. Implementation of targeted leadership training programs for women and establishing community-based environmental monitoring systems would enhance climate resilience while addressing gender inequities. FUNDING: This research was funded by ECF's postdoctoral fellowship from the Gordon and Betty Moore Foundation at the London School of Hygiene and Tropical Medicine and Stanford University
Mind the Clinic-Community Gap: Re-evaluation of Test Performance and False Positive Results in Community-Wide Tuberculosis Screening.
Get PDFCommunity-wide screening for bacteriologically confirmed pulmonary tuberculosis may reduce the tuberculosis burden, although concerns of overtreatment remain because of false positive diagnoses due to subpar specificity of current bacteriological tests for screening. Our review and data analysis show that clinic-based test specificity estimates of Xpert against culture underestimate performance in communities, for both Xpert MTB/RIF(99.8% for community vs 98.4% for clinic) and Xpert Ultra (99.4% vs 95.6%, respectively), reducing the presumed false positivity of sputum Xpert, using culture as the reference, by 86.8% and 85.4%, respectively, compared with clinic-based specificity estimates. These findings support large-scale evaluation of community-wide screening for tuberculosis
Reducing extreme heat impacts on health in pregnant women and infants: a community based intervention in Kilifi, Kenya.
Get PDFHigh ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members, and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behaviour-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and postpartum women (n = 10), mothers-in-law (n = 10), male spouses (n = 10), and community influencers (n = 40). Researchers and local community health volunteers supported pregnant and postpartum women and their household networks weekly for 4 months. At month five, a structured interview, originally administered at baseline, was repeated to evaluate understandings of heat risks and changes in behaviour (reducing exposure to heat by changing daily schedules, reducing heavy workload, and increasing spousal support). Pregnant and postpartum women reported a better understanding of the effects of heat on their health and the newborn, including the importance of staying hydrated, breastfeeding frequently, and avoiding heavy clothing for newborns. They also reported an increase in mothers-in-law and male spouses assisting with household chores and disseminating heat-health messaging to families. However, women noted that male spouses who supported them with chores sometimes reported being stigmatized by their peers. Community approaches to support pregnant and postpartum women during heat periods are feasible, and key community influencers can be trained to include heat-health messaging in their daily routines. Additional research is needed to examine whether repeated training is required to ensure sustainability. Future heat interventions focusing on maternal and neonatal health should consider factors such as employment, age, and depth of support networks
Micronutrient Powders Combined With Malaria Chemoprevention to Improve Anaemia and Cognitive Function in Early Childhood in Mali: A Cluster-Randomised Trial.
Get PDFA cluster-randomised controlled trial was conducted in 60 communities in southern Mali to evaluate the impact of micronutrient powders (MNP) combined with seasonal malaria chemoprevention (SMC) on anaemia (primary endpoint), Plasmodium infection, stunting and cognitive function in children < 5 years. The 60 communities were randomly allocated to the intervention or control arm, and cross-sectional biomedical and cognitive surveys were conducted after 1 and 3 years in a random sample of 3 and 5 years olds (1052 and 1081 children, respectively). All children aged 3-59 m in intervention and control communities received two rounds of SMC each year during the peak malaria season, and in intervention communities, all children aged 6-59 m additionally received 4 months of daily MNP after the peak malaria season. Despite a high baseline prevalence of anaemia and good fidelity to intervention, this trial found no evidence of impact on study outcomes. The prevalence of anaemia was similar in both arms for both age groups after 1 and 3 years of intervention-after 3 years, the prevalence of anaemia amongst 3-year olds was 57.6% in the intervention arm versus 60.1% in the control group (p = 0.352). For 5-year olds, it was 51.3% and 53.0%, respectively (p = 0.607). No effect was observed on stunting or cognitive function either
Social factors, health policy, and environment: implications for cardiovascular disease across the globe.
Get PDFCardiovascular disease (CVD) is the leading cause of deaths worldwide, with 80% occurring in low- and middle-income countries. These countries are characterized by rapid urbanization, poorly funded health systems, poor access to prevention and treatment strategies, and increasing age and a higher prevalence of chronic disease. Rapid urbanization has contributed to the significant environmental and societal changes affecting daily life habits and cardiovascular health. There is growing awareness that environmental and social exposures and policies can influence CVD directly or through behavioural risk factors. However, much of this knowledge comes from studies in high-income countries and is applied to low- and middle-income countries without evidence to indicate this is appropriate. This state-of-the-art review will present and synthesize key findings from the Prospective Urban Rural Epidemiology study and related studies that have aimed to understand the environmental, social, and policy determinants of cardiovascular health in countries across varying levels of economic development through an urban/rural lens. Emerging from these findings are future policy and research recommendations to accelerate the reduction of the global burden of CVD
Statistical analysis plan for the LAST ACT clinical trial; a Leukotriene A4 hydrolase Stratified non-inferiority Trial of Adjunctive Corticosteroids for HIV-negative adults with Tuberculous meningitis.
Get PDFTuberculous meningitis (TBM) is the most severe form of tuberculosis. Corticosteroids are currently recommended as an adjunctive therapy in HIV-negative adults with TBM. However, benefit from corticosteroids in TBM may depend upon host leukotriene A4 hydrolase ( LTA4H) genotype and the corresponding inflammatory phenotypes. This article describes the planned analyses for the primary publication of the results of the LAST ACT clinical trial (NCT03100786): 'Leukotriene A4 hydrolase Stratified Trial of Adjunctive Corticosteroids for HIV-negative adults with Tuberculous meningitis'. The primary hypothesis addressed by the trial is that LTA4H genotype, in particular CC or CT genotype, determines whether adjunctive dexamethasone benefits or harms adults with TBM. The trial was an LTA4H genotype stratified, parallel group, randomised, double blind, placebo-controlled multi-centre Phase III trial of dexamethasone given for 6-8 weeks in addition to standard anti-tuberculosis drugs. LTA4H genotype (CC, CT, TT) was determined in all participants prior to randomisation; only those with CC or CT genotype were randomised to dexamethasone or placebo. All TT genotype participants received dexamethasone because prior data indicated survival was increased by dexamethasone in this genotype. The primary endpoint was all-cause death or new neurological event over the first 12 months after randomisation. We took a hybrid trial-design approach which aims to prove non-inferiority of placebo first but also allows claiming superiority of placebo in case dexamethasone causes substantial harm. This statistical analysis plan expands upon and updates the analysis plan outlined in the published study protocol
School Meals Case Study: Angola
Get PDFThis school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The School Meals Case Study of Angola serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
The role of fruit trees in reducing food insecurity and improving nutrition security of rural households: A case study of the KwaZulu-Natal province, South Africa.
Get PDFDespite calls to increase fruit consumption, food and nutrition security strategies often overlook the inclusion of fruit trees in the rural food systems. Hence, this study investigated the role of fruit trees in reducing food insecurity and improving nutrition security among rural households in the KwaZulu-Natal province, South Africa. Descriptive statistics, household food insecurity access scale (HFIAS), household food insecurity access prevalence (HFIAP), food consumption score (FSC), principal component analysis (PCA), and ordered logit model were used to analyze survey data from 305 households. The results showed that only 29.8% of the households were food secure, while the rest were either mildly (36.4%), moderately (27.9%), or severely (5.9%) food insecure. Moreover, 4.6% of the households consumed poor diets, 23.0% of the sampled households were at the borderline, and 72.5% consumed an acceptable diversity of food groups. The ordered logit model findings showed that growing fruit trees, consumption of wild fruits, household size, off-farm income, access to irrigation, access to training, livestock ownership, and psychological capital significantly influenced household food insecurity and nutrition security. The study recommends the implementation of awareness campaigns promoting the planting of fruit trees and the consumption of locally available wild fruits. There is a need for nutrition-related training programs and workshops to enhance awareness of the importance of growing and consuming fruits among rural households. The collective participation of the private sector, government, researchers, civil society organizations, policymakers, politicians, and farming rural households in building awareness is also recommended
The effect of location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014-2021: A retrospective cohort study.
Get PDFBACKGROUND: High HIV prevalence has been documented among people who inject drugs in Myanmar particularly in mining and borderland areas. We estimated incidence of HIV among people using drugs (via injecting and other routes) and examine associations between location in mining or borderland areas and risk of infection. METHODS AND FINDINGS: Analysis of data among clients registered at harm reduction programmes across Sagaing region, Kachin, and Northern Shan States between 2014-2021. Data on sociodemographic, drug use characteristics and clinic-level data on borderland or mining locations were collected at time of registration. Characteristics, repeat HIV testing and HIV seroconversion were analysed using a cohort approach. We use Poisson regression models to examine associations between location in a borderland or mining area and incidence of HIV, adjusting for confounders. Data were available for 85,093 clients, 52,526 reported HIV tests and 20.0% were seropositive. 38,670 clients had no or only one recorded HIV result. The median time between HIV tests was 1.1 years. Among 13,359 clients with 2 or more HIV tests the HIV seroconversion rate was 3.8 per 100 person years (pyrs) (95% CI 3.6-4.0). Incidence among those who injected drugs was 6.8 per 100/pyrs, 8.9 among those aged ≤ 25 years, 2.3 among women, 2.3 among those who had migrated, 5.6 among those located in border areas, and 3.7 among those in mining areas. After adjusting for confounders, HIV incidence remained higher for people located in borderland areas (Incidence Rate Ratio 1.67 95% CI 1.13-2.45) but there was no evidence of association between location in a mining area and HIV seroconversion. CONCLUSIONS: Findings highlight the need to intensify harm reduction interventions with a focus on cross-border interventions. Increasing uptake of HIV testing alongside the scale up of evidenced based interventions is urgently needed to curb the high rates of HIV transmission associated with drug use, particularly among young people
Intermittent suppressive posaconazole therapy is ineffective at mitigating cardiac and digestive tract pathologies in an experimental model of chronic Chagas disease.
Get PDFInfections with Trypanosoma cruzi cause Chagas disease, a chronic condition that can give rise to debilitating cardiac and/or gastrointestinal damage. However, it is unclear why only ~30% of individuals progress to symptomatic pathology, why this can take decades to become apparent, and why there is such a wide range of disease outcomes. Disease pathology is a long-term cumulative process resulting from collateral damage caused by inflammatory immune responses that continually eliminate transient parasite infections in the heart and/or gastrointestinal tract. The guiding principle behind anti-parasitic drug development is that a sterile cure is required to prevent progression to symptomatic pathology. Evidence suggests that the cumulative damage required to reach the symptomatic threshold is determined by a number of factors, including host and parasite genetics, which govern the intensity and location(s) of infection. Therefore, an alternative therapeutic strategy could involve long-term intermittent treatment, which may not confer sterile cure but is able to suppress the parasite burden to a level where the disease does not become symptomatic within the lifetime of the infected individual. To test this hypothesis, we used an experimental murine model that displays both cardiac and digestive tract pathologies. Mice were given intermittent treatment with posaconazole under conditions that initially reduced the parasite burden by >99% but did not confer sterile clearance. Our results show that this did not provide long-term protection against the key cardiac or gastrointestinal manifestations of Chagas disease, and that sterile cure should remain the single goal of the drug development community