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Thirteen-Year Sequelae of Marburg Virus Disease Survival: Persistent Cardiometabolic, Immunometabolic, and Haematological Alterations in the Absence of Psychological Morbidity.
Get PDFBackground: Marburg virus disease (MVD) is a highly lethal filoviral infection, yet its long-term health consequences remain poorly understood. We present one of the most temporally distant evaluations of MVD survivors, conducted 13 years post-outbreak in Uganda, offering novel insights into chronic physiological, biochemical, haematological, and psychosocial outcomes. Methods: A cross-sectional, community-based study compared ten MVD survivors with nineteen age- and sex-matched unexposed controls. Clinical evaluations included vital signs, anthropometry, mental health screening, and symptom reporting. Laboratory analyses covered electrolytes, inflammatory markers, renal and liver function tests, haematology, and urinalysis. Standardised psychological assessments measured anxiety, depression, perceived stigma, and social support. Findings: Survivors exhibited an elevated body mass index (BMI), higher systolic and diastolic blood pressure, and lower respiratory rates compared to controls, indicating ongoing cardiometabolic and autonomic changes. These trends may reflect persistent cardiometabolic stress and potential alterations in autonomic regulation, warranting further investigation. Biochemically, survivors exhibited disruptions in serum chloride, bilirubin, and total protein levels, suggesting subclinical hepatic and renal stress. Haematological analysis revealed persistent reticulocytosis despite normal haemoglobin levels, indicating long-term erythropoietic modulation. Despite these physiological changes, survivors reported minimal psychological morbidity, sharply contrasting with the post-recovery profiles of other viral haemorrhagic fevers. Stigma was prevalent during the outbreak; however, strong family support alleviated long-term psychosocial distress. Interpretation: Thirteen years post-infection, MVD survivors demonstrate multisystem physiological perturbations without marked psychological sequelae. These findings challenge assumptions of universal post-viral trauma and highlight the necessity for tailored survivor care models. Future longitudinal studies should investigate the mechanistic pathways underlying cardiometabolic and haematological reprogramming to inform intervention strategies in resource-limited settings
Intimate partner violence during pregnancy and its association with pregnancy and childbirth complications: A prospective cohort study.
Get PDFIntimate partner violence (IPV) during pregnancy increases the risk of adverse outcomes for both the woman and foetus. However, there is limited research on its scope and impact in many sub-Saharan African countries. In this study, we investigated the effects of IPV during pregnancy on pregnancy and childbirth complications in Ethiopia. Prospective, longitudinal data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) Cohort 1 study covering a sample of 2635 women followed up until one year postpartum was used for analysis. Information on IPV during pregnancy and obstetric complications were collected from women at six-week follow-up visits. Multivariable log-binomial regression estimated the risk of antepartum, intrapartum, and postpartum complications associated with IPV of any type, physical IPV and sexual IPV during pregnancy. The prevalence of any IPV type was 13%, only physical IPV was 4.6%, and only sexual IPV was 7.1%. Physical IPV was associated with an increased risk of worsening vision at night during pregnancy (adjusted relative risk [aRR]=2.47, 95% Confidence Interval [95%CI]=1.46 - 4.77), intrapartum haemorrhage (aRR=1.65, 95%CI=1.11 - 2.46), and intrapartum convulsion (aRR=1.98, 95%CI=1.34 - 2.94). Sexual IPV was associated with increased risk for antepartum convulsion (aRR=1.93, 95%CI=1.07 - 3.48), leaked/ruptured membrane (aRR=2.86, 95%CI=1.59 - 5.14), malpresentation (aRR=2.37, 95%CI=1.17 - 4.80), intrapartum convulsions (aRR=1.86, 95%CI=1.16 - 2.98), postpartum haemorrhage (aRR=1.68, 95%CI=1.18 - 2.40) and fever with foul discharge (aRR=2.03, 95%CI=1.40 - 2.93). Overall, the experience of any IPV type increased the risk for the above in addition to migraine, postpartum convulsion, and abnormal vaginal discharge. There is a need to embed IPV sensitisation campaigns in maternal health policies and interventions and to empower women to report cases for timely intervention
Effect of the 2022 COVID-19 booster vaccination campaign in people aged 50 years in England: Regression discontinuity analysis in OpenSAFELY-TPP.
Get PDFSARS-CoV-2 vaccines are highly effective in preventing severe COVID-19 but require boosting to maintain protection. Changes to circulating variants and prevalent natural immunity may impact on real-world effectiveness of boosters. With NHS England approval, we used linked routine clinical data from >24 million patients to evaluate the effectiveness of the 2022 combined COVID-19 autumn booster and influenza vaccine campaign in non-clinically vulnerable 50-year-olds in England using a regression discontinuity design. Our primary outcome was a composite of 6-week COVID-19 emergency attendance, COVID-19 unplanned hospitalisation, or death. By 26 November 2022, booster vaccine coverage was 11.1 % at age 49.75 years increasing to 39.7 % at age 50.25 years. The estimated effect of the campaign on the risk of the primary outcome in 50-year-olds during weeks 7-12 after the start of the campaign was -0.4 per 100,000 (95 % CI -7.8, 7.1). The results were similar when using different follow-up start dates or when estimating the effect of vaccination (rather than the campaign). This study found little evidence that the autumn 2022 vaccination campaign in England was associated with a reduction in severe COVID-19-related outcomes among non-clinically vulnerable 50-year-olds. Possible explanations include the low risk of severe outcomes and substantial pre-existing vaccine- and infection-induced immunity. The booster campaign may have had effects beyond those we estimated, including reducing virus transmission and incidence of mild or moderate COVID-19
Samar Cobra (Naja samarensis): The Intersection of Clinical Toxinology and Wildlife Conservation in the Philippines.
No full textKeywords: biodiversity conservation; Naja samarensis; neurotoxic venom; Philippines; public health; Samar cobra; snakebite envenomatio
Is inverse probability of censoring weighting a safer choice than per-protocol analysis in clinical trials?
Get PDFDeviation from the treatment strategy under investigation occurs in many clinical trials. We term this intervention deviation. Per-protocol analyses are widely adopted to estimate a hypothetical estimand without the occurrence of intervention deviation. Per-protocol by censoring is prone to selection bias when intervention deviation is associated with time-varying confounders that also influence counterfactual outcomes. This can be corrected by inverse probability of censoring weighting, which gives extra weight to uncensored individuals who had similar prognostic characteristics to censored individuals. Such weights are computed by modelling selected covariates. Inverse probability of censoring weighting relies on the no unmeasured confounding assumption whose plausibility is not statistically testable. Suboptimal implementation of inverse probability of censoring weighting which violates the assumption will lead to bias. In a simulation study, we evaluated the performance of per-protocol and inverse probability of censoring weighting with different implementations to explore whether inverse probability of censoring weighting is a safe alternative to per-protocol. Scenarios were designed to vary intervention deviation in one or both arms with different prevalences, correlation between two confounders, effect of each confounder, and sample size. Results show that inverse probability of censoring weighting with different combinations of covariates outperforms per-protocol in most scenarios, except for an unusual case where selection bias caused by two confounders is in two directions, and 'cancels' out
The characterization of Klebsiella pneumoniae associated with neonatal sepsis in low- and middle-income countries to inform vaccine design.
Get PDFKlebsiella pneumoniae is the leading cause of neonatal sepsis, strongly associated to antimicrobial resistance, with no vaccine available. K-antigens (KAg) have been identified as potential targets, but their diversity makes vaccine development challenging. Alternatively, the use of subcapsular O-antigens (OAg) raises questions about antibodies accessibility. We characterized clinical isolates from the BARNARDS study, designed to identify the burden of neonatal sepsis in low-middle income countries. Genomic prediction was verified through structural analysis of polysaccharides. Antibodies generated against common KAg and OAg bound all homologous organisms, regardless of specific polysaccharide structural features. Interestingly, anti-KAg antibodies exhibited bactericidal activity against a comparable number of isolates as anti-OAg antibodies. There was no association between polysaccharide characteristics and K. pneumoniae susceptibility to killing. Antibody cross-reactivity among different KAg was observed, together with extensive cross-reactivity among OAg antibodies. This study aids in defining an optimal vaccine composition to prevent neonatal sepsis caused by K. pneumoniae
Pathways to mental health services across local health systems in sub-Saharan Africa: Findings from a systematic review.
Get PDFGlobally, over 280 million individuals suffer from mental disorders, and almost 85% in low-resource settings do not receive any therapy. In sub-Saharan Africa (SSA), many patients are forced to either live with untreated mental illness or seek care from traditional or religious leaders due to the high treatment cost. This literature review identifies pathways to access mental health services and proposed a collaborative model for care across SSA. We systematically searched five electronic databases (Embase and MEDLINE via OVID, CINAHL, PsycINFO, and Global Index Medicus) using the following search terms, 'pathways to care', 'mental disorders,' and 'sub-Saharan Africa' for primary studies reporting on pathways to care for mental disorders in SSA. There were no restrictions on the study's date. Overall, the electronic database search produced 3399 search results, of which we retrieved 194 articles for full-text screening and 29 studies included in the analysis. This study finds that traditional and faith-based healers play an integral role in the pathway to care; more than 70% used traditional and religious healers as the first point of care for mental health care. The median duration for the delay in seeking treatment in a health facility was six months. Patients who sought care from traditional and faith healers were found to have experienced the most prolonged delay without treatment. Age, gender, level of education, marital status, and geographical location were some of the factors associated with the pathway choice. Patients who sought care from traditional and faith healers as the first point of care were found to have experienced the most extended delay without treatment when they arrived at the hospital. The study proposes and recommends a new model for collaboration between biomedical, traditional and faith-based healers that focuses on education through training and adopting a new referral framework
Assessing Community and Social Media Influence to Increase Influenza Vaccine Uptake among Youth in Soweto, South Africa (The Bambisana Study): Protocol for a Mixed Methods Pretest-Posttest Intervention Study.
Get PDFBACKGROUND: Seasonal influenza has an estimated global reach of 3-5 million infections, with 290,000-650,000 influenza-related deaths yearly. Despite its efficacy in reducing morbidity and mortality, influenza vaccination rates remain low globally and in South Africa. Youth between the ages of 18 and 34 years are not prioritized for influenza vaccines although influenza surveillance in South Africa shows that individuals aged 19-44 years present the highest asymptomatic episodes and the lowest medically attended illness. This creates an opportunity to investigate if and how vaccine demand can be created in the absence of clear imperatives to vaccinate. The study tests the effectiveness of tailored, context-specific education, and community engagement, including community and social media to increase influenza vaccination uptake. Tailored, context-specific education, community engagement, reliable vaccine supply, and free, localized access are all critical for improving perceptions of, increasing confidence in, and motivating the uptake of vaccination. OBJECTIVE: This study will explore strategies to increase influenza vaccine uptake amongst economically marginalized youth aged 18-34 years in Soweto (South-Western Townships), South Africa, where influenza vaccines are not universally accessible through the public health system for this age group. METHODS: The Bambisana Study uses an innovative approach, including community influencers and social media to increase the uptake of influenza vaccines through designing and testing an integrated communications strategy targeted at economically marginalized youth in Soweto, South Africa. The study uses a mixed methods pretest-posttest intervention design to test the effects of the interventions. The intervention will consist of the following components: (1) social media campaign, (2) microinfluencers on and offline, and (3) nonsocial media focused, offline microinfluencer-led engagement within communities. Quantitative data will be collected using a randomized household sample pre- and posttests, and clinic surveys with vaccinees and clinic attendees who declined vaccination. Focus group discussions (FGDs) will be conducted pre- and post intervention with participants aged ≥18 years, and 20 key informant interviews (KIIs) will be conducted with key influencers including religious leaders, traditional healers, and youth leaders. FGDs and KIIs will be audio-recorded and transcribed into English for analysis using framework thematic analysis, and quantitative data analyses will be conducted using SAS Enterprise (Guide 7.15; SAS Institute). RESULTS: This study was funded in December 2022, with recruitment having started in May 2023. As of May 2024, all data collection is complete, with data analyses and preparation of peer-reviewed publications in progress. The first results are expected to be submitted for publication in November 2024. CONCLUSIONS: Enhancing perceptions of, bolstering confidence in, and fostering uptake of vaccination relies heavily on the efficacy of yearly influenza vaccination initiatives, personalized education tailored to specific contexts, active community involvement, consistent vaccine availability, and easily accessible, cost-free distribution channels at the local level. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60481
Sexual risk and HIV prevention choices among men who are mobile for work: Results from a rapid ethnographic assessment for the Mobile Men trial in South Africa and Uganda.
Get PDFIn preparation for a trial implementing oral and long-acting Pre-Exposure Prophylaxis [LA-PrEP] for mobile men in South Africa and Uganda, we conducted a rapid ethnographic assessment at each trial site between November 2023 and July 2024. We present findings from that assessment on men's views on sexual risk and HIV prevention options which informed the trial. Each rapid ethnographic assessment took 15 days of continuous work in each community using a set of participatory methods: transect/spiral walks, ethnographic observations, conversations, in-depth interviews (IDIs) and focus/natural group discussions (GDs) with community members, health service providers and mobile men. We conducted 50 GDs, 61 IDIs and 297 informal conversations with men and women from four sites in Uganda and five in South Africa. Mobile men at the study sites were engaged in the transport industry (as taxi and truck drivers), construction and fishing. Many of these men were reported to be engaged in multiple sexual relationships. Being away from home, boredom and consumption of alcohol were reasons given for having many partners. Sex without a condom was widespread and was the preferred choice of the men because, they said, of increased sexual pleasure. None of the men was using PrEP. Men often said that PrEP was just for women. When given information on injectable and oral PrEP many men said that they would prefer injectable PrEP to avoid having to carry pills whilst travelling and, in addition, they would not have to remember to take pills. PrEP offers a convenient HIV prevention option for men who are mobile for work. The desire for condomless sex and the availability of oral and injectable PrEP may increase uptake. However, the associated risk of other sexually transmitted infections and blood borne viruses linked to not using a condom requires preventive interventions
Adolescent mental, sexual, and reproductive health in Ghana: a stakeholder analysis of actors' influence over policy formulation and implementation.
Get PDFOne in five adolescents (aged 10-19 years) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be underwhelming. Stakeholders or actors are architects of policy, bringing their ideological values, interests, power, and positions to policy formulation and implementation and thus influencing the policy process. We analysed multilevel stakeholder interests, positions, power, and their influence on adolescent mental, sexual, and reproductive health policy formulation and implementation in Ghana, West Africa, using a single-case study design with multiple embedded subunits of analysis. The case was defined as actors, their power, interests, positions, and their influence on policy formulation and implementation processes in adolescent mental, sexual, and reproductive health. A conceptual framework of conflict and synergies between stakeholder interests, power, and positions and their influence on policy formulation and implementation was used to guide the analysis. Data were obtained from key informant in-depth interviews with 19 global and national level and 16 subnational level stakeholders. Focus group discussions were also conducted with 4 district health management teams, 9 groups of frontline health workers, and 20 groups of in and out of school adolescents in four districts in the Greater Accra region of Ghana. The multiple stakeholders in adolescent health, including adolescents themselves, had sometimes synergistic and sometimes divergent and conflicting views on policy agendas, formulation, and approaches to implementation. Unresolved conflicts between powerful stakeholders in the public or bureaucratic arena stalled or hampered policy formulation and implementation, whereas consensus and adequate resourcing moved processes forward. It is important to invest effort in understanding actors, their power, positions, and interests in context to inform policy content and framing to increase the chances of consensus and effective policy formulation and implementation processes