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Incorporating Machine Learning Techniques to Enhance Rodent Surveillance in Marginalized Urban Communities.
Get PDFEffective management of rodent pests necessitates efficient population surveillance. Many of the available methods currently used for estimating rodent populations are either costly or time-intensive. Rodent trapping demands significant resources, while tracking plates (TP) require high technical expertise and weeks to months of dedicated effort to satisfactorily interpret the plates. Here, we propose integrating Machine Learning techniques to evaluate plates with signs of rodent marks and compare their accuracy with that of conventional human-interpreted plates. We employed the Otsu method to transform plates from RGB color images to grayscale images, highlighting regions of interest. Subsequently, we applied a global threshold to create binary images, assigning values above a globally determined threshold as 1s and others as 0s. The original images were transformed into new versions with 25 small samples, highlighting regions of interest based on the binary images. We used dimensionality reduction methods to identify the fundamental structure of high-dimensional data and determined the most important patterns of interest on the plates. Among the methods, Principal Component Analysis, Independent Component Analysis, and Legendre Moments methods were used to visualize patterns and conduct exploratory data analysis. The k-nearest neighbors, a versatile and intuitive classification method relying on the similarity principle, predicted the feature vector of PCA, ICA, and LM ( L pq ) results. Ultimately, results from PCA and LM compared favorably against the conventional labur-intensive manual method, thus proffering those in the field of disease ecology a better alternative for conducting timely and cost-effective rodent surveillance to monitor rodent distribution hotspots during rodent management programs. We propose a novel approach that could significantly enhance the protocols of rodent surveillance programs, particularly in Low- and Middle-Income Countries, where expertise in interpreting TPs may be limited to enhance rodent surveillance evaluation and timely rodent management while contributing to the indirect control of rodent-borne zoonoses
Weekly azithromycin for 48 weeks impacts nasopharyngeal microbial prevalence and Streptococcus pneumoniae serotypes in children with HIV-associated chronic lung disease.
Get PDFHIV-associated chronic lung disease (HCLD) accounts for over 50% of deaths in children living with HIV. Azithromycin reduces the risk of respiratory exacerbations in children with HCLD, but its impact on respiratory pathogens and Streptococcus pneumoniae serotypes in HCLD remains partially understood. We investigated the impact of azithromycin on the prevalence and density of respiratory microbes in children enrolled in the BREATHE randomized controlled trial. Nasopharyngeal swabs collected from 287 participants at baseline, 48 and 72 weeks were analysed using nanofluidic qPCR testing for 94 S. pneumoniae serotypes, 12 bacterial species, and eight respiratory viruses. No differences were observed between microbial colonisation in the azithromycin and placebo groups at baseline or 72 weeks. At 48 weeks, overall bacterial colonisation was significantly lower in the azithromycin group compared to placebo (adjusted Odd Ratio [aOR]: 0.45, 95% CI 0.25-0.82; p=0.008), with reduced colonisation of S. pneumoniae (aOR: 0.37; 95% CI: 0.24-0.71; p=0.003) and non-typeable Haemophilus influenzae (aOR: 0.29; 95% CI: 0.14-0.61; p=0.001). The 13-valent pneumococcal conjugate vaccine serotypes (19F and 23F) and non-vaccine type (15A/F) were most commonly observed in both groups at all time points. Findings suggest that azithromycin reduces nasopharyngeal colonisation of certain bacteria in HCLD during treatment but has no long-lasting effects after treatment cessation.Trial registration: The BREATHE trial (ClinicalTrials.gov Identifier: NCT02426112, registered date: 24/04/2015)
Integrated health checks as a person-centred approach to systematic screening of household tuberculosis contacts: A realist-informed mixed-methods study.
Get PDFGlobally, tuberculosis incidence and mortality is driven by syndemic interactions of tuberculosis with other chronic conditions including HIV, diabetes and undernutrition in a deleterious social and structural context, often characterised by poverty. Systematic screening for tuberculosis among household contacts is a core element of the WHO tuberculosis strategy but is hampered in high-tuberculosis incidence settings by health system constraints and low participation by household members of people with tuberculosis. Reframing screening as a health check, informed by the syndemic framework, could improve uptake and address proximate determinants of tuberculosis. Within a larger research study aimed at evaluating new tuberculosis diagnostic tests we developed and, using mixed methods, evaluated an integrated health check in a prospective cohort of tuberculosis household contacts in Zimbabwe. This included screening for a range of health conditions, health education and counselling, and on-site treatment or referral. Of 836 identified household contacts, 700 (84%) participated in tuberculosis screening. Of those, 467 people (67% women, median age 28 years) were invited to the health check; all participated in the intervention. One percent (n = 5/459) were diagnosed with tuberculosis. Almost two thirds (n = 288) had at least one unmet health need (either undiagnosed or uncontrolled diabetes, hypertension, HIV, anaemia, undernutrition, common mental health disorders, vision impairment, or tuberculosis). Of those referred following the health check, 66% accessed care for at least one condition, with variation across conditions. In-depth interviews with participants (n = 28), informed development of a refined explanatory theory, illustrating the benefits of a syndemic theory-based approach to tuberculosis screening for household contacts. Members of tuberculosis affected households have multiple, intersecting and unmet health needs. A holistic approach to systematic screening of household contacts guided by the syndemic framework could improve the health of these vulnerable people, advancing progress towards both tuberculosis and sustainable development goals
Barriers and enablers to help-seeking for common mental disorders among young people in low-income settings: Perspectives from Zimbabwe.
Get PDFMETHODS: We utilised a qualitative research design and conducted 32 semi-structured interviews with young people (15-24 years) across high schools and the Friendship Bench (FB) in Harare between 20 December 2022 and 30 September 2023. Interviews were audiotaped and transcribed verbatim and then coded using an inductive approach to capture patterns grounded in participants' experiences. Thematic analysis was utilised to develop relevant codes and identify relevant themes. RESULTS: Nine themes were generated including six themes related to barriers (factors that hinder help-seeking for CMDs) and three themes related to enablers (factors that facilitate help-seeking for CMDs). Barriers identified include perceived stigma, privacy and confidentiality issues, unavailability of services, lack of awareness, financial challenges and lack of incentives. Enablers identified include raising awareness, implementing school based initiatives and enhancing accessibility and affordability of mental health services. CONCLUSION: This study revealed significant barriers and enablers to help-seeking for CMDs among young people in Zimbabwe. Addressing these multifaceted barriers and leveraging the identified enablers is key to creating supportive systems that encourage young people in low-resource settings to seek and engage with mental health services, ultimately improving their mental wellbeing and overall quality of life
Delivery models to improve adherence to medicines for chronic diseases in primary care
Get PDFGlobal efforts to improve medication adherence have increasingly recognised that suboptimal control of chronic diseases is shaped not only by patient behaviour but also by the design and performance of health-care delivery systems. Although adherence is widely accepted as crucial to improved long-term outcomes, the structural role of medication-delivery models in supporting or constraining adherence remains underexplored. In this Health Policy, we provide an analysis of delivery systems of medicines for chronic diseases in 31 countries and aim to assess their regulatory designs, cost-efficiency, effects on access and adherence, and affordability to inform future dispensing policy. Across countries, medicines for chronic diseases are distributed through varied systems, including in-person pharmacy pick up and mail-order programmes. Innovations such as direct-to-consumer e-pharmacies, automated dispensers, and drone-based delivery have emerged from both large private-sector companies and adaptations in low-resource settings driven by necessity. However, many high-income systems have been slow to innovate, and these innovations experience challenges and barriers
Adherence to antiretroviral therapy among female sex workers in Kampala, Uganda.
Get PDFBACKGROUND: Increased access to antiretroviral therapy (ART) for key populations who bear a disproportionate burden of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), including female sex workers (FSWs), reduces onwards transmission. This is, however, dependent on achieving high levels of adherence to ART. AIM: To determine the level of adherence to ART and associated factors among FSWs. SETTING: An urban HIV clinic in Kampala, Uganda. METHODS: This cross-sectional study enrolled 226 FSWs accessing HIV care between May 2017 and June 2017. We assessed self-reported adherence using interviewer-administered questionnaires and reviewing medical records. We defined high-level adherence as those who scored ≥ 95% at assessment. Using multivariable logistic regression, we identified factors independently associated with adherence. RESULTS: Overall, 59.2% of participants were adherent to ART. Major reasons for non-adherence were being away from home (40.8%) and forgetfulness (26.7%). In the multivariable model, owning a phone (adjusted odds ratios [AOR]: 2.90; 95% confidence intervals [CI]: 1.07, 7.88), a 10-year increase in age (AOR: 1.60; 95% CI: 1.00, 2.60) and being a widow (AOR: 0.22; 95% CI: 0.05, 0.87) were independently associated with adherence. CONCLUSION: This baseline assessment builds a case for the development and scale-up of targeted intervention strategies to increase ART adherence among FSWs. Incorporating information and communication technology in routine adherence counselling could be scaled up among FSWs. CONTRIBUTION: Our study highlights the possibility of integrating mobile phone-based adherence support in routine HIV care and informs the design of targeted interventions to curtail HIV transmission
Clinically diagnosed tetanus in a 58-year-old female with breast fungating mass.
No full textBACKGROUND: Tetanus remains a rare but potentially fatal disease, typically associated with traumatic wounds. However, necrotic malignancies such as fungating breast tumors may also serve as an entry point for Clostridium tetani infection. CASE PRESENTATION: We report the case of a 58-year-old female with a 3-year history of a fungating left breast mass who presented with trismus. A diagnosis of tetanus was made clinically. The patient received treatment with anti-tetanus globulin, metronidazole, and she was placed in a dark room with sound insulation and shielding. The surgical team was consulted for wound management. However, in accordance with the patient's refusal, surgical debridement was not performed. Instead, local wound cleansing and supportive management were initiated. CONCLUSIONS: Tetanus should be considered in patients with necrotic tumors presenting with trismus, especially in low-resource settings where immunization histories are uncertain. Early intervention is crucial to reduce morbidity and prevent complications
Temporal modulation of gene expression in a controlled Schistosoma mansoni human infection model.
Get PDFBACKGROUND: Schistosomiasis is caused by parasitic blood flukes of the genus Schistosoma. Despite ongoing mass drug administration efforts, the disease remains a major public health burden in endemic regions. A better understanding of early host responses to schistosomiasis is critical for developing effective vaccines and therapeutics.
METHODS: We conducted a longitudinal transcriptomic study of peripheral blood samples from 30 Schistosoma-naïve volunteers participating in two controlled human infection trials with male- or female-only S. mansoni cercariae. Blood was collected at six time points over 20 weeks post-infection. Whole-transcriptome RNA sequencing and integrative analyses, including differential gene expression, gene set enrichment, protein interaction networks, co-expression clustering, and immune module profiling, were employed to characterize temporal modulation of genes related to immune responses.
RESULTS: Robust and highly time-dependent transcriptional responses were observed, peaking at Week 4 post-infection. Differential gene expression and pathway analyses revealed activation of immune responses, including type I and II interferon signaling, chemokine-mediated pathways, and antigen presentation. Notably, both Th1 and Th2 signatures were evident at Week 4. Key immune hubs included IFNG, TNF, and IL1B, along with transcriptional regulators such as STAT1 and IRF7. Blood transcription module analysis further highlighted transient activation of interferon and plasma cell-related responses.
CONCLUSIONS: This study provides a comprehensive transcriptional map of early host responses to S. mansoni infection in humans. The findings underscore the central role of interferon pathways, early mixed Th1/Th2 polarization, and inflammation-associated gene signatures in shaping host response to S. mansoni infection. These insights may inform the rational design of vaccines and biomarkers for schistosomiasis
Early Marriage, Preterm Birth, and School Dropout: An Intergenerational Cycle of Risk?
Get PDFBACKGROUND: Across generations, girls' early marriage recurs in high-risk groups; however there is poor understanding of how behavior and biology interact in this context. We hypothesized an intergenerational cycle of risk, linking early marriage, preterm birth, and school dropout, and evaluated evidence for specific components of this cycle in low-/middle-income countries.
METHODS: We conducted a systematized review, searching articles published from 2000 to 2025. We tested four hypotheses. H1: early marriage is associated with preterm birth; H2: preterm birth is associated with low educational attainment; H3: school dropout is associated with early marriage. Hypothesis-specific search terms and eligibility criteria were applied. We also tested hypothesis H4: preterm birth is associated with reduced cognitive function, by evaluating systematic reviews of research from any setting.
RESULTS: We identified 184 empirical articles for H1-H3, with 26 satisfying the criteria for full review, and 5 systematic reviews for H4. The available evidence supported H1 and H3, but was weak for H2. For H3, studies indicated contrasting directions of association. The systematic reviews demonstrated evidence supporting H4. The majority of empirical studies reviewed had a low risk of bias.
CONCLUSIONS: An intergenerational cycle of risk linking early marriage, preterm delivery and low educational attainment is plausible, involving both behavioral pathways (e.g., school dropout and early marriage) and biological mechanisms (e.g., preterm birth and cognitive function). Few studies have investigated the prospective associations of preterm birth with school outcomes, or school dropout with early marriage, in low- and middle-income countries
Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study.
Get PDFBACKGROUND: The United Kingdom Soft Drinks Industry Levy was introduced in April 2018, resulting both in changes in sugar levels in drinks and purchases of drinks. Both mechanisms could impact on the incidence and prevalence of raised body weight, diabetes and diet-related diseases, and therefore, have implications for economic costs to the health sector.
OBJECTIVES: To model future impacts of the Soft Drinks Industry Levy on population health and health sector costs and to estimate net monetary benefit to the health system. DESIGN AND METHODS: Proportional multistate lifetable modelling study - open and closed cohort analyses.
SETTING AND POPULATION: All children and adults in the United Kingdom.
INTERVENTION: The Soft Drinks Industry Levy is a two-tier levy of £0.18/l on drinks with between 5 and 8 g of total sugars/100 ml and of £0.24/l on drinks with ≥ 8 g of total sugars/100 ml.
MAIN OUTCOME MEASURES: We evaluated impact of the sugar reduction on: (1) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050 and (2) lifetime population health (measured in quality-adjusted life-years), change in costs to the health sector and the resulting net monetary benefit.
DATA SOURCES: We estimated a per person reduction in sugar from a previously published interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval 2.4 to 13.6) reduction in sugar at 1 year after implementation. Our multistate lifetable model is parameterised using data from population health monitoring surveys, the Global Burden of Disease project, the Human Mortality Database and the Office for National Statistics. Health sector costs were obtained from Department of Health and Social Care budget allocations.
RESULTS: The model predicts that the Soft Drinks Industry Levy will reduce the prevalence of overweight and obesity in the United Kingdom by 0.18% points (95% uncertainty interval: 0.059 to 0.31) for males and by 0.20% points (0.064 to 0.34) for females. In the first 10 years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000-600,000) dental caries, 12,000 (3700-20,000) cases of type 2 diabetes, 3800 (1200-6700) cases of cardiovascular diseases and 350 (110-590) cases of obesity-related cancer. For the current United Kingdom population, it is estimated that the Soft Drinks Industry Levy will add 200,000 quality-adjusted life-years (63,500-342,000) over their lifetime and avert £174 million (£53.6-319) in their costs of health care (discounted at United Kingdom Treasury rates). At a United Kingdom Treasury value of £60,000 per quality-adjusted life-year, it is estimated that the Soft Drinks Industry Levy will produce a net monetary benefit of £12.2 billion (£3.88-20.8) for the health system.
LIMITATIONS: Modelled results assume that the effect of the Soft Drinks Industry Levy remains constant into the future. The longevity of the effect of the Soft Drinks Industry Levy has not been tested.
CONCLUSION: This study of the United Kingdom Soft Drinks Industry Levy tiered tax on sugar content provides further evidence that sugar-sweetened beverage taxes have the potential to achieve meaningful improvements in population health and reduce health sector spending.
FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/130/01