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Modelling the impact of climate and the environment on the spatiotemporal dynamics of Lyme borreliosis in Germany.
Get PDFBACKGROUND: Lyme borreliosis (LB) is a predominant vector-borne disease in Europe, with Germany reporting endemic circulation for at least the past two decades. Climatic and environmental conditions are key drivers of tick activity, and human exposure to tick bites. Understanding the climatic and environmental factors driving LB dynamics can help devise decision-support tools to guide interventions and adaptation strategies. METHODS: Using a Bayesian modelling framework, we assessed the delayed and nonlinear associations between climate variation and land use change and monthly LB case counts from the German national notification system at a district level from 2009 to 2022. We evaluated the predictive performance of our model and then predicted risk trends in states without mandatory notification. We then used the fitted risk function for maximum temperature to assess long-term trends in relative risk since the 1950s. FINDINGS: Our analyses revealed that climate and environmental factors are positively associated with LB cases reported to the national notification system. Maximum temperature between 10.5 °C and 26.3 °C two to four months prior, relative humidity levels exceeding 78.8% six months prior, and exceptionally wet conditions accumulated over three months, lagged by one month, were associated with an increased risk of LB. The effect of relative humidity was only relevant in areas suitable for deer population, potentially linked to tick survival. Predictions from our model identified significant increasing trends in Schleswig-Holstein, Hamburg, and Lower Saxony, three states without mandatory case notification. We also observed an increasing trend in maximum-temperature related LB relative risk in all Federal States, with the largest percentage change in the period 2013-2022 in northern districts, compared to 1951-1970. INTERPRETATION: Our study underscores the role of climatic variables as potential drivers of LB risk in Germany. We identified optimal conditions that may be related to human exposure and tick survival and detected long-term upward trends nationwide, including in areas without mandatory notification. This decision-support modelling framework emphasises the added value of expanding LB surveillance in Germany and across Europe to address the emerging risk of tick-borne infectious diseases. FUNDING: Helmholtz Association, Helmholtz Climate Initiative, Wellcome Trust, Royal Society, and Horizon Europe
A Scoping Review of School-Based Nutrition and Physical Activity Interventions Conducted in Mexico.
Get PDFIntroduction: As the Mexican economy has developed, ultra-processed, high fat, low fiber, and high sugar foods have become more prevalent. Almost one in four children in the country is overweight or obese. The Mexican government has school nutrition guidelines and policies. Several schools have implemented programs to improve child nutrition and physical activity knowledge and behaviors in an effort to reduce childhood overweight and obesity. The aim of this review is to assess the range of school-based nutrition and physical activity interventions and their possible impact on health and wellness. Methods: A scoping review of English and Spanish language published peer-reviewed studies examined existing literature on school-based nutrition and physical activity interventions implemented in Mexican schools for children and adolescents. The 17 studies meeting inclusion criteria were analyzed for program content and outcomes. Results: All interventions had some impact on either knowledge, attitudes, and/or behaviors. Almost all interventions incorporated parents. These programs occurred within the context of national guidelines issued by the Mexican government and a renewed focus on the increasing problem of childhood obesity. Conclusion: Mexico's school-based nutrition and physical activity interventions can impact nutritional knowledge, food and beverage choices, and physical activity behaviors
A systematic review and meta-analysis of the impact of environmental heat exposure on cardiovascular diseases, chronic respiratory diseases and diabetes mellitus in low- & middle-income countries.
Get PDFClimate change has led to an increase in global temperatures and adversely impacted human health, for example, by exacerbating the burden of non-communicable diseases. This systematic review and meta-analyses aim to synthesize evidence on the effect of heat exposure on the morbidity and mortality associated with cardiovascular diseases, chronic respiratory diseases and diabetes mellitus in Low-and Middle-income countries (LMICs). Five databases (Medline, Embase, Web of science, Global health and Africa wide information) were initially searched using keywords related to heat, cardiovascular, respiratory disease, diabetes and LMICs to identify relevant peer-reviewed studies, published from inception to June 2024. An updated PubMed search on 29 April 2025 was done to identify additional eligible studies. Meta-analyses were conducted to quantify the pooled effects of the association between temperature and disease-related mortality/morbidity. The searches found 3884 studies, of which 31 were included in the review. A narrative synthesis was conducted for all the studies, and 18 studies were included in the meta-analyses. We found a positive association between heat exposure and mortality/morbidity related to the three diseases. With each 1 °C rise in temperature, cardiovascular and respiratory mortality risk increased by 2.1 % and 4.1 % respectively. The risk of cardiovascular morbidity was higher, at 6.7 %. A higher heat-related mortality and morbidity was also observed in those aged 65-years plus, and in women. These findings show populations in LMICs are vulnerable to adverse effects of heat exposure. The higher risk of morbidity outcomes is a novel finding and may indicate differential access to care and disease management
"Utility of Cerebrospinal Fluid Unstimulated Interferon-Gamma (IRISA-TB) as a Same-Day Test for Tuberculous Meningitis in a Tuberculosis-Endemic, Resource-Poor Setting".
Get PDFTo the Editor—We read with great interest the recently published article by Randall et al titled “Utility of Cerebrospinal Fluid Unstimulated Interferon-Gamma (IRISA-TB) as a Same-Day Test for Tuberculous Meningitis in a Tuberculosis-Endemic, Resource-Poor Setting.” We applaud the investigators for their efforts to evaluate same-day host-based diagnostics for tuberculous meningitis (TBM) and agree that improved TBM diagnostic testing remains a priority and would likely improve mortality in this vulnerable population. However, we would like to highlight that in diagnostic accuracy studies that lack a perfect gold standard reference test, as is the case with TBM, consistency among studies is important
Incident type 2 diabetes and its risk factors in men and women aged 40-60 years from four sub-Saharan African countries: results from the AWI-Gen study.
Get PDFBACKGROUND: The incidence of type 2 diabetes in sub-Saharan Africa is expected to increase, but few longitudinal studies have characterised its risk factors. This study aimed to determine the incidence of type 2 diabetes over 33 481 person-years and identify its principal risk factors in middle-aged adults (ie, those aged 40-60 years) from four sub-Saharan African countries. METHODS: Longitudinal data were available from 6553 participants aged 40-60 years at baseline from study centres in South Africa, Kenya, Ghana, and Burkina Faso. Sociodemographic, behavioural, clinical, and biochemical data were collected at baseline and after an interval of 5-6 years. The prevalence of type 2 diabetes was determined at each timepoint and diabetes incidence was calculated. A two-stage individual participant data meta-analysis was used to identify baseline risk factors for incident diabetes. FINDINGS: The overall incidence of type 2 diabetes was 14·6 (95% CI 13·4-16·0) cases per 1000 person-years. The incidence was highest in South Africa with 21·8 (19·5-24·4) cases per 1000 person-years, and lowest in west Africa with 5·5 (4·4-6·9) cases per 1000 person-years. Baseline glucose (adjusted odds ratio 1·37; 95% CI 1·16-1·42), being male (1·32; 1·12-1·54), family history of type 2 diabetes (1·22; 1·01-1·46), unemployment (1·19; 1·03-1·37), hypertension (1·21; 1·01-1·45), BMI (1·03; 1·02-1·04), and waist circumference (1·02; 1·01-1·03), were associated with a higher risk of incident type 2 diabetes, while adequate baseline physical activity (0·87; 0·76-1·00) was associated with lower risk. INTERPRETATION: The high incidence of type 2 diabetes in this middle-aged sub-Saharan Africa population is influenced by several modifiable risk factors that should inform interventions to mitigate the disease burden. FUNDING: National Institutes of Health, Department of Science and Innovation (South Africa), and the South African Medical Research Council
Associations Between Self-Perceived Psychosocial Stress and Markers of Adiposity in Ga Mashie, Urban Ghana: Evidence from a Cross-Sectional Population-Based Survey
Get PDFPrior research from Ghana suggests psychosocial stress is associated with lower body mass index (BMI) and waist circumference (WC), both markers of adiposity, contrasting with meta-analyses showing positive associations in other settings. This study aimed to explore how stress was associated with markers of adiposity in urban Ghanaian adults. Data included 854 adults from the Contextual Awareness, Response and Evaluation Diabetes in Ghana survey carried out in November–December 2022 in Ga Mashie, a deprived area of the capital Accra. Associations between self-perceived stress (Perceived Stress Scale 10, categorized into low and average–high stress) and BMI or WC-for-height ratio (WHR) were assessed using linear regression. Results were adjusted for survey design and confounders and stratified by sex. Greater stress was associated with higher BMI and WHR in females (adjusted coeff. [95% CI]: BMI: 2.3 [0.5, 4.0], WHR: 0.03 [0.00, 0.06]). No associations were found in males. These findings highlight the need to understand the complex interactions between gender, stress, and increasing burdens of obesity and other associated non-communicable diseases in urban African settings, with a view to designing context-specific interventions to reduce risk
Counterfactual Groups to Assess Vaccine or Treatment Efficacy in HIV Prevention Trials in High-Risk Populations in Uganda.
Get PDFBACKGROUND: Assessment of efficacy in HIV prevention trials remains a challenge in the era of widespread use of active controls. We investigated use of counterfactual groups to assess treatment efficacy. METHODS: We used data from placebo arms of two previous HIV prevention efficacy trials (Pro2000 vaginal microbicide trial, 2005-2009: ISRCTN64716212 and dapivirine vaginal ring trial, 2013-2016: NCT01539226) and four observational cohorts (two in each of the periods; (a) during the conduct of a simulated HIV vaccine efficacy trial (SiVET), 2012-2017, and (b) prior to SiVET (2005-2011)) and compared HIV prevention efficacy trial targeted outcomes with SiVETs. SiVET participants were administered a licensed hepatitis B vaccine at 0, 1 and 6 months mimicking an HIV vaccine efficacy trial schedule. Participants were tested for HIV quarterly for one year. The probability of the SiVET assignment conditioned on the measured participants' baseline characteristics were estimated using propensity scores (PS) and matched between SiVET and placebo arm of trials. Similar calculations were repeated for observational cohorts in the pre- and during SiVET periods. We compared HIV incidence rate ratio (IRR) between SiVET and the trials or observational data before and after PS matching. RESULTS: This analysis involved data from 3387 participants; observational cohorts before SiVET 1495 (44.2%), placebo arms of previous trials 367 (10.8%), observational cohorts during SiVET conduct 953 (28.1%) and SiVETs 572 (16.9%). Before propensity score matching (PSM), there were significant imbalances in participants' baseline characteristics between SiVET, and all the other studies and HIV incidence was lower in SiVET. After PSM, the participants' characteristics were comparable. The HIV incidence in SiVET was similar to that in the previous trial, IRR = 1.01 95% CI: 0.16-4.70), p = 0.968, and observational data during SiVET, IRR = 0.74, 95% CI 0.34-1.54), p = 0.195, but much lower compared to the observational data pre-SiVET, IRR = 0.48, 95% CI: 0.20-1.04), p = 0.023. CONCLUSIONS: PSM can be used to create counterfactual groups from other data sources. The best counterfactual group for assessing treatment effect is provided by data collected in the placebo arm of previous trials followed by that from observational data collected concurrently to the current trial (SiVET). Even with PSM, observational data collected prior to the current trial may overestimate treatment effect
Intralesional Treatment of Non-American Cutaneous Leishmaniasis with Multiple Lesions.
Get PDFA 44-year-old male developed five ulcerated plaques on the left upper limb (Figure 1) while in Sicily, Italy. The size of lesions varied between 1 and 2.5 cm 1 year before presentation at the Hospital for Tropical Diseases, London. There was no lymphadenopathy, lymphangitis, or subcutaneous induration. He was HIV uninfected. The ulcerated lesions had not responded to separate courses of oral clarithromycin, doxycycline, or cotrimoxazole. A skin biopsy showed granulomatous inflammation, and Leishmania donovani complex DNA was detected, confirming the diagnosis of cutaneous leishmaniasis (CL)
Incorporating Community Case Management in Risk-Based Surveillance for Malaria Elimination in the Dominican Republic.
Get PDFAs countries strive for malaria elimination, it is crucial to gather sufficient evidence to confirm the absence of transmission. Routine surveillance data often lack the sensitivity to detect community transmission at low levels. In the Dominican Republic, community health workers (CHWs) have been deployed in malaria foci to perform active case detection. This study aimed to assess the added value of CHWs in enhancing the health system's malaria detection capabilities. Freedom from infection (FFI) is a statistical framework designed to demonstrate the absence of malaria by using routinely collected health data. We adapted this framework to include CHW data, estimating their contribution to the health system's malaria detection ability. The model was applied to facility and CHW data from 33 facilities across nine provinces in the Dominican Republic, covering the period from January 2018 to April 2022. The likelihood that a facility's catchment population is free from malaria infection (Pfree) was achieved in 52% of facilities by using only routine data, sustained for an average of 13 months. With the addition of CHW data, 88% of facilities reached Pfree, sustained for an average of 37 months. Incorporating CHW data enhanced the precision of model estimates by over 500-fold. The study demonstrated the near absence of malaria in several facility catchment populations. It highlighted the importance of community case management in supplementing routine surveillance, thereby improving the precision of malaria transmission estimates. These findings support the further application of the FFI framework to accelerate progress toward malaria elimination in the Dominican Republic
The association between systemic inflammation and albuminuria among people living with HIV: A cross-sectional study from Botswana.
Get PDFTreated human immunodeficiency virus (HIV) is associated with persistent systemic inflammation, even after many years of sustained viral suppression following initiation of antiretroviral therapy (ART). Albuminuria is common among people living with HIV (PLWH), but the impact of persistent systemic inflammation on outcome of albuminuria is not well understood. Thawed serum samples from PLWH who participated in an albuminuria prevalence study in Gaborone, Botswana, between January 2020 and March 2022, were selected randomly for a cross-sectional study of the link between inflammation and albuminuria. Systemic inflammation (interleukin [IL] 1β, IL 6, and soluble cluster of differentiation-163 [sCD163]) was assessed using enzyme linked immunosorbent assay, and albuminuria was reported as urinary albumin-creatinine ratio (ACR) (mg/g), as obtained from the parent study. The association between systemic inflammation and albuminuria was first explored by ACR quartiles, graphically using simple linear models, and then using general additive models for the adjusted analysis. The study population comprised 715 ART treated PLWH, with a mean age of 49.9 (SD 10.7) years, median HIV disease duration of 13.5 (IQR 8.7-16.7) years, and 398/715 (55.7%) were male. The relationship between log transformed ACR and sCD163 was linear, with regression coefficient β = 0.10, P-value = .02 but was nonlinear for log transformed IL-1β and IL-6, β = 0.10, P -value = .82 and β = -0.04, P-value = .36, respectively. In the final adjusted general additive models, sCD163 was not associated with ACR, P-value = .137. IL-1β, IL-6, and sCD163 were not associated with ACR among ART treated PLWH. Novel strategies to identify inflammatory pathways that may promote albuminuria among PLWH should consider other innovative and sensitive markers of both systemic and organ specific inflammation