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Proceedings from the Third International Post-Tuberculosis Symposium: expanding the circle.
Get PDFIn light of the recent growth in interest and knowledge of post-TB sequelae, there were high levels of engagement during the 3rd International Post-Tuberculosis Symposium held in Stellenbosch, South Africa. This multi-disciplinary symposium aimed to: 1) Advocate for greater global awareness of post-TB sequelae and empower TB-affected communities; 2) Advance knowledge by sharing current evidence and identifying key priorities; 3) Foster collaborations by strengthening research networks and developing concrete plans for research driven advocacy; and 4) Advance the field by establishing areas of consensus around diagnosis, care, and management. Guided by a 14-member Steering Committee, 9 academic working groups came together to develop key content for plenary sessions and facilitated workshops related to: Patient Engagement, Epidemiology and Modelling, Pathogenesis, Post-TB Lung Disease; Cardiovascular and Pulmonary Vascular Disease; Central Nervous System and Musculoskeletal Disease; Paediatrics Economic; Social and Psychological Sequelae; and Advocacy, Policy, and Stakeholder Engagement. Each group outlined progress within their respective fields and defined key priorities to focus discussion. The Symposium further catalysed coordinated action for the post-TB community of patients, advocates, clinicians, and researchers to define a clear path towards improving outcomes, reducing inequities, and ensuring TB survivors receive the care and support they deserve
The prevalence of depression and anxiety and associated factors among school-going adolescents in poverty and conflict-affected settings in Uganda.
Get PDFBACKGROUND: Schools could play a vital role in mental health care, particularly in low-income countries such as Uganda. An understanding of the prevalence and associated factors of mental health symptoms among school-going adolescents is essential for designing effective school-based interventions in Uganda This is important given Uganda's regional disparities, where adolescents in post-conflict areas may face higher exposure to trauma and limited access to mental health care compared to those in non-conflict regions. This study aimed to investigate the prevalence rates of depressive and anxiety symptoms among school-going adolescents aged 14 to 17 years in both post-conflict and non-conflict settings. It also examines factors associated with moderate depressive and anxiety symptoms in both settings. METHODS: In total, 2845 school-going adolescents (1,273 boys; 16.3 ± 1.0 years) were screened using the Patient Health Questionnaire-9 - adolescent version, Generalized Anxiety Disorder-7, and self-report items on food insecurity, health and wealth status, history of childhood abuse and neglect and level of physical activity. Logistic regression models were applied to examine predictors of moderate to severe levels of depression and anxiety symptoms. RESULTS: Findings indicate that 67.5% (n = 1905) reported at least mild, 34.1% (n = 962) at least moderate, 12.7% (n = 359) at least moderate-severe and 4.9% (n = 138) severe symptoms of depression, while 65.6% (n = 1860) at least mild, 27.5% (n = 777) at least moderate and 7.8% (n = 219) severe symptoms of anxiety. In the multivariable analyses, female sex, food insecurity, poor self-reported health, co-morbid anxiety symptoms, and a history of abuse and neglect were all significantly associated with a higher odds of moderate symptoms of depression, while female sex, living in a post-conflict setting, food insecurity, poor self-reported health, co-morbid depressive symptoms, and a history of abuse were all significantly associated with a higher odds of moderate anxiety symptoms. CONCLUSIONS: A substantial proportion of school-going adolescents in Uganda report at least moderate symptoms of depression and anxiety. Government and public sector agencies should re-evaluate their strategies at both family and school levels, particularly in underserved settings. Schools can serve as platforms for screening-and-referral pathways and group-based psychosocial programs, while the health system should strengthen capacity for co-occurring conditions
Land use gradients drive spatial variation in Lassa fever host communities in the Eastern Province of Sierra Leone.
Get PDFThe natal multimammate mouse (Mastomys natalensis) is the primary reservoir host of Mammarenavirus lassaense (LASV), a zoonotic pathogen causing Lassa fever and endemic to West Africa. The occurrence and abundance of this species is regulated by the human environment and biotic interactions with other small-mammal species, but these ecological drivers remain poorly understood in the regions where Lassa fever outbreaks are observed. We developed a Bayesian multi-species occupancy model incorporating incomplete detection to assess habitat use from data obtained as part of a multi-year small-mammal trapping study (43,226 trap nights across four village sites in Sierra Leone, 2020-2023). We investigated the effects of land use gradients and small-mammal community dynamics on the spatial distribution of M. natalensis. Mastomys natalensis occupancy increased along a gradient from forest to agriculture to village habitats but was reduced in the peri-urban site compared to rural settings. Invasive rodent species influenced this pattern, with Mus musculus presence associated with reduced M. natalensis occupancy in the peri-urban site. We did not observe a similar effect when considering the co-occurrence of invasive Rattus rattus with M. natalensis in rural settings. These findings suggest that land use and species interactions drive spatial heterogeneity in M. natalensis populations, potentially explaining reduced Lassa fever incidence in urban areas. The results highlight the importance of considering community dynamics when predicting the risk of outbreaks of endemic zoonoses and the need to widen the context of studies of LASV transmission beyond the primary reservoir host species. To better assess public health risk and improve allocation of limited resources, we recommend more precise characterisation of small-mammal communities in LASV endemic regions, particularly in areas undergoing rapid land use change which may alter community-level small-mammal biodiversity
Genomic surveillance uncovers regional variation in HCV transmission networks in rural United States.
No full textHepatitis C virus (HCV) remains a public health concern in the United States, particularly in rural communities where the opioid epidemic accelerates transmission among people who use drugs (PWUD). Despite this growing burden, the genetic features and transmission dynamics of HCV in these settings are poorly understood. We analyze 692 HCV antibody-positive specimens collected from rural communities in ten U.S. states using amplicon-based deep sequencing and the Global Hepatitis Outbreak and Surveillance Technology (GHOST) platform to reconstruct transmission networks. Among sequenced individuals, 29.5% are linked within clusters. Cluster structure varies by region from sparse networks in Ohio to dense clusters in New England and phylogenetic analyses show that some networks persist for over a decade, indicating sustained transmission. Nearly half of all clusters involve individuals connected through social recruitment, suggesting peer-referral strategies effectively identify transmission chains. Penalized regression retains only a few individual factors including younger age, peer or partner recruitment, illegal income, methamphetamine use, each with modest effects. These findings suggest that clustering is shaped primarily by social and structural contexts rather than individual characteristics and underscore the importance of integrating genomic surveillance with social-network insights to detect emerging HCV clusters and guide targeted interventions in underserved rural communities
A novel intron variant is associated with emerging pfdhps mutant haplotypes in West and Central African Plasmodium falciparum.
Get PDFSulfadoxine-pyrimethamine plays a key role in Plasmodium falciparum chemoprevention across Africa, yet the protective efficacy of SP is undermined by mutations conferring resistance in the genes encoding dihydrofolate reductase (pfdhfr) and dihydropteroate synthase (pfdhps). The emergence and spread of the pfdhps 431V mutation suggests that this may confer resistance and be selected by drug use. Here, we report a non-coding mutation a548383t, which expands a di-nucleotide repeat in the first intron of pfpppk-dhps. The first intron and second exon of the pfdhps gene were analysed by target amplicon sequencing of 929 P. falciparum-positive blood samples from Nigeria, Cameroon, Tanzania, The Democratic Republic of Congo, and Côte d'Ivoire. The intron mutation was found in Nigeria, Côte d'Ivoire, and Cameroon in association with the 431V mutation. In particular, the intron mutation was most highly associated with the VAGKGS haplotype (OR = 211.7, P < 0.001), followed by the VAGKAS (OR = 39.2, P < 0.001), and VAGKAA (OR = 33.6, P < 0.001) haplotypes. Additionally, a reduced di-nucleotide repeat diversity was observed in 431V-positive variants. The intron variant is significantly associated with the 431V mutation which is consistent with previous reports of selective sweeps around VAGKGS. The association of the 548383t mutation with both VAGKGS, VAGKAS and VAGKAA might indicate these lineages either have a common ancestor or that the intron variant 548383t has a functional association with 431V. More research is needed to determine if the association is simply genetic hitchhiking, or if the intron variant confers a phenotypic advantage
National and regional Temporal trends and forecasting of preterm birth in brazil: evidence from National birth data (2014-2023) with projections to 2030.
No full textBACKGROUND: Preterm birth (PTB) remains one of the leading causes of neonatal morbidity and mortality globally. In Brazil, regional disparities and socioeconomic inequalities significantly affect maternal and perinatal outcomes. This study aims to describe national and regional trends in preterm birth in Brazil from 2014 to 2023, examine sociodemographic disparities, and forecast future rates through 2030 using time-series analysis.
METHODS: We conducted a population-based ecological analysis using data from the Brazilian Live Birth Information System (SINASC) from 2014 to 2023. PTB was defined as delivery before 37 completed weeks of gestation. Descriptive statistics were employed to explore maternal, obstetric, and neonatal characteristics. Temporal trends were assessed using Prais-Winsten regression to estimate Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) at a significance level of 5%. A national monthly time series was constructed using Forecasting models, including Seasonal Autoregressive Integrated Moving Average (SARIMA) and Generalised Autoregressive Conditional Heteroskedasticity (GARCH).
RESULTS: The analysis included over 25.5 million live births. The national prevalence of PTB increased from 11.3% in 2014 to 11.9% in 2023, with an AAPC of 0.28% (95% CI: 0.43 to 1.00; p < 0.001). Higher rates were consistently observed among those without a formal education (15.1%). Regional disparities were evident, with the highest rates among mothers aged ≥ 35 years (13.6%) and those aged < 20 years (12.8%), as well as among those in the North (12.2%) and Northeast (11.5%) regions. SARIMA modelling indicated a continued upward trajectory through 2030. In contrast, more educated women (≥ 12 years) are expected to maintain lower and stable rates (< 13%).
CONCLUSIONS: PTB rates in Brazil have shown a rising trend over the past decade, with marked regional and social inequalities. Forecasts indicate that these disparities may increase by 2030 unless effective, evidence-based, and context-specific interventions are implemented. These findings highlight the urgent need for targeted public health policies and prenatal care strategies aimed at reducing preventable PTB and promoting maternal and neonatal equity across the country
Synthesis and evaluation of nitroheterocyclic aromatic adamantane amides with trypanocidal activity. Part II.
Get PDFIn this article, we report the design, synthesis, and biological evaluation of a new series of nitroheterocyclic aromatic adamantane amides targeting trypanosomes. These compounds feature diverse substituents on the adamantane scaffold, variations in side chain linker length, and a range of nitroheterocyclic moieties. This work represents a continuation of our previous efforts, with a particular focus on elucidating the structural and functional role of the linker connecting the phenyladamantane core to the nitroheterocyclic ring. The structure-activity relationship data underscore the importance of strategic modifications in enhancing the pharmacological profile of these compounds against trypanosome parasites. Further modifications are recommended to optimize the physicochemical properties of the current derivatives to improve intracellular targeting of trypanosomatids, an important clinical stage in their life cycle
Child public health interventions for conflict-affected populations: A systematic review.
Get PDFArmed conflict causes pervasive harm to children, and humanitarian responses to support them face significant challenges. This review aims to summarise the evidence on the effectiveness of interventions to treat, protect, and promote child public health in conflict-affected populations. A systematic review was performed, with searches of major databases and the grey literature from 1 January 2012 - 20 February 2025. Included studies provided data on child or caregiver outcomes associated with interventions to support children affected by armed conflict. Studies on nutrition and perinatal interventions were excluded. Data were extracted on the setting, population, intervention design, study type, and findings. The searches yielded 3,601 records. 51 intervention studies met inclusion criteria, 39% of which were trials. Studies were mainly from Africa (51%), the Middle East (25%) and Asia (18%). The majority of studies focused on mental health and psychosocial support (MHPSS) (N = 29, 57%). MHPSS, child protection, and/or parenting interventions were the focus of trials as well as intersectoral interventions. Somatic child health interventions (N = 19, 37%) focused on immunisation, adolescent sexual and reproductive health, toxic stress, and telemedicine services. Five studies measured development outcomes and one intervention targeted children with disabilities. Over half of the studies were carried out amongst displaced populations. Intervention design varied widely within and between sectors. Studies showed promising results, particularly for non-specialist MHPSS interventions. Only 20% of studies assessed intervention safety. The evidence for child public health interventions to support conflict-affected populations is increasing, with increased numbers of studies over time, and improved study design, execution, and reporting. However, the evidence remains poor, limited to a few topic areas and with continued geographical disparities. There are notable gaps in evidence on the safety of interventions, their medium- and long-term impacts, sustainability, and interventions for child development and children living with disabilities
Efficacy, safety, and immunogenicity of Lassa fever vaccines: A living systematic review and landscape analysis of vaccine candidates.
Get PDFBACKGROUND: Lassa fever (LF) is an acute viral hemorrhagic illness endemic in West Africa, representing significant public health challenges, particularly for pregnant persons and children who experience higher morbidity and mortality. Although several vaccine candidates are being developed, no LF vaccine has been licensed yet.
METHODS: We conducted a living systematic review (LSR) of the literature to evaluate the safety, efficacy, effectiveness, and immunogenicity of LF vaccines. We performed biweekly searches in major biomedical databases, trial registries, preprint servers, and other sources. Eligible studies included preclinical studies, clinical trials, and observational studies published from January 2014 to April 2025. Reviewer pairs screened studies extracted data (REDCap), and assessed risk of bias independently. Data synthesis involved random-effects pairwise and proportion meta-analyses (R software), with GRADE assessment of evidence certainty. PROSPERO registries: (CRD42024514513; CRD42024516754).
RESULTS: Searches retrieved 1423 records, including 51 studies, 2 clinical trials in adults involving 88 vaccinated persons, and 49 preclinical studies of 30 vaccine candidates. Trials evaluated Recombinant Measles-Vectored (MV-LASV) and Recombinant Vesicular Stomatitis Virus-based (rVSVΔG-LASV-GPC) LF vaccine candidates. No published clinical trials were found to evaluate LF vaccines in special populations such as pregnant persons, infants, children, or adolescents. Although injection site reactogenicity was reported, no vaccine-related serious adverse events (SAEs) were reported in study participants. Immunogenicity was robust in adults, with vaccines achieving around 95% seroconversion at 30 days. Preclinical data evaluated nine different platforms. Findings are disseminated via an interactive online dashboard (https://safeinpregnancy.org/living-systematic-review-lassa/).
CONCLUSION: Currently, two LF vaccine candidates that have advanced to clinical trials exhibit high immunogenicity, but the safety profile in healthy adults is still limited. Clinical evidence in pregnant persons, infants, children, and adolescents is absent. Vaccine platforms of interest have been identified in preclinical studies, providing information on those that could advance to clinical studies
"I live with pain, it cannot go away": Lived experiences of childhood and adolescent pulmonary tuberculosis survivors - a qualitative study.
Get PDFChildhood and adolescent tuberculosis (TB) survivors often face ongoing challenges even after completing their treatment. While the biomedical aspects of TB recovery are well studied, there is still limited understanding of how young survivors cope with the long-term impact of TB on their daily lives, development, and aspirations. Guided by an illness-narrative and phenomenological perspective, this qualitative study explored the lived experiences of children and adolescents who had completed treatment for pulmonary TB in The Gambia. Using a phenomenological approach, we purposively selected 33 participants from a larger longitudinal cohort study. Data were collected through participatory workshops that incorporated art-based methods and semi-structured in-depth interviews. Thematic analysis was used to identify patterns in participants' post-treatment experiences. Four main themes emerged: (1) persistent physical health challenges, such as fatigue and chest pain; (2) psychosocial difficulties, including stigma, fear of recurrence, and social withdrawal; (3) educational disruption and academic setbacks; and (4) evolving career aspirations, shaped by both limitations and newfound motivation. Participants' experiences varied by age and gender, with younger children relying on caregiver interpretations and older adolescents articulating complex emotional and identity-related reflections. Gender norms influenced the types of responsibilities and social roles participants attempted to resume. The findings highlight the multifaceted and long-term impact of TB on young survivors. Recovery was experienced as a continuum from illness to post-treatment life, requiring rehabilitation-oriented support that integrates psychosocial counselling, school re-entry, and community-based stigma reduction. Integrating such support into post-TB care and public health programming is essential to improving outcomes for paediatric TB survivors