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‘When we put our thoughts and ideas together, policy makers are listening to us’: Hope-work and the potential of participatory research
Get PDFThis article brings together a theorisation of hope with the everyday practices of participatory research against a difficult – often entrenched – policy context. We posit that ‘hope-labour’ can characterise engagement in participatory research, which can itself be generative of hope as part of resistance to the status quo. This novel analysis links, and is relevant to, broader theorisations of resistance and critical policy analysis. While there is a growing recognition of the need to subvert traditional forms of political activism and engagement, there has been less specific theorisation of how and why participatory research might play a role. This article corrects this, drawing directly on four years of participatory research working with parents and carers living on a low income to explicate how hope manifests in our practice. We argue it is important to recognise and carefully work through the significant ethical challenges which characterise hope-labour in participatory research. These include how hope is mobilised and the markedly different ‘stakes’ at play in working with hope for researchers and participants. These represent stubborn challenges, and it is incumbent on researchers to be transparent with participants about them in line with an ethics of reciprocity and feminist research praxis. Research can be aimed at a different – and radical – future, because of its orientation towards delivering substantive changes but also, and significantly, because it foregrounds a fresh, different way of collaborating and connecting, one that values and incorporates a diversity of expertise and promotes collective self-determination rather than competition
Exploiting nectar and blood feeding cues and phagostimulants to optimise Attractive Targeted Sugar Baits against a sand fly vector of leishmaniasis.
No full textBACKGROUND: Leishmaniasis presents a major public health problem for a large number of countries requiring effective integrated management of the vector, sand flies, for sustained control. Such strategies need to be economically and environmentally sustainable and adaptable to the behaviour of local vectors. One such tool is Attractive Targeted Sugar Baits (ATSB) that exploit the necessity of sand flies to acquire sugars between bloodmeals. Here we explored the kinetics and cues for sugar and blood feeding to improve the efficacy of ATSBs against sand flies.
METHODS: A fluorescent assay was developed to quantify sugarmeals to assess the feeding efficiency of colony-reared female Lutzomyia longipalpis sand flies.
RESULTS: Sand flies showed a range of preferences for different sugars presented on cotton wool and could be manipulated to deposit them into the crop and/or midgut. We found that the combination of 10% sucrose and 10% fructose allowed flies to obtain the largest sugarmeals taken to the crop. Sugarmeals were taken to both the crop and midgut when it contained 200 mM bovine serum albumin (BSA) as a source of protein and 1 mM adenosine triphosphate (ATP) as a phagostimulant. Using this combination, the efficacy of the ingested insecticide fipronil was significantly increased; reducing the 50% lethal concentration from 584 µM to 1.65 µM in a sugarmeal that promoted the simultaneous uptake of the insecticide into the midgut as well as the crop.
CONCLUSIONS: In this study we highlight the potential of understanding the cues used by vectors to sugar feed and blood feed. By incorporating blood feeding phagostimulants, such as BSA and ATP, in ATSB we vastly improve their killing efficiency against sand flies. This demonstrates a new approach to target these disease vectors
Nationwide study of respiratory-related hospitalisations and deaths in preterm children in Brazil: a registry-based study.
No full textBACKGROUND: Preterm birth and respiratory diseases disproportionately affect low-and middle-income countries. Although preterm birth is a major contributor to the burden of respiratory morbimortality in early childhood, most evidence comes from high-income settings. To address this gap, we examined respiratory-related hospitalisations and deaths among preterm children in Brazil.
METHODS: We conducted a population-based cohort study using the CIDACS Birth Cohort, which included all live births in Brazil from January 1, 2011, to November 30, 2018. Preterm infants were defined as infants born before 37 weeks of gestation. We examined respiratory-related hospital admissions and deaths in children under five. Mean ratios (MR) and 95% confidence intervals (CI) were estimated using the Ghosh-Lin model; hazard ratios (HR) were estimated using Cox models. Maternal characteristics were adjusted through inverse probability weighting, with treatment probabilities estimated via entropy balancing.
RESULTS: The study included 3,239,563 live births, with 288,466 (8.9%) classified as preterm. The MR for under-five respiratory hospitalisation, comparing preterm to term births, was 1.40 (95%CI:1.38-1.42), peaking at 1.68 (1.63-1.72) between 28 and 90 days, declining to approximately 1.18 (1.10-1.28) at the fourth year. For respiratory disease deaths, the under-five HR was 3.94 (3.62-4.30). Respiratory-related mortality was highest between 28-90 days of age, with an HR of 4.66 (4.00-5.43), decreasing to 1.25 (0.62-2.51) by three years of age.
CONCLUSION: Preterm newborns have a higher risk of respiratory illness than full-term children, particularly in their first year. This understanding can guide health strategies to address premature birth issues by identifying important periods of vulnerability
One health-sustainability intersections: an umbrella systematic review with a new integrated definition of sustainability and a meta-conceptual framework.
Get PDFUNLABELLED: This umbrella systematic review synthesizes existing conceptual approaches to sustainability across human, animal, and environmental health disciplines, framed within the One Health paradigm. The study aims to develop a conceptual framework for analysing sustainability across One Health initiatives, interventions, and programs. The review included 38 studies that met the inclusion criteria, focusing on definitions, conceptual frameworks, and analytical frameworks of sustainability. Deductive thematic synthesis revealed key determinants and characteristics of sustainability, highlighting both similarities and differences across sectors. Across the 38 included reviews, we identified characteristics of sustainability existing along a process-outcomes continuum which we further grouped into fifteen process-focused characteristics, and outputs and outcomes that were categorized across a variety of contexts including acute emergency or humanitarian settings as well as within a stable macroeconomic and social construct. The review identified that sustainability has over time become more well defined and evaluated within the human health sector, with fewer review studies addressing it for animal and environmental health. Multisectoral studies often integrate the Brundtland Commission’s definition of sustainability, emphasizing social, economic, and environmental dimensions. The findings also highlight the importance of equity, resilience, and systems thinking in sustainability assessments. The analysis in our review underscores the need for a more holistic and integrated approach to sustainability that considers the interconnectedness of human, animals and ecosystems and that addresses the co-benefits and trade-offs across sectors. In our synthesis these concepts were coded from included reviews and mapped onto both the integrated definition and the meta-conceptual framework, ensuring they were structurally embedded into the proposed approach. A new integrated definition of sustainability is proposed, emphasizing quality-assured systems, services and interventions that are just and equitable, while being socially, economically, and environmentally viable, adaptable over time, and optimised for health benefits across humans, animals, and ecosystems without compromising future generations’ well-being. The accompanying evidence derived meta-conceptual framework serves as a normative guide for analysing sustainability in One Health contexts, adaptable across varying scales and health challenges. It is intended for use by policymakers, implementers and evaluators working on multisectoral programmes in human, animal and environmental health, particularly where a trade-off or co-benefit analysis is needed and where integrated approaches are being developed or scaled. Our study offers a robust evidence-based foundation for designing, assessing and implementing sustainable practices across One Health initiatives. Future research should focus on validating and further refining this framework through empirical studies across sectors and diverse One Health contexts. Particular attention should be given to addressing the gaps in sustainability assessments within the animal and environmental health sectors. As global health challenges continue to evolve, fostering a shared understanding of sustainability and promoting cross-sectoral collaboration will be essential for developing resilient and effective health interventions. In an era marked by increasing environmental pressures and shifting geopolitical landscapes, the principles of sustainability and One Health are more relevant than ever. This review contributes to the ongoing discourse on sustainability, providing a roadmap for stakeholders to navigate the complexities of multisectoral collaboration and ensure lasting impacts on global health and well-being across ecosystems. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42522-025-00187-z
Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe: Results of a decision analytical model.
Get PDFImproving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of 700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (<1000 copies/mL), 10% will have high VL (≥1000 copies/mL) and 57% would have died. With Zvandiri, ART adherence improves, decreasing annual probability of virological failure or death. After 40 years, 65% will have undetectable viral load, 23% low VL, 3% high VL and 9% would have died. Zvandiri results in 1,345 LYs gained at incremental cost of 372 per LY gained. Zvandiri also results in 1,246 QALYs at incremental cost of 99 per QALY. The ICER is highly sensitive to programme costs, health-related utilities, and the discount rate. Zvandiri is a cost-effective intervention for reducing virological failure and death in ALHIV. Our analysis likely underestimates the full benefits of the intervention by not accounting for reductions in HIV transmissions resulting from higher virological suppression observed in full transmission models
Memory B-cells elicited by different HPV vaccine regimens in the DoRIS randomised controlled trial.
Get PDFProphylactic human papillomavirus vaccines such as Cervarix® and Gardasil®9 induce robust and sustained antibody responses over time. One driver of such responses is memory B-cells (MBCs), primed during initial HPV-vaccine exposure. As part of the Dose Reduction Immunobridging and Safety Study (DoRIS), MBCs were evaluated in peripheral blood mononuclear cells by enzyme-linked immunosorbent spot assay at baseline and at 5 visits post-first vaccine dose to Month 36 in 930 Tanzanian girls randomly allocated to 3, 2, or 1 doses of either vaccine. Most ( > 90%) participants had detectable MBCs at all time points, with maximum responses by Month 7. Geometric mean frequency HPV-specific MBCs and the proportion responding declined thereafter for both vaccines in the 2 and 3-dose arms. MBC frequencies were lower in single-dose than in 2- and 3-doses recipients at all time points subsequent to Month 1. By Month 36, MBC responses to both vaccines for both HPV16 and 18 were similar across all dosing arms. The clinical significance of the dose response remains to be evaluated; however, the presence of MBCs in the circulation after 3 years with a single vaccine dose is encouraging in terms of generating long-lasting protection with a one-dose vaccination strategy
Exploring the social-ecological potential for indigenous agroforestry in peri-urban areas: a participatory mapping approach.
Get PDFPeri-urban agroforestry can provide affordable, fresh, and nutritious food and a departure from conventional forms of cropping. Indigenous foods are well-adapted to local conditions, and may hold cultural and economic value for peri-urban residents. Social, ecological, and economic variables influence the feasibility of indigenous agroforestry in peri-urban areas. This study uses participatory mapping and geographic information systems (GIS) to assess these variables and to map suitable spaces and species for peri-urban indigenous agroforestry at three peri-urban sites in Durban, South Africa. We find that: land tenure, livelihood opportunities, and indigenous food perceptions factor into socioeconomic preferences; topography and soil quality influence ecological feasibility; access to water and roads influences perceived economic viability. Although GIS techniques can identify land suitability, participatory mapping adds local fine-scale context to enhance decision-making. Based on the social-ecological conditions at the three sites, we suggest specific configurations of locally adapted foods and farm designs for peri-urban agroforestry. Our study demonstrates how agroforestry is more feasible in places where basic living conditions are fulfilled, and how co-design can improve recognition of local needs, accessibility to services, and balancing urban green equity
Exploring a One Health approach to sustainability with international One Health and Global Health Security experts - differences, similarities and trade-offs between sectors.
Get PDFSustainability in global health remains inconsistently defined and operationalised across human, animal, and environmental health sectors. As the One Health approach gains global traction-particularly in addressing complex, 'wicked' health problems such as pandemics, antimicrobial resistance, and ecosystem degradation-there is a growing need for shared conceptualisations of sustainability to support cross-sectoral collaboration and ultimately, long-term impacts. This study explores how One Health and health security experts from diverse disciplines understand and construct the meaning and determinants of sustainability. We conducted a qualitative study underpinned by the Social Construction Framework (SCF) through semi-structured interviews with 29 global experts from human, animal, and environmental health domains. Participants were purposively sampled from key technical advisory bodies, including the One Health High-Level Expert Panel, the World Bank Pandemic Fund, and the Quadripartite. Data were collected via online interviews between July 2023 and March 2024, transcribed verbatim, and analysed thematically using an inductive approach. Participants offered multi-dimensional definitions of sustainability; they distinguished between process-oriented (e.g., institutional longevity, financing, local ownership) and outcome-oriented (e.g., ecological regeneration, intergenerational well-being) views. Human health experts emphasised health system continuity, while animal health participants highlighted economic and disease control outcomes. Environmental experts framed sustainability around planetary resilience and equity. Cross-sectoral convergence was found on key determinants: political commitment, stable financing, workforce capacity, community ownership, and adaptability. Our findings underscore that sustainability in One Health is a socially constructed and sectorally influenced concept. Differences in framing, deservingness, and measurement priorities reflect different sectoral mandates, but also reveal potential trade-offs and synergies. To operationalise One Health effectively, an integrated sustainability framework is needed - one that aligns sectoral priorities, recognises diverse metrics, and fosters long-term, adaptive collaboration. This study provides an empirical basis for shaping such a framework, rooted in the lived experiences and perspectives of global experts
Global performance of machine learning models to predict all-cause mortality: systematic review and meta-analysis.
Get PDFWe aimed to review the literature on the performance of machine learning models to predict all-cause mortality. The systematic review was protocolled in PROSPERO (CRD42023476567) following PRISMA guidelines. Searches were conducted in PubMed, LILACS, Web of Science, and Scopus databases. Studies predicting all-cause mortality using machine learning were analyzed with random-effects models, with heterogeneity assessed using I2 statistics and quality evaluated using TRIPOD + AI. The meta-analysis included 88 studies. Most of the studies were from the United States (n = 25) and China (n = 20). Overall pooled AUC was 0.831 (95% CI 0.797-0.865), with extreme heterogeneity (I2:100%). The majority of the studies included no social variables in the models (89.8%). Subgroup analysis showed similar performance between general population studies and disease-specific populations. Models from high-income countries were similar to those from low- and middle-income countries. Meta-regression showed covariates that affected the results: algorithm, population type, study quality score, and study CI imputation. Equity-oriented sub-group analysis (< 10%) and external validation in other datasets (8.0%) were scarce. Overall, machine learning models showed high performance to predict all-cause mortality, but also highlighted equity gaps. The limitations reduce the potential of public health's evaluation and deployment due to the risk of perpetuation of social disparities. Extreme heterogeneity indicates highly context-dependent performance requiring local validation before implementation assessment
Access to hypertension services and health-seeking experiences in rural Coastal Kenya: A qualitative study.
Get PDFGlobally, hypertension causes 10.8 million deaths annually. However, in Kenya, like in other low-and middle-income countries, access to hypertension care remains limited and inequitable. Understanding patients' journeys in accessing care along the care cascade is critical to inform patient-centred care and policy improvements. This study aimed to explore patient experiences in accessing primary care services for hypertension along the care cascade in rural Coastal Kenya-a setting with a high hypertension burden. We conducted a qualitative cross-sectional study and collected data using in-depth interviews (n = 24) and five focus group discussions (n = 30) with hypertension patients and their adult family caregivers in two purposively selected sub-counties in Kilifi County. We conducted and transcribed the interviews in Kiswahili and Giriama (local languages) and translated them into English. We used QSR NVivo 12 for data management. We analysed the data using a framework approach and interpreted our findings using Levesque's access framework. Access to hypertension screening and diagnosis services was undermined by information barriers which led to inadequate awareness and lack of knowledge about hypertension and its causes. There were perceptions of inadequate health facility capacity to offer hypertension screening services, particularly to 'healthy' individuals thus presenting as a barrier to demand for screening services. Acceptability of care was undermined by inadequate patient counselling at diagnosis and perceived disrespectful treatment of patients. Access to treatment and diagnostic tests was undermined by unaffordable care, limited availability of medicines and equipment, long waiting times, and inaccessible health facilities. Having health insurance enabled access to care; however, most participants were uninsured. Participants adapted to these access barriers by reducing/skipping daily medication doses, resorting to alternative forms of care (e.g., herbal treatments and faith healing), and changing health facilities for routine clinic appointments. Access to care for older patients (i.e., ≥70 years) and those with complications was enabled by family caregivers who coordinated and navigated the health system on their behalf. Our findings show that people living with hypertension experience a combination of interacting individual, community, and health system-related barriers to accessing care. There is a need to systematically address identified barriers and ensure patient-centred responses that meet patients' needs. Strengthening the health system's capacity to ensure availability and affordability of treatment and diagnosis services, creation of community hypertension awareness, adequate patient counselling at screening and diagnosis, and involvement of family caregivers for older patients are examples of urgent interventions to improve access to hypertension care