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Heterogeneity of malaria transmission in urban settings in Ethiopia: A seroprevalence and risk factor analysis.
No full textMalaria remains a significant public health concern in Ethiopia, affecting both rural and urban populations. In urban settings, rapid unplanned expansion, poor drainage, and population movement are increasingly creating aquatic habitats that support vectors such as Anopheles stephensi, thereby leading to complex and underestimated transmission patterns. Serology-based risk factor analyses offer a sensitive indicator of recent and past exposure, helping to reveal underlying transmission patterns and more tailored interventions. This study assessed malaria seroprevalence and associated risk factors among residents of three towns in Ethiopia: Adama, Metehara, and Awash Sebat Kilo to better characterize transmission dynamics and identify context-specific vulnerabilities. A community-based cross-sectional survey was conducted from January 30 to March 14, 2020, involving 912 individuals from randomly selected 196 households. Malaria infection was diagnosed using rapid diagnostic tests (RDTs) and quantitative polymerase-chain reaction (qPCR). Serological analyses were performed to determine exposure to Plasmodium falciparum and Plasmodium vivax. The study found a low malaria prevalence of 0.78% by RDT and 4% by qPCR, with 1.7% of cases due to P. falciparum and 2.3% due to P. vivax. The overall seroprevalence was 19.4% (149/767) for P. falciparum and 18% (139/767) for P. vivax using combined short-lived response markers. Seroprevalence rates varied among towns, with Awash Sebat Kilo showing the highest exposure for recent markers (36.5% for P. falciparum; 28% for P. vivax) compared to lower rates in Adama (2.8% and 2.8%, respectively). Proximity to breeding sites (OR = 2.8, 95% CI: 1.1-7.4; p = 0.037) and being older than 15 years (OR = 4.0 95% CI: 2.1-7.6; p < 0.001) were significant risk factors for P. falciparum and P. vivax malaria exposure, respectively. This study demonstrates marked heterogeneity in malaria exposure across urban settings, with the lowest seroprevalence observed in Adama and higher levels in Awash Sebat Kilo. The findings emphasize the importance of incorporating serological surveillance into routine monitoring and highlight the need for targeted, locally tailored control strategies. Such tailored approaches will be increasingly critical, particularly in the context of emerging urban transmission risks driven by the expansion of An. stephensi in the region
Greening mitigates heat-related mortality in Paris.
Full text linkCities are vulnerable to heat-related health impacts due to the compounding effects of urban heat island (UHI) and rising temperatures because of climate change. Here we characterise the contextual factors exacerbating and attenuating the risk of mortality associated with high temperature in the city of Paris. Findings suggest that reducing urban heat and mitigating UHI through urban greening should be at the forefront of adaptation strategies to prevent heat-related health impacts in cities
Street space reallocation under austerity: The case of low traffic neighbourhoods in the UK
Full text linkStreet space reallocation measures, such as Low Traffic Neighbourhoods (LTNs), have attracted substantial controversy in the UK and elsewhere, for instance around reported poor engagement with residents and local actors. However, limited attention has been given to the political-economic context shaping scheme implementation, such as the impacts of reduced resources or of the use of short-term, contingent funding. Based on 37 interviews with officers and councillors who implemented or sought to implement LTNs in 12 English local authorities, and part of a larger project investigating the impacts of LTNs in London, this paper addresses this gap. It shows how challenges to design, engagement and delivery of LTNs are often linked to funding scarcity and processes of projectification, advancing the literature on transport governance and controversy
Preparing Communities for Participatory Research: A Brief Report
Full text linkWhile participatory research is increasingly used in global health, more has been written for researchers compared to communities. This article synthesizes insights from a community panel convened during a participatory research workshop. The discussion identified key factors for communities to understand and assumptions to set aside when beginning participatory research. These considerations may help communities navigate power imbalances, inclusively design, and participate as more equal partners in research. Implications for participatory methodology and partnership training are also discussed
Recurrence of HIV-associated cryptococcal meningitis in pregnancy and the post-partum period.
Full text linkWe report a case of recurrent cryptococcal meningitis in a pregnant woman living with vertically acquired HIV. Despite effective treatment of primary infection prior to pregnancy, she later experienced a microbiological relapse of cryptococcal meningitis during pregnancy, and an immune-reconstitution inflammatory syndrome in the post-partum period. This case emphasises the impact of pregnancy related immunological changes on the natural history of complex infections. This case illustrates the challenges of managing opportunistic infections throughout pregnancy and the influence of perinatal immunological changes on disease course
Maternal screening coverage and determinants during facility-based antenatal care in Nigeria: analysis of the 2018 Demographic and Health Survey.
Full text linkBACKGROUND: Antenatal care (ANC) provides an opportunity for early identification and treatment of pregnancy-related conditions to prevent adverse maternal and foetal outcomes. The influence of socioeconomic and health system factors on maternal screening during ANC remains unclear. We evaluated the coverage and determinants of facility-based ANC use and components related to maternal screening for common pregnancy-related conditions in Nigeria.
METHODS: Using data from the 2018 Nigeria Demographic and Health Survey, we estimated the percentage of women aged 15–49 years who reported facility-based ANC for their most recent live birth in the 5 years preceding the survey. Among them, we estimated the percentage who received care components related to maternal screening (blood pressure measured, and urine and blood samples taken) at least once. We used logistic regression to examine the association between household wealth and 1) facility-based ANC utilisation and 2) screening components of care received. Facility type (private or public sector) was considered as an effect modifier.
RESULTS: Among the sample of 21,792 women, 72.8% reported facility-based ANC. Most ANC users reported having had their blood pressure measured (95.2%), and their blood (89.3%) and urine samples taken (88.0%). All three screening components were received by 83.4% of facility-based ANC users. Compared to women from the poorest quintile, the richest had significantly higher adjusted odds of having facility-based ANC (aOR 4.25, 95% CI: 3.23 – 5.59) and, among ANC users, of receiving all three screening components (aOR = 3.43, 95% CI: 2.52 – 4.68). The adjusted odds of receiving all three components were 49% lower among women who used private ANC compared to those who used only public providers (aOR = 0.51, 95% CI: 0.43 – 0.61). There was no evidence of interaction by facility type.
CONCLUSION: Wealth inequality is associated with disparities in the utilisation of facility-based ANC and maternal screening. Socio-economically disadvantaged women, who are most in need of maternal health services, face a ‘double penalty’ of deprived ANC use and maternal screening during ANC. Interventions focused on mitigating these disparities can help improve maternal outcomes. Concerted efforts are required to regulate the private facilities and strengthen the public facilities to provide high-quality maternal healthcare services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-026-02269-1
Comparative assessment of the impact of iron deficiency on HbA1c accuracy in non-anaemic individuals with type 2 diabetes: A secondary data analysis.
Full text linkPURPOSE: Results from a few studies have been conflicting regarding whether iron deficiency affects HbA1c reliability, and the mechanisms by which iron might influence HbA1c are not fully understood. We aimed to compare the relationship between HbA1c and average glucose levels measured by continuous glucose monitoring, retrospectively, in iron-replete and iron-deplete states among non-anemic type 2 diabetes mellitus (T2DM) patients. METHODS: We compared the differences in HbA1c between iron-replete and iron-deplete groups using the Chi-square test for categorical data and the Mann-Whitney U test for continuous data. We also evaluated the correlation between HbA1c and mean plasma glucose for both iron-replete and iron-deplete individuals using Pearson's correlation and linear regression. RESULTS: A total of 146 of the 213 participants screened had complete data and were included in the final analysis. 43 out of 146 (29.5%) had iron deficiency, and 103 were iron-replete. No significant difference was observed in HbA1c levels between iron-replete and iron-deplete individuals: 69 (51.0, 85.0) vs 62 (46.0, 83.0) mmol/mol, P = 0.291). There was a strong positive correlation between HbA1c and mean plasma glucose concentration for both iron-replete and iron-deplete individuals (Pearson Correlation coefficient: 0.88 (0.83-0.92) and 0.93 (0.88-0.98), respectively). CONCLUSIONS: HbA1c correlates well with mean blood glucose even in the iron-deplete state amongst non-anaemic T2DM individuals. However, larger studies are needed to confirm these findings, particularly at screening and diagnostic thresholds
Exploring the IS-capades of Klebsiella pneumoniae: insertion sequences drive metabolic loss in obscure sub-lineages.
Full text linkIntroduction. Klebsiella pneumoniae is an opportunistic pathogen that causes a wide spectrum of infections within healthcare settings and the community. Four K. pneumoniae sub-lineages, defined using core gene multi-locus sequence types, are known to cause distinct infections of the nasal and/or upper respiratory passages: SL91 and SL10031 (also referred to as subspecies ozaenae), SL10032 (subspecies rhinoscleromatis) and SL82. These sub-lineages have also demonstrated reduced carbon source utilization, which, in other species, has been linked with high loads of insertion sequences (ISs).Methods. We performed comparative genomics, analysed IS composition and loads and constructed genome-scale metabolic models for available public sequences from these four sub-lineages. These were then compared with other sub-lineages from the wider K. pneumoniae population.Results. The four focal sub-lineages displayed significantly higher IS loads (median range, 88-120 per genome) than other K. pneumoniae sub-lineages (median range, 12-73). Notably, each K. pneumoniae sub-lineage had unique IS profiles, consistent with distinct evolutionary trajectories of IS acquisition and expansion. Across sub-lineages, higher IS loads were inversely associated with the number of metabolic model genes per genome (R2=0.16; P<0.001), as well as predicted aerobic substrate utilization for phosphorus sources (R2=0.39; P<0.001), as per a second-degree polynomial regression model (n=1,664 genomes). Additionally, the four IS-dense sub-lineages displayed a combination of convergent, sub-lineage-specific substrate utilization losses, including the parallel loss of 3-phospho-d-glycerate, d-glycerate-2-phosphate and phosphoenolpyruvate utilization as carbon/phosphorus sources. Finally, inspection of IS insertion sites demonstrated frequent and non-destructive insertion next to transcriptional, carbohydrate and amino acid metabolism genes.Conclusions. IS accumulation in K. pneumoniae was significantly associated with reduced metabolic substrate usage, consistent with an inverse relationship between IS load and metabolic capacity. Despite these losses, the affected lineages still demonstrate substantial metabolic breadth, consistent with early-stage, ongoing reductive evolution
Level and determinants of district primary healthcare system technical efficiency in Ghana: two-stage stochastic frontier analysis.
Full text linkBACKGROUND: Primary healthcare (PHC) is critical towards achieving Universal Health Coverage (UHC). In Ghana, PHC is organised at the district level and plays a key role in the country's pursuit of UHC. However, many districts face challenges not only with limited resources but also with how effectively they are used. We examined how efficiently districts in Ghana use their health resources and what factors are associated with this efficiency. METHODS: We used a two-step stochastic frontier analysis model using data from 181 districts. The output variable was a composite coverage index derived from eight PHC service indicators for 2021, primarily reflecting maternal and child health and infectious disease services. Input variables included district health expenditure for 2020/2021 and the number of health facilities and clinical staff in 2021. We then assessed the associations between efficiency scores generated by the model and health systems, socioeconomic and demographic factors, such as health facility type, insurance coverage, literacy level, Gini coefficient, poverty incidence, urbanisation and population density. RESULTS: On average, districts operated at 87% efficiency, with scores ranging from 65% to 99%. Two factors were associated with the efficiency. First, districts with a higher proportion of PHC facilities tended to use resources more efficiently (coeff=0.151; 95% CI=0.041 to 0.261). Second, districts with greater income inequality were less efficient, measured by the Gini coefficient (coeff=-0.858; 95% CI=-1.146 to -0.252). CONCLUSION: Districts in Ghana have the potential to improve PHC outputs by about 13% on average by better use of existing resources and addressing determinants of efficiency. Findings suggest that districts with a higher proportion of PHC facilities and lower income inequality tend to be more efficient. These patterns highlight the value of strengthening PHC infrastructure and pursuing equity-focused policies as part of strategies to enhance efficiency in district health systems
Genome-wide analyses of Mycobacterium tuberculosis complex isolates reveal insights into circulating lineages and drug resistance mutations in The Gambia.
Full text linkTuberculosis (TB), caused by the Mycobacterium tuberculosis complex (MTBC), remains a pressing global health challenge, with a high burden in West Africa, including The Gambia. Understanding the genetic diversity of circulating MTBC strains is essential for improving diagnosis, surveillance and treatment strategies. In this study, we characterise the population structure and drug resistance landscape of MTBC strains circulating in The Gambia over nearly two decades (2002-2021). We analysed whole-genome sequencing (WGS) data from 1,803 TB isolates. Lineage 4 (L4) was predominant (67.2%), followed by the West Africa-restricted lineage 6 (L6, 26.6%), with L4 exhibiting greater genetic diversification over time. Drug susceptibility profiling of these isolates revealed that 78% (1421/1803) were drug-susceptible, while 6.5% (119/1803) harboured resistance to first-line drugs, primarily to isoniazid, rifampicin, or both. Notably, 15.5% (282/1803) isolates carried mutations classified as having uncertain significance according to the WHO resistance catalogue. Comparative analyses revealed a lineage 6-specific ethambutol-associated mutation of uncertain significance (embC Ala307Thr) occurring at a higher frequency in Gambian isolates than in the broader West Africa region or globally. Structural modelling demonstrated that many first-line drug resistance mutations are located in highly conserved, solvent-inaccessible regions of target proteins, often impacting protein stability, suggesting a trade-off between drug resistance, bacterial fitness, and evolutionary adaptation. Together, these findings highlight the coexistence of globally widespread and regionally restricted MTBC lineages in The Gambia and reveal a substantial burden of resistance-associated mutations of uncertain significance in the WHO catalogue. Sustained genomic surveillance and region-specific interpretation of resistance mutations are essential to support End TB strategies in high-burden settings