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Effectiveness of stand-alone and multi-component water, sanitation and hygiene interventions to reduce mortality in childhood: a network meta-analysis
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Mortality in childhood constitutes the vast majority of the global burden of disease due to diarrhoea and respiratory infection, which is closely related to water, sanitation and hygiene (WASH) use by households. Here we use a component network meta-analysis to evaluate the comparative effectiveness of stand-alone and multi-component WASH interventions in reducing all-cause mortality in childhood in low- and middle-income countries. We find that interventions improving water supplies in quantity and drinking water are associated with reductions in all-cause mortality. Furthermore, we find that, when initial water supplies are improved, hygiene and sanitation interventions are more effective, suggesting that having enough water for washing enables better hygiene and defaecation practices. We also find that WASH packages are less effective than stand-alone interventions and that there are no synergies between interventions. On the contrary, we find some evidence of antagonistic interactions, particularly among interventions with intensive behaviour change components. These findings caution against the implementation of multi-component interventions and also favour prioritizing approaches that improve water supply conditions first. We highlight coordination problems and conflicts between the behavioural changes promoted by the interventions as potential causes of antagonistic interactions
Too Hot to Ignore: The Escalating Health Impact of Heatwaves in Brazil.
Get PDFHeatwaves (HWs) are becoming more frequent and severe, posing a significant threat to human health. Studies have shown that extreme heat, whether as incremental temperature increases or prolonged HWs, is associated with an increased risk of heat-related illnesses. However, there is still limited understanding of how these impacts unfold in Brazil, given its unique social, environmental, and health-system contexts. I this perspective article, we explore the effects of HWs on human physiology, examine the social and biological factors that contribute to heat stress, and identify vulnerable populations at disproportionate risk. We also discuss the potential consequences of extreme heat in other aspects of society, such as agriculture and energy, and assess the challenges of strengthening resilience in Brazil's health sector. Our key contribution are to make visible the hidden burden of heat-related mortality, to examine how fragmented governance constrains the adaptive capacity of Brazil's health sector, and to reflect on pathways to strengthen resilience to heatwaves
Molecular Identification of Anopheles (Diptera: Culicidae) Species in Native Communities of a Northeastern Region of Peru.
Get PDFBACKGROUND: Malaria is a severe health problem in native communities of Condorcanqui in the Amazonas region of Peru. Recently, the number of malaria cases has increased considerably following a Plasmodium falciparum outbreak in 2019. However, there is no information on the anophelines acting as Plasmodium vectors in this area. This study aimed to identify Anopheles species circulating in previously unexplored native communities of Condorcanqui. Additionally, we sought to detect the presence of DNA from P. vivax and P. falciparum parasites in mosquitoes. METHODS: During three exploratory visits between March and September 2022, 453 mosquitoes were collected using Shannon traps and CDC light traps. Only specimens morphologically identified as Anopheles sp. were subjected to molecular confirmation through PCR amplification and sequencing of the Cox1 barcode region. Plasmodium parasites were detected using nested PCR targeting of the 18S rRNA subunit, while human blood meal feeding was evaluated using a human β-globin marker. RESULTS: A total of 66 specimens were molecularly confirmed as anopheline species: An. benarrochi B, An. triannulatus, An. Costai, and An. nimbus. Six specimens of An. benarrochi B were exclusively positive for Plasmodium parasites by PCR. Moreover, four specimens tested positive for Plasmodium and the presence of human blood, suggesting the anthropophilic behavior of An. benarrochi B and its possible role as a potential malaria vector in this area. CONCLUSIONS: In conclusion, while this study provides valuable insights into the potential role of Anopheles benarrochi as a malaria vector in Amazonas, further research is essential to fully understand its behavior and transmission dynamics in the region
The Ethics of Molecular Epidemiology for Infectious Diseases
Get PDFThis chapter aims to introduce the reader to the major ethical norms and principles that underpin biomedical research, as-well-as public health research and practice as they relate to
infectious diseases. It outlines some of the key ethical issues highlighted in the literature
which are likely to arise when designing and conducting molecular investigations. These
include; the ethical significance of working with vulnerable individuals and
communities; respecting privacy and confidentiality within the context of open science;
managing the relationship between molecular research and practice; and the ethical
challenges of working across cultures. The chapter then goes on to explore practical
ethical issues, such as informed consent, data-sharing, research collaborations and
conflicts of interest, that researchers and practitioners may encounter and how these
may be addressed. Lastly, a brief overview of legal and regulatory frameworks relevant
to molecular epidemiology and infectious disease are presented. The chapter aims to
equip researchers and practitioners to be able to identify, evaluate and act upon the
ethical aspects of the professional practice in molecular epidemiology for infectious
diseas
Deliberative dialogues in rural South Africa reveal public support and communication challenges in HIV cure research: uMkhanyakude district, KwaZulu-Natal.
Get PDFBACKGROUND: There is a need to build public support for the conduct of HIV cure research. It is important to enhance the public understanding of HIV cure strategies in resource-constrained settings with high HIV prevalence. Adopting deliberative approaches allows information to be shared interactively, building knowledge on the topic and unpacking the complexity of the science. METHODS: We conducted deliberative community dialogues in rural KwaZulu-Natal, South Africa, with the Africa Health Research Institute community engagement team and Community Advisory Board members. We discussed the public understanding of 'HIV cure' and current scientific approaches. Detailed written notes were taken in anonymised format. Data were later analysed thematically, with three main themes identified: (i) understanding of HIV cure trials; (ii) HIV scientific procedures; and (iii) HIV cure messaging. RESULTS: Participants' questions and discussion revealed support for research on HIV cure but limited knowledge and understanding. Participants had questions about trial procedures, risks of antiretroviral therapy interruptions, efficacy, cost and monitoring of viral loads. There is need for simple, accessible language about the complex science to avoid misunderstanding among community members. CONCLUSION: On going challenges in effectively communicating complex scientific concepts highlight the importance of ongoing community engagement and education in HIV cure research
UK Social Care Workers’ Intention to Leave During COVID-19: A Longitudinal Analysis
Get PDFBackground: The UK’s social care sector, employing 1.6 million workers, faces profound challenges exacerbated by the COVID-19 pandemic. This study explores the nuanced factors influencing care workers’ intentions to leave the current employer and sector altogether during this critical period.
Methods: Utilising a two-wave online longitudinal survey, data from 1,791 care workers were analysed. The survey included adapted questions from validated workforce surveys and qualitative insights from stakeholders during the pandemic.
Findings: There is a complex interplay of factors influencing care workers’ intentions to leave. High job satisfaction is associated with lower intent to leave. Yet, disparities in satisfaction with pay, promotion, and work-life balance persist. The pandemic appeared to impact intention to leave minimally but heightened abuse instances. Visible markers—notably colour—emerged as significant factors, emphasising the need for tailored interventions. Strong job support is associated with increased intent to leave, underscoring the fine employee-manager relationship. The middle-aged group showed the highest intent to leave, warranting further exploration.
Implications: Tailored interventions acknowledging the intersectionality of age, gender, and race are crucial for enhancing job retention in the social care sector. A comprehensive long-term care workforce strategy is urgently needed, addressing immediate concerns and deep-rooted challenges to empower the entire workforce. Collaborative efforts are essential for crafting sustainable solutions that support and uplift the social care workforce
The effectiveness of mobile app-based interventions in facilitating behaviour change towards healthier and more sustainable diets: a systematic review and meta-analysis.
Get PDFBACKGROUND: Digital health apps have been shown to influence healthy eating, but whether they can promote environmentally friendly diets remains unclear. In countries where diets typically contain a high proportion of carbon-intensive foods (e.g., meat), transitioning to healthier alternatives (e.g., fruit, vegetables, and legumes) can substantially reduce food-related greenhouse gas emissions while also improving public health. Our systematic review and meta-analysis aimed to investigate the effectiveness of mobile apps in facilitating more sustainable and healthier diets among adults from high-income countries. METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health, GreenFILE, Web of Science, Cochrane Trials, and ClinicalTrials.gov from inception until Jan 20, 2025. We included studies that reported the effects of app-based behavioural interventions on the consumption of fruit, vegetables, legumes, nuts, fish, dairy, and/or meat, compared to a control, baseline period, or different intervention. For outcomes measured in at least two studies, we conducted random effects meta-analysis and meta-regression to understand population differences and the role of specific intervention components. RESULTS: Of the 7356 records screened, 21 were included. Nine studies scored ‘high’, 10 scored ‘fair’, and two scored ‘low’ for reporting transparency. Combined, the studies analysed 12,898 participants, interventions lasted from three days to six months, and outcomes were assessed up to 12 months post-intervention. Forty percent of studies targeted populations with at least one health risk factor and 81% of study populations did not meet dietary guidelines at baseline for their primary outcome. Meta-analyses indicated that app use led to increased fruit and vegetable consumption (0.48 portions/day, 95% CI 0.18, 0.78, p = 0.002) and a small decrease in meat consumption (-0.10 portions/day, 95% CI -0.16, -0.03, p = 0.004), with meat-focussed apps showing as more effective than general apps for meat reduction. Meta-regression also revealed that message-based content was particularly effective in promoting meat reduction. There were no pronounced effects on legume or dairy consumption, or differences across populations. CONCLUSION: Our results indicate that apps could be a valuable addition to the multiple interventions required to promote sustainable diets. However, to strengthen the evidence for outcomes beyond fruit and vegetables, we need standardised reporting of populations and intervention components. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12966-025-01823-7
Association Between Herpes Zoster and Risk of Incident Fragility Fractures in US Veterans: A Matched Cohort Study.
Get PDFBACKGROUND: Herpes zoster (HZ) and fragility fractures typically affect older adults and present major burdens to healthcare systems. While HZ is associated with an increased risk of neurological, ocular, skin, and visceral complications, it is unclear whether it affects long-term bone health. Therefore, we aimed to compare the risk of fragility fractures in Veterans with HZ relative to matched Veterans without HZ in the United States. METHODS: We used routinely collected data from the Veterans Aging Cohort Study (VACS-National) from 01/01/2008 to 31/12/2023. Veterans with incident HZ diagnoses aged 40+ were matched on age, sex, race, ethnicity, site of care, and calendar time with up to five Veterans without HZ. The association between HZ and subsequent fragility fractures (defined as hip/femoral, shoulder/upper arm, vertebral, and wrist/forearm fractures) overall and by site was assessed using a Cox model stratified by matched set adjusting for sociodemographic, lifestyle, and clinical confounders. Age, frailty, and receipt of antivirals (AVT) within 7 days of exposure were investigated as potential effect modifiers for the relationship. RESULTS: We included 229,992 Veterans with HZ matched to 1,134,519 Veterans without HZ. Both groups were comparable in median age (67.8 vs. 67.7 years), percentage males (93.5% vs. 93.7%), and median follow-up time (5.9 vs. 5.4 years). Veterans with HZ had a 15% higher risk of incident fragility fracture (aHR = 1.15, 95% CI: 1.13, 1.18) compared to Veterans without HZ. The increased risk was observed for each fracture site. There was evidence of interaction by age, frailty, and receipt of AVT, as older, frailer, and AVT-treated Veterans had a higher risk of fragility fracture. CONCLUSIONS: Veterans with HZ were at a higher risk of fragility fractures relative to Veterans without HZ, highlighting the need for improved fracture prevention among those diagnosed with HZ. Further research in non-Veteran and female populations will improve generalizability
Antibiotic surveillance: an action-oriented integrated approach. SEDRIC Working Group Inventory, Proceedings and Annex
Get PDFMonitoring the types and volumes of antibiotics distributed, used and discharged across these systems is critical to provide evidence for action. With limited resources, implementation of multiple tools and recommendations for antibiotic monitoring is challenging. A Wellcome Trust SEDRIC Working Group set out the principles and case study illustrations for establishing antibiotic surveillance in resource-constrained settings. The output of that work is available at Wellcome Open. This document contains the Inventory of tools for antibiotic data capture and analysis across One Health domains, Working Group proceedings and an Annex describing the Antibiotic Surveillance System in Brazil
A longitudinal, population-based, record-linked natural experiment on the effects of extreme heat events on mental health in urban communities: a study protocol.
Get PDFINTRODUCTION: Studies suggest that extreme heat events can have negative effects on mental health. However, characterisation of these effects in urban communities remains limited, and few studies have investigated the potential modifying effects of demographic, clinical and environmental characteristics. The aim of this study is to address this knowledge gap and quantify the impacts of extreme heat on mental health, health service use and mental well-being in vulnerable urban populations. METHODS AND ANALYSIS: In this multidisciplinary project, we will assess mental health outcomes in different populations by bringing together two distinct datasets: electronic health record (EHR) data on mental health service users and data from general public participants of Urban Mind, a citizen science project. We will use EHRs from the South London and Maudsley NHS Foundation Trust (SLaM) and the North London NHS Foundation Trust (NLFT), from six boroughs which collectively cover more than 1.8 million residents in Greater London, to capture mental health service use and mortality among people with existing diagnoses of mental illness across 2008-2023. We will use smartphone-based ecological momentary assessment data from Urban Mind to measure mental well-being in the general population (2018-2023). These datasets will be linked to high-resolution spatiotemporal data on temperature, fine and coarse particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), Normalised Difference Vegetation Index (NDVI) and density of large mature tree canopy. We will employ novel quasi-experimental designs, including case time series and case-crossover analysis, to examine the impact of extreme heat on mental health and explore effect modification by sociodemographic, clinical and environmental factors, including air pollution and types of green space coverage. We will also develop a microsimulation model combined with the InVEST urban cooling model to assess and forecast the mental health and social care impacts of extreme heat events and the mitigation of these impacts by different green space coverage and pollution-reduction policies. With a core team composed of researchers, community organisations, industry partners and specialist policy experts, this project will consider lived experience, benefit from broad stakeholder engagement and address gaps in policy and practice. ETHICS AND DISSEMINATION: Each component of this project has been approved by the relevant ethics committee (ref RESCM-22/23-6905 for Urban Mind, LRS/DP-23/24-41409 for the co-development of a screening tool, 23/SC/0257 for the SLaM EHRs, and 24/EE/0178 for the NLFT EHRs). Our dissemination plan includes peer-reviewed scientific articles, policy briefs, a practical guide on fostering ecological and human resilience at the neighbourhood level, and a technical guide for planting and improving the growing conditions of large canopy trees