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International prevalence patterns of low eGFR in adults aged 18-60 without traditional risk factors from a population-based cross-sectional disadvantaged populations eGFR epidemiology (DEGREE) study.
Get PDFThe disadvantaged populations eGFR (estimated glomerular filtration rate) epidemiology (DEGREE) study was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally. Therefore, we estimated the age-standardized prevalence of eGFR under 60 ml/min per 1.73m2 in adults aged 18-60, excluding participants with commonly known causes of CKD; an ACR (albumin/creatinine ratio) over 300 mg/g or equivalent, or self-reported or measured (HT) hypertension or (DM) diabetes mellitus, stratified by sex and location. We included population-representative surveys conducted around the world that were either designed to estimate CKDu burden or were re-analyses of large surveys. There were 60,964 participants from 43 areas across 14 countries, with data collected 2007- 2023. The highest prevalence was seen in rural men in Uddanam, India (14%) and Northwest Nicaragua (14%). Prevalence above 5% was generally only observed in rural men, with exceptions for rural women in Ecuador (6%) and parts of Uddanam (6%‒8%), and for urban men in Leon, Nicaragua (7%). Outside of Central America and South Asia, prevalence was below 2%. Our observations represent the first attempts to estimate the prevalence of eGFR under 60 without commonly known causes of CKD around the world, as an estimate of CKDu burden, and provide a starting point for global monitoring. It is not yet clear what drives the differences, but available evidence supports a high general-population burden of CKDu in multiple areas within Central America and South Asia, although the possibility that unidentified clusters of disease may exist elsewhere cannot be excluded
Contextual adaptation and validation of the international Pro-VC-Be tool for measuring healthcare worker vaccine confidence in Nigeria.
Get PDFBACKGROUND: Vaccine hesitancy among healthcare workers (HCWs) is a global concern, needing reliable tools to measure HCW vaccine confidence. We adapted and validated the 10-item 'iPro-VC-Be' tool for the Nigerian context.
RESEARCH DESIGN AND METHODS: We conducted a 3-step process. First, contextual adaptation using expert round-table discussions and cognitive interviews with HCWs in Oyo and Jigawa States (12/2023-05/2024). Second, translation and back-translation to Hausa, Igbo and Yoruba, including HCW group discussions (05/2024). Finally, testing validity in all languages, using a test-retest approach (06/2024-09/2024).
RESULTS: Sixty-four participants contributed to adaptation, 25 researchers and 39 HCWs supported translations, 435 HCWs completed the first survey, and 263 completed the re-test. Of the 10 iPro-VC-Be items, 3 were unchanged, 6 had language edits, and 1 was replaced. The Cronbach's alpha indicated good internal reliability, and overall the intraclass correlation coefficient indicated moderate re-test reliability. Confirmatory factor analysis supported goodness of fit across multiple indices, but one negatively framed item performed poorly. Items assessing confidence in vaccines and trust in government were significantly associated with HCW vaccine uptake.
CONCLUSION: The adapted iPro-VC-Be was valid, however, we recommend using a shorter 6-item version for Nigeria that does not include items linked to immunization resources
Evidence of rapid rise in population immunity from SARS-CoV-2 subclinical infections through pre-vaccination serial serosurveys in Pakistan.
Get PDFBACKGROUND: Understanding factors associated with protective immunity against emerging viral infections is crucial for global health. Pakistan reported its first COVID-19 case on 26 February 2020, but experienced relatively low COVID-19-related morbidity and mortality between 2020 and 2022. The underlying reasons for this remain unclear, and our research aims to shed light on this crucial issue. METHODS: We conducted a serial population-based serosurvey over 16 months (rounds 1-4, July 2020 to November 2021) across households in urban (Karachi) and rural (Matiari) Sindh, sampling 1100 households and 3900 individuals. We measured antibodies in sera and tested a subset of respiratory samples for COVID-19 using polymerase chain reaction (PCR) and antigen tests, also measuring haemoglobin (Hb), C-reactive protein (CRP), vitamin D, and zinc in round 1. RESULTS: Participants showed 23% (95% confidence interval (CI) = 21.9-24.5) antibody seroprevalence in round 1, increasing across rounds 2-4 to 29% (95% CI = 27.4-30.6), 49% (95% CI = 47.2-50.9), and 79% (95% CI = 77.4-80.8), respectively. Urban residents had 2.6 times (95% CI = 1.9-3.6) higher odds of seropositivity than rural residents. Seropositivity did not differ between genders. Individuals aged 20-49 years had 7.5 (95% CI = 4.6-12.4) times higher odds of seropositivity compared to children aged 0-4 years. Most participants had no symptoms associated with COVID-19, with no reported mortality. Vitamin D deficiency was linked to seroprevalence. COVID-19 was confirmed in 1.8% of individuals tested via RT-PCR and antigen tests. CONCLUSIONS: The data suggests a steady increase in humoral immunity in Pakistan, likely due to increased transmission and associated asymptomatic disease. Overall, this reflects the longitudinal trend of protection against severe acute respiratory syndrome coronavirus 2, leading to the relatively low morbidity and mortality observed in the population
Environmental, Socio-Demographic and Behavioral Factors of Stunting in Children Under 2 Years of Age in Rural Gujarat – An Ethnographic Study
Get PDFBackground: The global burden of malnutrition affects millions of children. Stunting, known as the chronic form of malnutrition, attacks the overall growth and development of the child. A child who is stunted is most likely to suffer from irreversible physical and mental damage. The study aims at formative research to identify and document various determinants of stunting in rural India.
Methods:
The study was conducted in Kherol village of Sabarkantha district. Through an ethnographic approach, eight children (four stunted and four non-stunted) under the age of 2 years were enrolled in the study. For identifying the determinants of stunting, the children were observed for three consecutive days (approx. 12 hours a day) by researchers after obtaining consent from the parents. The observations were then analyzed based on the broad themes that emerged from the study.
Results:
The observations were classified in to themes and analysis was conducted. The themes identified for analysis were feeding practices, food hygiene, animal exposure and sanitation and hygiene. Consumption of packet and junk food was found to be more among, stunted children. Families of children from non-stunted group maintained a better personal hygiene. Frequency of breastfeeding was found more among children of non-stunted group. Practice of handwashing after animal exposure was found poor among members of children who were stunted.
Conclusion:
Improper feeding and poor hygiene and sanitation practices have a potential to jeopardize the nutritional status of young children and can be the mainspring for children to suffer from malnutrition and its lifelong consequences
Isothermal recombinase polymerase amplification based diagnostics for female genital schistosomiasis and human papillomavirus: a review of combined molecular diagnostic opportunities.
Get PDFWomen in sub-Saharan Africa face complex, multifaceted challenges to their health, including a high burden of infectious diseases aggravated by socioeconomic factors. Parasitic and sexually transmitted infections both cause significant morbidity and mortality. Co-infections compound these effects, leading to high rates of chronic illness and making diagnosis and treatment challenging. There are no integrated approaches for the detection of female genital schistosomiasis (FGS), a gynaecological condition caused by Schistosoma haematobium, and high-risk human papillomavirus (HR-HPV), responsible for over 90% of all cervical cancer cases worldwide. FGS is a chronic condition with health outcomes such as infertility and abortion and remains severely under-reported. HR-HPV infection is the main aetiological agent of cervical cancer, the leading cause of cancer death in women in sub-Saharan Africa. Both can be disabling and stigmatizing to the sufferer. A key to disease management at patient and community levels is accurate and available diagnostics. Due to both FGS and HPV diagnostics utilising cervicovaginal samples, they are ideal candidates for a multiplex molecular diagnostic. The standard molecular diagnostics (namely PCR), through the detection of pathogen DNA, are constrained in low resource settings by requirement of a highly reliable source of energy, reliance on a cold-chain, and prohibitive costs. Isothermal molecular diagnostics are an alternative method to PCR that are more suited to basic settings. This review explores current isothermal diagnostics, with a focus on RPA/RAA, a very simple isothermal technology, for FGS and HPV and proposes the development of a multiplex isothermal diagnostic test to enable integrated screening
International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions.
Get PDFBACKGROUND: Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many countries, no study has yet synthesized available data to produce international norms. The objective of this study was to generate international sex- and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.
METHODS: Systematic searches were conducted in 6 databases/web search engines (MEDLINE, SPORTDiscus, Embase, Web of Science, CINAHL, and Google Scholar) up to December 1, 2023. We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age. Pseudo data were generated using Monte Carlo simulation following harmonization for methodological variation. Population-weighted Generalized Additive Models for Location, Scale, and Shape were used to develop sex- and age-specific norms for absolute HGS (kg) and HGS normalized by height (Ht, m) squared (i.e., HGS/Ht2 in kg/m2). Norms were tabulated as percentile values (5th to 95th) and visualized as smoothed percentile curves.
RESULTS: We included data from 100 unique observational studies representing 2,405,863 adults (51.9% female) aged 20 to 100+ years from 69 countries and regions tested from the year 2000 onward. On average, absolute and normalized HGS values negligibly improved throughout early adulthood, peaked from age 30-39 years (at 49.7 kg (males) and 29.7 kg (females) for absolute HGS or 16.3 kg/m2 (males) and 11.3 kg/m2 (females) for HGS/Ht2), and declined afterwards. The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.
CONCLUSION: This study provides the world's largest and most geographically comprehensive international norms for adult HGS by sex and age. These norms have utility for global peer-comparisons, health screening, and surveillance
Climate Change and Gender-Based Violence: International Legal Obligations and Proactive Strategies for Protection
No full textThis chapter examines the complex interplay between the impacts of climate change and gender-based violence (GBV), focusing on state and international legal obligations to protect, promote and respect the right of women to be free from violence. While the stressors associated with climate change are complex and cumulative, emerging advances in data analytics and predictive modelling offer new opportunities for proactive risk management. Significantly, such advances potentially transform the identification of GBV risks from reactive responses to proactive prevention, including through early action warning systems. Given the current and future availability of such knowledge and technology, states and international organisations are under de facto ‘due diligence’ obligations, stemming from their intersecting de jure commitments under international human rights and climate law. Critically these obligations include an ongoing responsibility to undertake research, analysis and communication about risks and effective management strategies to protect women in both an individual and collective capacity
Metabolic reprogramming and gut microbiota ecology drive divergent Plasmodium vivax infection outcomes in Anopheles darlingi.
Get PDFAnopheles darlingi is the principal malaria vector in the Amazon basin, where Plasmodium vivax accounts for the majority of cases. Despite its epidemiological importance, the molecular and microbial determinants of A. darlingi susceptibility to P. vivax remain poorly understood. Here, we investigated vector-parasite-microbiota interactions using experimental infections with field-derived P. vivax gametocytaemic blood, which produced two distinct infection phenotypes: low and high oocyst burdens. Transcriptomic profiling of mosquito midguts across key parasite developmental timepoints revealed that low-infection mosquitoes mounted an early and sustained response characterised by activation of detoxification pathways, redox regulation, aromatic amino acid catabolism, and purine depletion, likely coordinated through neurophysiological cues, which collectively create a metabolically restrictive environment for parasite development. These physiological changes were accompanied by reduced bacterial diversity and enrichment of Enterobacteriales and Pseudomonadales, taxa previously linked to anti-Plasmodium activity. Conversely, high-infection mosquitoes exhibited limited metabolic reprogramming, expansion of Flavobacteriales, and transcriptional signatures consistent with permissive physiological states, potentially associated with reproductive trade-offs. Importantly, low infection outcomes consistently arose from bloodmeals with the lowest gametocyte densities, suggesting that host- and parasite-derived components of the bloodmeal act as early conditioning factors that prime the mosquito midgut for either resistance or susceptibility. These findings reframe A. darlingi vector competence to P. vivax not as a fixed immune trait but as a dynamic outcome of early redox, metabolic, and microbial interactions. They also highlight ecological and physiological targets for transmission-blocking strategies and reinforce the importance of studying vector-parasite interactions in regionally relevant systems
Harnessing nanotechnology to combat antimicrobial-resistant pathogens: a multidisciplinary approach to strengthen global public health defense systems
Get PDFBackground: Antimicrobial resistance (AMR) is a crucial global health threat that reduces the effectiveness of conventional antibiotics and contributes to significant morbidity, mortality, and economic burdens, particularly in low-resource settings. This review harnesses the transformative potential of nanotechnology to mitigate the complex issues of AMR from a multidisciplinary perspective.
Main body of the abstract: Metal-based nanoparticles, such as silver, zinc oxide, and copper oxide, exhibit strong bactericidal activity through mechanisms including membrane disruption, reactive oxygen species generation, and the release of toxic metal ions. Carbon-based nanomaterials, such as graphene oxide, carbon nanotubes, and carbon dots, further enhance antimicrobial efficacy owing to their high surface area and customizable functionalization. Smart nanocarriers, including liposomes, dendrimers, and polymeric nanoparticles, enable targeted drug delivery, co-delivery of synergistic agents, and controlled stimuli-responsive release, thereby improving therapeutic efficacy while limiting systemic toxicity. In addition, nanosensors with colorimetric, electrochemical, fluorescent, and surface-enhanced Raman spectroscopy properties demonstrate significant promise for the rapid and sensitive diagnosis of resistant pathogens, including applications in point-of-care testing. Clinical and preclinical studies have demonstrated the effectiveness of nanoparticle-based treatments against multidrug-resistant infections, including methicillin-resistant Staphylococcus aureus, drug-resistant tuberculosis, Escherichia coli, and Pseudomonas aeruginosa. However, challenges such as toxicity concerns, manufacturing scalability, regulatory uncertainties, and environmental risks are significant issues. Despite these advances, their translation into clinical practice remains limited. Current evidence is largely derived from in vitro and animal studies, with relatively few human trials, and long-term safety data are lacking in this regard. Concerns persist regarding their toxicity, biodistribution, cost, regulatory frameworks, and potential environmental impacts. Furthermore, emerging evidence suggests that bacteria may also develop adaptive responses to nanoparticles. Collectively, these findings underscore the potential of nanotechnology in AMR management while emphasizing the critical need for systematic safety studies, clinical validation, and regulatory standardization.
Short conclusion: Nanotechnology holds significant potential for combating AMR; however, its clinical success and translation depend on bridging the gap between laboratory innovation and safe, equitable, and sustainable clinical application
Progress and challenges in Nipah vaccine development and licensure for epidemic preparedness and response.
Get PDFINTRODUCTION: Nipah virus is a high-consequence pathogen that causes sporadic outbreaks with high mortality, and there are currently no vaccines or therapeutics available for Nipah. Vaccine development against Nipah faces challenges due to its current epidemiology with limited outbreak sizes, which impedes the feasibility of conducting vaccine efficacy trials focused on disease endpoints. AREAS COVERED: We review the progress of Nipah vaccine candidates in human clinical trials and highlight the challenges in evaluating the vaccine efficacy due to the sporadic nature of Nipah outbreaks, given the epidemic potential of Nipah virus and its implications for pandemic preparedness. We examine the alternative regulatory pathways, including the US FDA's Animal Rule and EMA's conditional marketing authorization, which permit vaccine approval based on surrogate markers rather than efficacy data from the large-scale Phase-3 efficacy trials. The need for standardized immune surrogate markers is emphasized, alongside calls for international collaboration to develop such endpoints and manage stockpile strategies. EXPERT OPINION: We recommend alignment among vaccine developers, regulators, and global health stakeholders to incentivize Nipah vaccine development and approval through alternative regulatory pathways, as well as ensuring epidemic preparedness via strategic vaccine stockpiling and response through targeted deployment strategies