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Adapting a Participatory Group Programme for Caregivers of Children with Complex Neurodisability from Low-, Middle-Income Countries to a High-Income Setting: Moving from "Baby Ubuntu" to "Encompass".
Get PDFThe "Baby Ubuntu" programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt "Baby Ubuntu" for use in ethnically and linguistically diverse, and economically deprived urban boroughs in the United Kingdom (UK). The process was guided by an adaptation team, including parents with lived experience, who explored the rationale for the intervention from local perspectives and its fit for this UK community. Through qualitative interviews and co-creation strategies, the perspectives of caregivers and healthcare professionals substantially contributed to the "Encompass" programme theory, drafting the content, and planning the delivery. Ten modules were co-produced with various topics, based on the "Baby Ubuntu" modules, to be co-facilitated by a parent with lived experience and a healthcare professional. The programme is participatory, allowing caregivers to share information, problem solve, and form supportive peer networks. The "Encompass" programme is an example of a "decolonised healthcare innovation", as it aims to transfer knowledge and solutions developed in low- and middle-income countries to a high-income context like the UK. Piloting of the new programme is underway
Optimization and Characterization of the Antimalarial Activity of N-Aryl Acetamides that are Susceptible to Mutations in ROM8 and CSC1.
Get PDFNew antimalarials are needed due to the threat of emerging resistance against existing antimalarial therapies. A phenotypic screen uncovered the N-aryl acetamide class that inhibits the development of P. falciparum asexual ring-stage parasites. The structure-activity relationship of this class was investigated, and key modifications were introduced that produced WEHI-326 with potent antimalarial activity. Enhancing the metabolic stability of this class will be a future challenge to achieve efficacy in a malaria mouse model. WEHI-326 was found to have a moderate barrier to resistance and a moderate rate of asexual kill, potently inhibited gametocyte and gamete development, and in turn, blocked the transmission of parasites to the mosquito. Forward genetics and cross-resistance profiling determined that parasites resistant to N-aryl acetamides had mutations in rhomboid protease 8 (ROM8) and the putative cation channel, CSC1. WEHI-326 will be an important tool in unraveling the role of ROM8 and CSC1 in P. falciparum development
Trust and the infodemic: reframing information threats in the realm of public health
Get PDFAmidst polarisation, public health threats and economic uncertainty, there is a concern around the impact of an overabundance of information: the infodemic. In this paper we argue that: information threats are a symptom of eroded trust, not the cause. Instead of viewing the overabundance of information as the primary problem, it should be understood as a reflection of wider trust processes; focusing on rebuilding trust offers a more effective approach than simply managing the infodemic. This includes promoting transparency and accountability from decision makers and fostering genuine community engagement when designing policy and vaccine confidence serves as an example of how trust, rather than information alone, drives public health decision making.We conclude that through understanding and rebuilding trust, rather than problematising information and individual consumption of information, we can strengthen community level public health responses
Tackling schistosomiasis in fisherfolk communities in Uganda: Enablers and challenges for implementing paediatric schistosomiasis mass drug administration from the perspective of district health authorities.
Get PDFBACKGROUND: Schistosomiasis remains a significant public health issue in Uganda, particularly among fishing communities. This study, nested within a larger community-based study (ADOPT) on introducing a new child-friendly praziquantel formulation for schistosomiasis, arpraziquantel, explored enablers and challenges perceived by district health authorities for implementing a mass drug administration (MDA) programme with arpraziquantel. METHODS: Respondents in this cross-sectional study were purposively selected in Bugiri and Hoima districts, Uganda. Key informant interviews were conducted in July 2022 and thematically analysed using the World Health Organization health system building blocks framework. RESULTS: In general, arpraziquantel is expected to be widely accepted, though some may oppose it for religious or political reasons, belief in witchcraft as a cause of schistosomiasis, or fear of side effects. High awareness of disease burden and the acceptance of the existing schistosomiasis MDA for adults and school-aged children were identified as enablers for successful implementation. Key implementation challenges include limited resources for sustained biannual MDAs, adequate remuneration of village health teams (VHTs), inadequate staff training, time constraints, uneven VHT workload, and weaknesses in the referral systems. Migration, difficulties sensitising mobile parents, and delayed meals due to poverty-complicating drug absorption requiring a full stomach-further hinder efforts. DISCUSSION: This study underscores the importance of addressing health systems' challenges through targeted measures to ensure effective and sustainable MDA of arpraziquantel, including enhanced training of VHTs and other staff, sensitisation of parents and key stakeholders at all levels, and adequate responses to potentially emerging side effects
Methylene blue treatment of fatal cerebral malaria and identification of potential blood biomarkers.
Get PDFCerebral malaria (CM) is a severe complication caused by Plasmodium falciparum infection, leading to persistent neurological impairments in survivors. To understand the complex mechanisms and investigate advanced diagnostic and treatment strategies targeting human CM, we utilize Plasmodium coatneyi-infected male rhesus macaques, a non-human primate model closely resembling P. falciparum infection in humans. Through differential gene expression analysis, our study demonstrates methylene blue's efficacy in reversing the detrimental effects of infection on the brainstem. Furthermore, by comparing our brainstem dataset from P. coatneyi-infected Macaca mulatta with two additional transcriptomic datasets (P. coatneyi-infected M. mulatta blood and P. falciparum-infected human blood), we identify nine genes associated with CM severity. Most of these genes are expressed in neutrophils, indicating their potential as blood biomarkers for diagnosing P. falciparum-induced fatal CM. This research highlights the necessity for new CM treatments and reveals promising biomarkers that could improve diagnosis and prognosis in affected individuals
Improvement to East African style experimental huts allows for more effective evaluation of vector control products for protection against vector-borne diseases.
Get PDFBACKGROUND: East African style experimental huts have been used in Tanzania since 1963 to evaluate vector control interventions such as insecticide-treated nets and indoor residual spraying. Over time, these huts have been modified to include eave baffles to minimise mosquito escape. In this study, we evaluated the impact of increasing baffle size and using netting to funnel mosquito entry into the room and prevent escape. We also explored mosquito entry behaviour using a sticky trap positioned on the hut exterior to determine if this behaviour could be leveraged for vector control. METHODS: This study was conducted in Moshi, Tanzania and included two trials. In trial one, we compared the original huts with baffles with small exit holes (4 × 110 cm at the wide end nearest the eave gap and 2 × 2 cm at the narrow funnel end) to those with a larger size of baffle exit hole (20 × 120 cm at the wide end and 4 × 10 cm at the narrow end). In trial two, we compared huts with a sticky trap on the exterior wall to those without. Data analyses used logistic regression models to compare mosquito entry, blood-feeding rates and exophily, adjusting for variation between huts, cows (for blood-feeding) and days of the trial. RESULTS: Larger eave baffles significantly increased entry of Anopheles gambiae Kisumu mosquitoes into huts [p = 0.01, adjusted odds ratio (AOR) 2.1, 95% confidence interval (CI) 1.2-3.8]. Blood-feeding rates were also significantly higher in huts with the larger baffle size compared to those with the original baffle size [p = 0.001, AOR 16.9 95% CI 4.9-59.0]. In trial two, 16% (95 CI 13.3-19.6) of An. gambiae Kisumu and 8% (95 CI: 6.3-10.5) of Anopheles arabiensis populations were collected on the sticky traps, significantly reducing mosquito entry into huts. With the presence of sticky traps, blood-feeding was inhibited by 12.7% for An. arabiensis and 32.6% for An. gambiae Kisumu. CONCLUSIONS: The results of this study support the use of larger baffle sizes in East African huts to capture larger numbers of mosquitoes and improve the evaluation of vector control tools. Although only a small proportion of mosquitoes were found to have had direct contact with the exterior of the hut before entry, the presence of sticky traps still reduced blood-feeding rates by limiting the entry of host-seeking mosquitoes
A Multicomponent Intervention to Improve Maternal Infection Outcomes.
Get PDFBACKGROUND: Maternal infection and sepsis are major causes of maternal death and severe illness worldwide, particularly in low- and middle-income countries. Inconsistent implementation of evidence-based recommendations for infection prevention and management and delays in detection and treatment of maternal sepsis contribute to the number of preventable deaths. METHODS: We conducted a cluster-randomized trial to assess a multicomponent intervention, the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program. This program was designed to support health care providers in achieving three goals: adherence to World Health Organization (WHO) hand-hygiene standards; adoption of evidence-based practices for maternal infection prevention and management; and early detection of sepsis and use of the FAST-M (fluids, antibiotics, source control, transfer if required, and monitoring) treatment bundle. Usual care was provided in the control group, along with dissemination of guidelines. The primary outcome was a composite of infection-related maternal death, infection-related near-miss event (events in which women survived a life-threatening complication), or severe infection-related illness (deep surgical-site, deep perineal, or body-cavity infection) among women who were pregnant or had recently been pregnant. RESULTS: We randomly assigned 59 health facilities (where 431,394 women gave birth during the trial) in Malawi and Uganda to the intervention group (30 clusters) or the usual-care group (29 clusters). A primary-outcome event occurred in 1.4% of the patients in the intervention group and in 1.9% of those in the usual-care group (risk ratio, 0.68; 95% confidence interval, 0.55 to 0.83; P<0.001). This effect was generally consistent between countries and among facilities of difference sizes and was sustained over time. CONCLUSIONS: Implementation of the APT-Sepsis program led to a significantly lower risk of a composite of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care. (Funded by the Joint Global Health Trials scheme and others; APT-Sepsis ISRCTN number, ISRCTN42347014.)
Drivers of decision-making for future adult vaccines: a best-worst scaling among community members and health care workers in Zambia.
Get PDFBACKGROUND: Several new vaccines for adults may soon become available, but low- and middle-income countries (LMICs) have limited experience with adult vaccination programs beyond COVID-19. Understanding the factors that influence vaccination decisions among community members and healthcare workers (HCWs) in such settings will be critical for optimizing uptake and rollout strategies. METHODS: We conducted a Best-Worst Scaling (BWS) exercise to determine which vaccination factors (n = 22) most influenced adult community members and HCWs in Lusaka, Zambia, for newly introduced vaccines. Vaccination factors included disease characteristics, vaccine characteristics, vaccine-related concerns, vaccine delivery features, social norms, and external motivators. Mean preference weights (MPWs), indicating relative importance, were calculated using hierarchical Bayes, and latent class multinomial logit analyses (LCA) were used to identify distinct preference groups. RESULTS: Of 472 participants (median age 30.0 years, 53.8% female, 9.6 % HIV-positive), 381 (76.4 %) were community members, and 91 (19.3 %) were HCWs. Disease characteristics (specific disease, infection likelihood, severity) and vaccine characteristics (efficacy, protection duration) were the most important factors influencing vaccine decision-making. LCA identified five community member and two HCW groups- all prioritized the specific disease targeted by the vaccine. Community groups included "Personal Health-Focused" (31.0 %, prioritizing disease severity and future vaccine-related health problems), "Disease Protection and Social Awareness" (22.8 %;prioritizing vaccine protection duration, broader social norms), "Incentive Motivated" (18.9 %; prioritizing financial incentives), "Vaccine Cautious" (15.5 %;prioritizing vaccine origin, safety concerns), and "Mandate Motivated" (11.8 %;prioritizing vaccination requirements). HCW groups were, "Disease and Efficacy Driven" (62.6 %;prioritizing vaccine effectiveness, disease severity, side effects) and "Pragmatic Minded " (37.4 %;prioritizing number of doses, protection duration, pregnancy safety). CONCLUSIONS: While disease-specific factors commonly shaped vaccine preferences, heterogeneity among community members and HCWs highlights the need for differentiated delivery and communication strategies that incorporate group-specific motivations and utilize trusted sources to optimize uptake of future adult vaccines in Zambia and other LMICs
Effectiveness of the 2023 Autumn XBB.1.5 COVID-19 Booster During Summer 2024 in the EU/EEA: A VEBIS Electronic Health Record Network Study.
Get PDFBACKGROUND: After a period of low SARS-CoV-2 activity, viral circulation increased in Europe from May 2024, driven by immune-evasive KP sublineages of the JN.1 variant. We estimated vaccine effectiveness (VE) of the XBB.1.5 dose administered in autumn 2023 against COVID-19-related hospitalisations and deaths in individuals 65 years of age or older during this period. METHODS: We conducted a multi-country cohort study across six EU nations in the VEBIS-EHR network using linked electronic health records. VE against COVID-19-related hospitalisation and death during June-August 2024 was estimated using Cox regression in a two-stage analysis, adjusting for demographics, comorbidities and prior vaccination history. RESULTS: Among individuals 65-79 and ≥ 80 years old, respectively, VE of the XBB.1.5 dose ≥ 6 months post administration was 13% (95% CI: -12% to 33%) and 7% (95% CI: -7% to 19%) against hospitalisation and 39% (95% CI: -7% to 65%) and 3% (95% CI: -23% to 23%) against deaths. CONCLUSIONS: XBB.1.5 vaccination provided minimal residual protection against severe COVID-19 outcomes among adults aged ≥ 65 years more than 6 months after vaccination, during the summer 2024 period of increased SARS-CoV-2 activity
Gender-responsive behaviour change research: leveraging women's and men's motivations to inform interventions for transitioning to piped water supply in Indonesia
Get PDFABSTRACT
This study investigates how a gender-responsive, behaviour-centred design (BCD) approach can support the transition from groundwater to piped water supply in low- and middle-income urban communities. Using a combination of literature review, qualitative research (20 participants) in a low-income community in West Jakarta, and a stakeholder workshop, the study identified gender-specific preferences and barriers influencing water-use behaviours. Women emphasised concerns about water quality, particularly taste and microbial content due to their caregiving and cooking responsibilities, while men prioritized cost-efficiency in infrastructure requirements. Guided by the BCD framework and a gender-transformative framework, researchers co-developed a campaign concept with stakeholders that addressed these differing motivations and where possible, avoided reinforcing traditional gender roles. The findings highlight the value of integrating gender considerations into behavioural interventions to promote equitable and sustainable access to safe water, with potential applicability to other sectors