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Discrepancy between active trachoma and tests of chlamydial infection in Alto Amazonas, Peru.
Get PDFBACKGROUND: Trachoma mapping in Latin America is incomplete, especially in indigenous communities of the Amazon thought to be at highest risk. The aim of this study was to determine the prevalence of clinical, microbiological, and serologic evidence of trachoma in a remote area of the Peruvian Amazon. METHODS: A population-based sample of households from rural communities in Alto Amazonas province was selected using two-stage cluster sampling. In children aged 1-9 years, conjunctival photographs, conjunctival swabs, and dried blood spots were collected. Photographs were graded for trachomatous inflammation-follicular (TF). Swabs were processed for Chlamydia trachomatis with a nucleic acid amplification test. Dried blood spots were assessed for antibody responses to C. trachomatis with a multiplex bead assay. RESULTS: A total of 778 children aged 1-9 years from 21 communities participated. The age-adjusted prevalence of TF among 1-9-year-old children was 25.4% (95%CI 21.3-29.5%), compared with 0.8% (95%CI 0.5-1.0%) for ocular C. trachomatis and 6.6% (95%CI 4.5-9.0%) for Pgp3-specific antibodies to C. trachomatis. CONCLUSIONS: This region of the Peruvian Amazon had a high burden of clinical trachoma but low levels of C. trachomatis ocular infection and seropositivity
2022-'23 Malawi rapid mortality mobile phone survey (RaMMPS) dataset.
Get PDFIn countries with limited civil registration and vital statistics systems, mortality estimates are often derived from periodic censuses and household surveys. Mobile Phone Surveys (MPS) offer a potentially cost-effective and efficient alternative for mortality monitoring. However, their utility for this purpose still requires rigorous evaluation. The Rapid Mortality Mobile Phone Surveys (RaMMPS) project aims to develop and validate methodologies for collecting mortality data through phone-based surveys. The Malawi RaMMPS fieldwork was conducted between 24 January 2022 and 28 July 2023 and included several survey modules, including respondent background characteristics, COVID-19 vaccination status, deaths in the household in the three months prior to the interview, parental survival histories, sibling survival histories, and pregnancy histories. The resulting datasets can be used for estimating mortality and assessing the impact of the COVID-19 pandemic. Survey paradata can be used for analysing respondent engagement and the data collection process in an MPS
"Basically a PR exercise…": a qualitative study of expert perspectives on 'performative versus evidence-informed' dengue vector control in the Asia-Pacific region.
Get PDFBACKGROUND: Dengue cases are increasing despite continued efforts to control its vectors, with the Asia-Pacific region projected to bear a substantial proportion of the global burden. However, literature on dengue vector control methods and evidence use in national control programmes in the region is limited. We thus aimed to explore expert perspectives on current methods and how to improve dengue vector control programmes across the region. METHODS: We conducted remote semi-structured interviews with a purposive sample of 23 dengue vector control experts with experience in the Asia-Pacific region, analysing data using an abductive thematic approach. FINDINGS: Participants indicated that monitoring, evaluation and operational research related to dengue vector control methods was deprioritised in many countries across the region and that national vector control resources were often directed to relatively inefficient yet highly visible insecticide-based methods such as adulticide fogging. They suggested additional investment in other forms of vector control, including Wolbachia-based technologies that show potential and should be tested in larger urban settings. They also noted that traditional environmental control methods such as source reduction and biocontrol were potentially the most sustainable Aedes vector control methods if conducted through better-resourced and better-evidenced community engagement approaches. CONCLUSIONS: The focus on visible and familiar methods evinces political concern for performative vector control. While understandable, refocusing national dengue vector control priorities on monitoring and evaluation/research evidence and mobilising communities can help Asia-Pacific countries improve Aedes mosquito management and therefore health outcomes
Conflict, caregiver violence and gendered parenting: A cross-sectional study among adolescent girls and young women participating in a girls' empowerment programme in Myanmar.
Get PDFAcross Myanmar, armed conflict and political instability have exacerbated poverty, food insecurity, and disrupted essential social protection services, severely affected people's health and wellbeing. This is especially pertinent for girls and young women, for whom gender inequalities are exacerbated during conflict, increasing their risk of various forms of violence. We aimed to measure the prevalence of parent/caregiver-perpetrated violence against adolescent girls across Myanmar and examine its association with exposure to conflict and gendered parenting practices following the 2021 military coup. We included 731 adolescent girls aged 10-17 years enrolled in a girls' empowerment programme, recruited from Mandalay, Yangon and Tanintharyi Regions, Shan State and Kachin State. We co-developed a cross-sectional survey tool with a team of peer-researchers, conducting it between September 2023 and January 2024. Measures included physical and psychological violence, exposure to conflict-related stressors and gendered parenting practices. Logistic regression analyses tested associations between key variables. 80.6% of participants reported psychological violence and 49.8% reported physical violence in the past year. Participants reporting 3 + conflict-related stressors were more likely to report physical violence (aOR=2.19, 95%CI = 1.24-3.89, p = 0.007), participants reporting 1-2 stressors were more likely to report psychological violence (aOR=2.04, 95%CI = 1.09-3.77, p = 0.025). Higher gendered parenting scores were associated with physical (aOR=1.06, 95% CI = 1.03-1.09, p < 0.001) and psychological violence (aOR=1.07, 95%CI = 1.03-1.10, p < 0.001). Conflict may exacerbate gendered parenting and is associated with more parent/caregiver-perpetrated violence. These findings highlight the need for interventions addressing adolescent girls' unique health and wellbeing needs in conflict-settings
A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: an international multicentre intervention study.
Get PDFBACKGROUND: Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi. METHODS: With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training. We used multivariable logistic regression and interrupted time series analysis to compare the coprimary outcomes-the percentage of patients achieving a syndromic diagnosis and the percentage achieving a microbiological diagnosis before and after the intervention. The study was registered at ClinicalTrials.gov (NCT04190303) and is complete. FINDINGS: Between Jan 5, 2021, and Nov 30, 2022, we screened 10 462 patients and enrolled a total of 2233 patients at 13 hospital sites connected to the four study centres in Brazil, India, and Malawi. 1376 (62%) were recruited before the intervention and 857 (38%) were recruited after the intervention. 2154 patients (96%) had assessment of the primary outcome (1330 [62%] patients recruited pre-intervention and 824 [38%] recruited post-intervention). The median age across centres was 23 years (IQR 6-44), with 1276 (59%) being adults aged 16 years or older and 888 (41%) children aged between 29 days and 15 years; 1264 (59%) patients were male and 890 (41%) were female. Data on race and ethnicity were not recorded. 1020 (77%) of 1320 patients received a syndromic diagnosis before the intervention, rising to 701 (86%) of 813 after the intervention (adjusted odds ratio [aOR] 1·81 [95% CI 1·40-2·34]; p<0·0001). A microbiological diagnosis was made in 294 (22%) of 1330 patients pre-intervention, increasing to 250 (30%) of 824 patients post-intervention (aOR 1·46 [95% CI 1·18-1·79]; p=0·00040). Interrupted time series analysis confirmed that these increases exceeded a modest underlying trend of improvement over time. The percentage receiving a lumbar puncture, time to appropriate therapy, and functional outcome also improved. INTERPRETATION: Diagnosis and management of patients with suspected acute brain infections improved following introduction of a simple intervention package across a diverse range of hospitals on three continents. The intervention is now being implemented in other settings as part of the WHO Meningitis Roadmap and encephalitis control initiatives. FUNDING: UK National Institute for Health and Care Research
Telehealth and people with disabilities in the United Kingdom: a scoping review.
Get PDFINTRODUCTION: Telehealth, also sometimes known as telemedicine, is the use of communication technologies to deliver healthcare remotely, has become increasingly vital, particularly since the COVID-19 pandemic. While telehealth can improve healthcare access, it may exacerbate inequities for people with disabilities. This scoping review explores the needs, experiences, and difficulties people with disabilities face when accessing telehealth services in the United Kingdom's (UK) National Health Service (NHS). METHODS: A systematic search was conducted using the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines. The search terms included variations of "telehealth," "disability," "impairment," "United Kingdom," and "NHS." Studies published after January 2010 were included if they addressed the experiences of people with disabilities when using telehealth. Ten studies met the inclusion criteria, and findings were synthesized into five key themes: patient and carer satisfaction, benefits of telehealth, healthcare provider perspectives, disability-specific barriers, and technological barriers. RESULTS: The studies highlighted varied experiences across different disabilities, telehealth technologies, and medical specialties. While patients and carers generally expressed satisfaction with telehealth's convenience and accessibility, a preference for face-to-face consultations remained. Key barriers included technological challenges such as poor internet connectivity, unfamiliarity with digital tools, and device access, as well as disability-specific challenges, particularly for sensory impairments. Reported benefits of telehealth included improved access to care and flexibility for patients with disabilities. However, healthcare provider perspectives highlighted concerns about the ability to build a rapport and perform thorough assessments remotely. CONCLUSION: Telehealth should complement traditional care through a hybrid approach. Future efforts must focus on improving technological accessibility, training healthcare providers, and co-designing solutions with patients to promote equitable healthcare access for people with disabilities
Marked Global Differences in Mortality in Male Patients with COVID-19: An Analysis of the CARDIO COVID 19-20 and WHF COVID-19 CVD Studies.
Get PDFBACKGROUND: COVID-19 has led to nearly seven million deaths and male sex has been reported as one of the main risk factors for mortality. Few studies have analyzed cohorts of male patients, especially in underrepresented regions in the medical literature, such as low and middle-income nations. To address this gap, we conducted large-scale, male-specific, multinational analyses, to improve understanding of factors associated with mortality in this high-risk population and global variations. METHODS: This is a prospective, multicenter study that includes data from the CARDIO COVID-19-20 registry and the WHF COVID-19 CVD study. A multiple Poisson regression model was performed to evaluate differences in factors associated with in-hospital mortality among male COVID-19 patients across different regions. RESULTS: We analyzed 4,899 hospitalized male COVID-19 patients from 32 countries: Africa (11.2%), the Americas (44.7%), Asia (33.8%), and Europe (10.2%). Median age was 59 years (IQR: 47-69), with 50.5% aged 40-64. ICU admission was 42.4%, and mortality was 19.2%, with marked regional differences (ranging from 6% in Europe to 26.9% in the Americas). Poisson regression showed age >80 years (aRR = 4.21) and IMV (aRR = 3.80) as the strongest factors associated with mortality. Other factors included diabetes, chronic kidney disease, myocarditis, and decompensated heart failure. Mortality risk was higher in Africa (aRR = 3.86), Asia (aRR = 2.72), and the Americas (aRR = 2.23) compared to Europe (p < 0.001). Anticoagulation/Antiplatelet therapy showed a potential correlation with survival. CONCLUSION: This study reflects the complexity of factors influencing COVID-19 mortality among male patients hospitalized with COVID-19, emphasizing global variability. The substantial differences in mortality noted across countries are likely due to differences in disease severity, comorbidities, clinical care, and health system factors. Age remains a primary risk factor, with older populations particularly vulnerable. Our findings underscore the need for targeted and tailored regional approaches to manage male COVID-19 patients
Human versus Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings (HumAn-1): protocol for a randomised controlled trial.
Get PDFINTRODUCTION: Long-acting insulin analogues are the standard of care for people with type 1 diabetes (T1D) in high-income countries but remain largely inaccessible and understudied in low-resource settings. In settings where glycaemic control is typically poor and food insecurity is common, long-acting insulin analogues may offer tangible clinical benefits for people with T1D. To determine whether insulin glargine, a long-acting insulin analogue, reduces the risk of serious hypoglycaemia and/or improves glycaemic time-in-range (TIR) versus human insulin regimens in this population, we are conducting the Human vs Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings randomised controlled trial. METHODS AND ANALYSIS: This is a 1:1 randomised, parallel-group clinical trial comparing biosimilar insulin glargine with human insulin (Neutral Protamine Hagedorn (NPH) or premixed 70/30 insulin) in 400 youth with type 1 diabetes (T1D) recruiting in Dhaka, Bangladesh (n=250) and Mwanza, Tanzania (n=150). Blinded continuous glucose monitors will be used to assess glycaemic control in both study arms over 14-day periods at baseline and at 3, 6 and 12 months after randomisation. The co-primary outcomes are the per cent time in serious hypoglycaemia (<54 mg/dL) and TIR (70-180 mg/dL) at 6 months of follow-up. Secondary outcomes include TIR at 12 months and time-in-hypoglycaemia, time-above-range, nocturnal hypoglycaemic events and glycaemic control (ie, haemoglobin A1C (HbA1c)) at 6- and 12-months of follow-up. Treatment satisfaction and quality of life are assessed at baseline, 6- and 12 month follow-up. Additionally, the study is conducting qualitative interviews, quantitative assessments of treatment satisfaction and quality of life, as well as assessing the cost-effectiveness of analogue insulin use in low-resource settings. ETHICS AND DISSEMINATION: This study was approved by the Institutional Review Board at the University of Pittsburgh (STUDY21110122), the National Health Research Ethics Committee at the National Institute for Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4265) and the Ethical Review Committee (ERC) of Diabetic Association of Bangladesh (BADAS-ERC/EC/22/405). Research findings will be shared by the local partner organisations and institutions with relevant stakeholders including youth living with diabetes, policy makers, healthcare workers and the general public. Findings will also be shared at local, regional and international scientific meetings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT05614089
Spatial distribution of Plasmodium vivax Duffy Binding Protein copy number variation and Duffy genotype, and their association with parasitemia in Ethiopia.
Get PDFBACKGROUND: Duffy Binding Protein (PvDBP) binding to the Duffy antigen receptor for chemokine (DARC) is essential for Plasmodium vivax invasion of human reticulocytes. PvDBP copy number variation (CNV) might increase parasite invasion and thus parasitemia. We examined the spatial distribution of PvDBP CNVs and DARC genotypes and their association with parasitemia in P. vivax endemic settings in Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS: P. vivax isolates (n = 435) collected from five P. vivax endemic settings in Ethiopia were genotyped by amplifying the GATA1 transcription factor-binding site of the Duffy blood group and the CNV of PvDBP was quantified. Parasitemia was determined using 18S-based qPCR. The majority of participants were Duffy positive (96.8%, 421/435). Of the few Duffy negative individuals, most (n = 8) were detected from one site (Gondar). Multiple copies of PvDBP were detected in 83% (363/435) isolates with significant differences between sites (range 60%-94%). Both heterozygous (p = 0.005) and homozygous (p = 0.006) patients were more likely to have been infected by parasites with multiple PvDBP copies than Duffy negatives. Parasitemia was higher among the Duffy positives (median 17,218 parasites/µL; interquartile range [IQR] 2,895-104,489) than Duffy negatives (170; 78-24,132, p = 0.004) as well as in infections with 2 to 3 PvDBP copies (20,468; 3,649-110,632, p = 0.001) and more than 3 PvDBP copies (17,139; 2,831-95,946, p = 0.004) than single copy (5,673; 249-76,605). CONCLUSIONS/SIGNIFICANCE: A high proportion of P. vivax infection was observed in Duffy positives in this study, yet few Duffy negatives were found infected with P. vivax. The significant prevalence of multi-copy PvDBP observed among Ethiopian P. vivax isolates explains the high prevalence and parasitemia observed in clinical cases. This suggests that vivax malaria is a public health concern in the country where the Duffy positive population predominates. Investigating the relative contribution to the maintenance of the infectious reservoir of infections with different genotyping backgrounds (both host and parasite) might be required
Antibiotic Susceptibility Patterns and Virulence Profiles of Classical and Hypervirulent Klebsiella pneumoniae Strains Isolated from Clinical Samples in Khyber Pakhtunkhwa, Pakistan.
Get PDFThe emergence of hypervirulent and carbapenem-resistant hypermucoviscous Klebsiella pneumoniae strains presents a significant public health challenge due to their increased virulence and resistance to multiple antibiotics. This study evaluates the antibiotic susceptibility patterns and virulence profiles of classical and hypervirulent K. pneumoniae strains isolated from various clinical samples. A total of 500 clinical samples were collected from patients at the Mardan Medical Complex and Ayub Medical Complex in KPK between July 2022 and June 2024. Among these, 64 K. pneumoniae strains were isolated and subsequently subjected to antimicrobial susceptibility testing (AST) and phenotypic virulence detection. Among the 64 isolates, 21 (32.8%) exhibited hypermucoviscosity, a characteristic associated with increased pathogenicity. Hemagglutination was observed in 35 (54.1%) of the isolates, indicating the presence of surface adhesins that facilitate bacterial adherence to host tissues. A high prevalence of biofilm formation was noted, with 54 (84%) isolates capable of forming biofilms, which are known to protect bacteria from antibiotics and the host immune response. Most isolates (59/64, 92.1%) were resistant against ampicillin, highlighting its limited efficacy against these strains. Conversely, the lowest resistance was observed for tigecycline, with only 15% (10/64) of the isolates showing resistance, indicating its potential utility as a treatment option. The study also found that 38 (59.3%) of the isolates were extended-spectrum beta-lactamase (ESBL) producers, 42 (65.6%) were multidrug-resistant (MDR), 32 (50%) were extensively drug-resistant (XDR), and 13 (20.3%) were resistant to carbapenems. The genetic study revealed biofilm producer and enhancer genes (mrkD, pgaABCD, fimH, treC, wzc, pilQ, and luxS) mainly in the hypervirulent strains. These hypervirulent strains also show a high number of resistance genes. The findings of this study underscore the critical need for the active surveillance of antimicrobial resistance and virulence determinants in K. pneumoniae. The coexistence of high levels of antibiotic resistance and virulence factors in these isolates poses a severe threat to public health, as it can lead to difficult-to-treat infections and increased morbidity and mortality