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The disproportionate toll of the COVID-19 pandemic on social trust in low- and middle-income countries
Get PDFHorizontal trust, which emerges from interdependence and shared values and norms among people of comparable social status, has been considered a crucial driver of individual health-protective behaviors and community resilience during health emergencies. However, recent data suggest the global decline in community resilience and its disproportionate impact on low- and middle-income countries (LMICs). To assess this empirically, we examined the difference in the degree of social trust, which was measured as trust in neighbors, in 94 countries between 2018 and 2020. The study dataset combined a global survey from the Wellcome Global Monitor and other country-level measures from Google Mobility Reports, the Johns Hopkins University’s COVID-19 Tracker, the United Nations, and the World Bank. Using a multilevel regression with post-stratification weights, we estimated that the global average decline in trust in neighbors until the early stage of the pandemic was 6 percentage points. This impact was disproportionately harsher for LMICs, causing the most salient drop of 17 percentage points among low-income countries, however, it was comparable among high- and middle-upper income countries. This finding implies a hightened degree of global disparities in social capital between LMICs and wealthier countries since the pandemic and calls for international collaboration and support to help LMICs address these additional social and economic burdens
Early-life gut microbiome associates with positive vaccine take and shedding in neonatal schedule of the human neonatal rotavirus vaccine RV3-BB.
Get PDFRotavirus vaccines are less effective in high mortality regions. A rotavirus vaccine administered at birth may overcome challenges to vaccine uptake posed by a complex gut microbiome. We investigated the association between the microbiome and vaccine responses following RV3-BB vaccine (G3P[6]) administered in a neonatal schedule (dose 1: 0-5 days), or infant schedule (dose 1: 6-8 weeks) in Indonesia (Phase 2b efficacy study) (n = 478 samples/193 infants) (ACTRN12612001282875) and in Malawi (Immunigenicity study) (n = 355 samples/186 infants) (NCT03483116). Vaccine responses assessed using anti-rotavirus IgA seroconversion (IgA), stool shedding of vaccine virus and vaccine take (IgA seroconversion and/or shedding). Here we report, high alpha diversity, beta diversity differences and high abundance of Bacteroides is associated with positive vaccine take and shedding following RV3-BB administered in the neonatal schedule, but not with IgA seroconversion, or in the infant schedule. Higher alpha diversity was associated with shedding after three doses of RV3-BB in the neonatal schedule compared to non-shedders, or the placebo group. High abundance of Streptococcus and Staphylococcus is associated with no shedding in the neonatal schedule group. RV3-BB vaccine administered in a neonatal schedule modulates the early microbiome environment and presents a window of opportunity to optimise protection from rotavirus disease
Genomic and functional analysis of rmp locus variants in Klebsiella pneumoniae.
Get PDFBACKGROUND: Klebsiella pneumoniae is an opportunistic pathogen and a leading cause of healthcare-associated infections in hospitals, which are frequently antimicrobial resistant (AMR). Exacerbating the public health threat posed by K. pneumoniae, some strains also harbour additional hypervirulence determinants typically acquired via mobile genetic elements such as the well-characterised large virulence plasmid KpVP-1. The rmpADC locus is considered a key virulence feature of K. pneumoniae and is associated with upregulated capsule expression and the hypermucoid phenotype, which can enhance virulence by contributing to serum resistance. Typically such strains have been susceptible to all antimicrobials besides ampicillin; however, the recent emergence of AMR hypermucoid strains is concerning. METHODS: Here, we investigate the genetic diversity, evolution, mobilisation and prevalence of rmpADC, in a dataset of 14,000 genomes from isolates of the Klebsiella pneumoniae species complex, and describe the RmST virulence typing scheme for tracking rmpADC variants for the purposes of genomic surveillance. Additionally, we examine the functionality of representatives for variants of rmpADC introduced into a mutant strain lacking its native rmpADC locus. RESULTS: The rmpADC locus was detected in 7% of the dataset, mostly from genomes of K. pneumoniae and a very small number of K. variicola and K. quasipneumoniae. Sequence variants of rmpADC grouped into five distinct lineages (rmp1, rmp2, rmp2A, rmp3 and rmp4) that corresponded to unique mobile elements, and were differentially distributed across different populations (i.e. clonal groups) of K. pneumoniae. All variants were demonstrated to produce enhanced capsule production and hypermucoviscosity. CONCLUSIONS: These results provide an overview of the diversity and evolution of a prominent K. pneumoniae virulence factor and support the idea that screening for rmpADC in K. pneumoniae isolates and genomes is valuable to monitor the emergence and spread of hypermucoid K. pneumoniae, including AMR strains
Global incidence, risk factors, and temporal trends of nasal cancer: A population-based analysis.
Get PDFBACKGROUND: Nasal cancer is a rare and fatal disease, with an incidence rate of <1 in 100,000, and a 5-year survival rate of around 30%. The study aims to investigate the worldwide disease burden, associated risk factors, and temporal incidence patterns of nasal cancer. METHODS: Data were obtained from multiple sources, including the Global Cancer Observatory, Cancer Incidence in Five Continents Plus, the Global Burden of Disease database, the World Bank, and the United Nations. The study utilized multivariable linear regression to investigate the relationship between risk factors and the incidence of nasal cancer by age for each country. Trend analysis was conducted using the joinpoint regression analysis program, and the average annual percentage change (AAPC) was calculated. The accuracy of trend estimations was assessed using the 95% confidence interval (CI). Additionally, the incidence of nasal cancer was examined by age and geographic location. RESULTS: A total of 37,674 new cases were reported in 2020 (ASR 4.2 per 1,000,000). The highest ASRs were observed in South-Eastern Asia (5.3) and Central and Eastern Europe (4.8). A number of risk factors were identified, such as higher HDI regions, higher prevalence of smoking, alcohol drinking, unhealthy dietary, and hypertension. In addition, physical inactivity was related to lower incidence. An overall decreasing trend was reported in the global population, but an increasing trend was discovered in males. CONCLUSIONS: The highest burden of nasal cancer was found in South-Eastern Asia and Central and Eastern Europe, potentially due to regional genetic factors and pollution issues. Targeted interventions are need in high-risk regions. Further studies are needed to investigate factors contributing to the increasing temporal trend of nasal cancer among the male population
Impact of long-term care insurance on medical expenditure and utilization and the comparison between different pilot schemes: evidence from China.
Get PDFOBJECTIVE: This study investigates the effect of long-term care insurance (LTCI) on medical expenditure and utilization in China and compares the effects between different pilot schemes. METHODS: We used four-wave data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018, covering 19 cities piloted by national government or local governments. We applied a staggered difference-in-differences (DID) strategy to identify the effect of LTCI. Heterogeneity tests were used to identify the effects of different pilot schemes. RESULTS: We found that LTCI implementation significantly reduces inpatient expenditure, annual inpatient visits, and monthly outpatient visits by 13.4%, 0.033, and 0.072, respectively. The effects of LTCI become more pronounced in pilot cities with government subsidies in financing or higher reimbursement ceilings. Compared to pilot schemes covering UEBMI & URRBMI program, the schemes only covering UEBMI program could significantly reduce inpatient and outpatient frequency by 0.029 and 0.069. Pilot schemes with more service items had lower outpatient frequency (β = -0.146), and pilot schemes with fewer service items had lower inpatient expenditure and frequency (β = -0.226 and β = -0.049). CONCLUSION: In general, this study found that LTCI implementation could effectively reduce the expenditure and utilization of medical services. The effects of different pilot schemes vary significantly. The results of this study further supplement the existing empirical evidence on the effect of LTCI and provide important policy implications for the future development of LTCI in China and other developing countries
Fifteen-year analysis of cervical cancer trends in Saudi Arabia.
Get PDFBACKGROUND: Incidence of invasive cervical cancer is low in Saudi Arabia, and it varies by nationality, region and stage. Understanding the trends is essential for designing interventions that align with global elimination goals. AIM: To estimate cervical cancer incidence trends by nationality, region and stage in Saudi Arabia. METHODS: In this retrospective study, we analysed data obtained from the Saudi Cancer Registry on all women (N = 3038) diagnosed with cervical cancer in Saudi Arabia from 2005 to 2019. We calculated the age-standardised incidence rates by nationality, region and stage at diagnosis using the world standard population. RESULTS: Incidence of cervical cancer varied by nationality, region and stage. Non-Saudi women had higher rates than Saudi women, while Makkah Region consistently had the highest rates, followed by Riyadh and Eastern regions. The proportion of localised-stage diagnoses increased from 24.2% in 2005 to over 40.0% in 2019, while cases with unknown stage decreased from 19.6% to 6.3%. CONCLUSION: In alignment with the global priority of eliminating cervical cancer, Saudi Arabia should intensify efforts to reduce its disease burden by ensuring equitable access to services across the cervical cancer continuum and raising awareness of the early signs and symptoms to increase early stage detection. There is a need to continuously monitor completeness and validity of cancer registry data to ensure that they are of high quality, relevant and suitable for policymaking
"As time passes, her disability becomes severe." The struggles and challenges of caring for children living with spina bifida and hydrocephalus in Uganda: perspectives from caregivers.
Get PDFPURPOSE: Spina bifida and hydrocephalus (SBH) are common neural tube defects that cause brain and spinal cord damage leading to loss of sensation, paralysis, deformities, and bladder/bowel dysfunction. Children with these conditions require substantial caregiving support. However, the specific challenges caregivers face remains poorly understood. This study explored the experiences of parents and siblings caring for a child or young adult with SBH. METHODS: Semi-structured interviews were conducted with 18 parents and 12 siblings in Central Uganda to understand their caregiving experiences. Thematic analysis was used to identify key challenges. FINDINGS: Caregivers reported significant challenges, including lack of knowledge about the condition, stigma and negative attitudes, inadequate healthcare services, lack of social support, financial strain, and difficulties managing health and hygiene. These challenges also disrupted their employment, schooling, and overall well-being. CONCLUSIONS: Caregivers face challenges such as limited resources, stigma, and financial strain, affecting both their well-being and the quality of care provided. Addressing these barriers requires improved healthcare services, greater community awareness, and enhanced social and financial support. Strengthening support systems for parents and siblings is essential to improving care and health outcomes for children. Targeted interventions are needed to better support caregivers and mitigate the burden of caregiving
Non-autoimmune, insulin-deficient diabetes in children and young adults in Africa: evidence from the Young-Onset Diabetes in sub-Saharan Africa (YODA) cross-sectional study.
Get PDFBACKGROUND: Studies of type 1 diabetes in sub-Saharan Africa have suggested that the clinical phenotype might differ from phenotypes reported elsewhere. We aimed to establish whether type 1 diabetes diagnosed in children and young adults in three countries across sub-Saharan Africa is of autoimmune origin. METHODS: In this observational, cross-sectional study, we identified participants without obesity from outpatient clinics in government and private hospitals in Cameroon, Uganda, and South Africa who were of self-reported Black African ethnicity with young-onset (age <30 years), insulin-treated, clinically diagnosed type 1 diabetes. We measured islet autoantibodies to GADA, IA-2A, and ZnT8A, and calculated a genetic risk score (GRS) for type 1 diabetes, which we compared with control populations without diabetes derived from the Uganda Genome Resource databank and other studies. Endogenous insulin secretion was assessed using plasma C-peptide. We compared findings with those for participants with self-reported Black (n=429) and White (n=2602) ancestry with type 1 diabetes from the SEARCH for Diabetes in Youth (SEARCH) study in the USA. FINDINGS: Of 1072 participants identified between Aug 28, 2019, and March 31, 2022 (Cameroon and Uganda), and Oct 3, 2007, to Sept 14, 2015 (South Africa), 894 were included in our analysis (454 [50·8%] were male and 440 [49·2%] were female): 248 participants were from Cameroon, 370 from Uganda, and 276 from South Africa. Participants from sub-Saharan Africa were diagnosed with diabetes at a median age of 15 years (IQR 11-19), with a median diabetes duration of 5 years (2-10), and a BMI of 21·7 kg/m2 (19·5-24·1). Only 312 (34·9%) of 894 participants were positive for islet autoantibodies; these participants had classic features of type 1 diabetes, including 225 (82·7%) of 272 with plasma C-peptide <200 pmol/L, and high type 1 diabetes GRS. Those without islet autoantibodies (582 [65·1%] of 894) had significantly lower median type 1 diabetes GRS than those with autoantibodies (9·66 [IQR 7·77-11·33] vs 11·76 [10·49-12·91]; p<0·0001), suggesting a subgroup with a non-autoimmune diabetes subtype, with clinical features and C-peptide concentrations not consistent with type 2 diabetes. Among participants diagnosed younger than 20 years, autoantibody-negative diabetes was also observed in 65 (15·1%) of 429 participants with Black ancestry in SEARCH (although less frequently than in sub-Saharan Africa [59 (55·1%) of 107]), and these participants also had a low type 1 diabetes GRS (median 10·41 [IQR 8·65-12·22] in autoantibody-negative subgroup). No such pattern was observed in White participants in SEARCH: 241 (9·3%) of 2602 were autoantibody negative and median GRS for type 1 diabetes was similar in autoantibody-negative and autoantibody-positive participants (median 13·42 [IQR 11·80-14·61] vs 13·49 [12·29-14·58]). INTERPRETATION: In sub-Saharan Africa, clinically diagnosed type 1 diabetes is heterogeneous, comprising classic autoimmune type 1 diabetes and a novel, non-autoimmune, insulin-deficient diabetes subtype. There is evidence of this subtype in Black but not White individuals in the USA. Therefore, alternative causes must be considered in this group of individuals, and understanding the drivers of this subtype might offer new insights into prevention and treatment. FUNDING: UK National Institute of Health and Care Research. TRANSLATION: For the French translation of the abstract see Supplementary Materials section
Prevalence of, and factors associated with oral sexual behaviours in men and women in Ibadan, Nigeria.
Get PDFBACKGROUND: Unprotected oral sex is associated with sexually transmitted infections (STIs) including HPV and associated head and neck cancers. However, many studies lack clear definitions of oral sex and there are few data from West Africa. This study assessed the pattern and prevalence of, and factors associated with oral sex among Nigerian men and women from the general population. METHODS: The Sexual Behaviours and HPV Infections in Nigerians in Ibadan (SHINI) study was a cross-sectional study conducted among men and women aged 18-45 years. Information on oral sexual behaviours was collected during a face-to-face interview by a sex-matched interviewer. Descriptive and multivariable analyses were used to analyse factors associated with oral sex in men and women. RESULTS: In total, 160/626 (26%) had ever any type of oral sex. Specifically, 78/626 (12%) had ever given and 139/626 (22%) had ever received oral sex in a heterosexual relationship. Overall, 35% (112/310) men had ever engaged in oral sex compared to women 15% (48/316 -p < 0.001). More men frequently reported ever receiving oral sex than women (33% vs. 12%; p < 0.001). There was no difference in the proportion of men and women that reported ever giving oral sex. Most (94%) participants never used any barrier protection during oral sex. Most men and women participants engaged in oral sex because of romantic relationship or being married. In the adjusted models, there was a higher odds of ever receiving oral sex (Adjusted odds ratio = AOR 4.01 95% CI 2.52-6.38) or engaging in any form of oral sex (AOR = 3.12, 95%CI 2.04-4.76) in men than women. CONCLUSION: Though, Nigerian men and women engage in oral sex in heterosexual relationship, but it is more commonly reported by men than women and most of them practiced it without barrier protection. It is recommended that sexually active men and women are counselled on risks associated with unprotected oral sex including STIs, HIV and HPV and associated cancers
HIV self-testing - the path from an innovation to a necessity.
Get PDFSelf-care and self-testing have emerged amongst the most powerful innovations and tools to advance global public health. The concept of self-testing is not new—early applications such as home-based glucose monitoring for diabetes, pregnancy tests, and cholesterol testing set the path for adoption in infectious disease [1]. The transformative potential of self-testing was demonstrated during the COVID-19 pandemic as a breakthrough enabled by lessons learned from self-testing adoption in the HIV response [2]. The HIV community led the way in pioneering diverse distribution models that expanded access, increased acceptability, promoted autonomy, and enhanced impact by embracing this empowering, person-centered approach to service delivery. Crucially, early investments in implementation research during the introduction and scale-up phase helped establish a strong and credible evidence base. In doing so, self-testing was not only normalized, but laid the groundwork for broader self-care across disease areas. These advancements would not have been possible, or available in low- and middle-income countries, without the Self-Testing Africa Initiative (STAR) [3]