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Knowledge, Attitude, and the Practice in Nosocomial Infection Control Among Afghan Healthcare Workers in Herat Afghanistan: A Cross-Sectional Study.
Get PDFBACKGROUND: Hospital-acquired infections (HIAs) remain a major threat to patient and healthcare worker (HCW) safety globally, with higher burden in low-resource settings. Despite moderate knowledge among HCWs in many low-income contexts, actual adherence to infection prevention practices is often poor. In Afghanistan, reductions in trained personnel and recurrent shortages of infection prevention supplies have further weakened routine infection control capacity. Evidence from the country is limited and data from western Afghanistan are lacking. This study assessed knowledge, attitude, and practice (KAP) regarding nosocomial infection control among HCWs in Herat.
METHODS: A cross-sectional study of 433 HCWs in 14 Herat health facilities used a self-administered, validated Persian KAP questionnaire to assess KAP toward nosocomial infection control; data were analyzed with SPSS 27 using descriptive statistics, chi-square tests, and logistic regression.
RESULTS: A total of 433 HCWs participated (mean age 27.35 ± 6.16 years; 52.9% female). The overall median KAP scores were 53.8%, 76.9%, and 32.3%, respectively, revealing a substantial knowledge-practice gap. Higher knowledge was significantly associated with older age, higher education, being a doctor, longer experience, and employment in private hospitals (p < 0.05). Positive attitude was more common among females, married participants, those with advanced education, longer working hours, and private sector staff (p < 0.05). Better practice was observed among single participants and those working ≤ 8 h per day (p = 0.024). Multivariate analysis showed that Bachelor's/MD degree, medical profession, and official or volunteer status independently predicted higher knowledge; female gender, lower economic status, and working in private hospitals predicted higher attitude; while shorter working hours predicted higher practice (p < 0.05).
CONCLUSION: HCWs in Herat, Afghanistan, exhibited moderate knowledge and positive attitudes toward nosocomial infection prevention, but adherence to infection control practices was low. Professional role, education, experience, training, and workload significantly influenced KAP, highlighting the combined impact of individual competencies and institutional factors. Strengthening infection control requires coordinated policies, adequate resources, hands-on training, and workload management to bridge the knowledge-practice gap, reduce nosocomial infections, and improve patient safety
Economic burden of typhoid fever by antimicrobial resistance in India: a modelling study 2023
Get PDFBackground: Typhoid fever and rising antimicrobial resistance contribute towards substantial morbidity in India. Introduction of typhoid conjugate vaccine in national immunisation schedule is under consideration to address this growing disease burden. In this study we estimated the economic burden of typhoid fever for 2023, disaggregated by age, provincial states of India, and fluoroquinolone resistance, from societal and government perspectives, to support national vaccination policy.
Methods: We developed a decision-tree model using Indian empirical data on typhoid epidemiology, care-seeking, clinical outcomes, and estimated direct and indirect costs for hospitalised and non-hospitalised typhoid fever patients. To reflect age-specific uncertainty in hospitalisation patterns and resulting economic burden, we used two primary scenarios. We estimated productivity losses due to premature mortality using the human capital approach, with the friction-cost approach as an alternative. We assessed uncertainty through probabilistic sensitivity analysis.
Findings: The economic burden of typhoid fever in India in 2023 was estimated at INR 123.0 billion (95% UI 76.7–215.5; US 157 million, 80–326) to the public health system (government perspective). Fluoroquinolone-resistant infections accounted for 87% of total costs. Children under ten years of age incurred the highest economic burden, contributing over half of the total costs. Households bore 91% of expenses, and 70,000 families faced catastrophic health expenditure. Maharashtra, Uttar Pradesh, Andhra Pradesh (including Telangana), Tamil Nadu, and West Bengal were the states estimated to account for 51% of the national costs. Productivity loss was INR 42.6 billion (15.7–111.1; US$ 515 million) based on the human capital approach and declined by 99.8% under the friction-cost approach.
Interpretation: Typhoid fever imposes a significant economic burden in India, shaped by fluoroquinolone resistance, children less than ten years of age, and high-burden provincial states of the country, resulting in considerable household financial strain. Our findings provide key evidence to support the introduction of the typhoid conjugate vaccine, enhance antimicrobial resistance control, and guide national health financing policies.
Funding: WISE programme; International Vaccine Institute; Vaccine Impact Modelling Consortium; Japan Agency for Medical Research and Development
Effective coverage practice in Ethiopia.
Get PDFEffective coverage measurement has emerged as a tool to help understand health system performance for the provision of high-quality health care. Using a cascade approach that combines data on demand- and supply-side steps, effective coverage measures highlight where gaps in the health system exist and how improvements might be made so that more people benefit from the potential of the health services available to them. In practice, however, there are challenges in making this work. This analysis paper aimed to highlight those challenges in calculating effective coverage in Ethiopia, using antenatal care as a test case, and propose a solution.In Ethiopia, government leaders are committed to taking a data-informed approach to improving health care quality. To support this, an effective coverage technical working group was formed of individuals with experience of effective coverage analysis in Ethiopia to share knowledge and create learning for a way forward.Through methods analysis of one common indicator, the effective coverage of antenatal care, four key challenges were identified by the group: (1) features of the data sources used, (2) the number of cascade steps included in the effective coverage calculations, (3) the data elements included within cascade steps and (4) the methods applied to generate composite indicators.Multiple small differences were observed to have an influence on the usability of effective coverage measures for decision-making. The group concluded that greater transparency in reporting effective coverage measures was urgently needed and proposed and discussed the use of a reporting checklist for this purpose
Breast Cancer in Cape Verde: Clinical-Molecular Profile and Impact of an International Treatment Partnership.
Get PDFPURPOSE: Breast cancer (BC) is becoming a significant public health issue in Cape Verde. Understanding the profile of BC cases is crucial for improving patient outcomes and guiding public health initiatives. This study aimed to investigate the clinical and pathologic characteristics, treatment approaches, and outcomes of BC cases diagnosed and treated at Agostinho Neto University Hospital between January 2015 and July 2021 following implementation of an international treatment partnership. METHODS: A retrospective analysis was conducted on 158 female patients with BC diagnosed during the study period. Data were collected on patient demographics, tumor characteristics, treatment protocols, and survival outcomes. Immunohistochemistry was performed on a subset of 114 patients to identify molecular subtypes. Descriptive statistics were used to summarize all variables. Overall survival was analyzed, and log-rank tests were performed to formally compare the survival curves and assess the statistical significance of any observed differences. Cox proportional hazard models were used to determine the independent effect of sociodemographic factors and clinical characteristics. RESULTS: The median age at diagnosis was 52.5 years, with patients ranging from 28 to 91 years. Most patients resided on Santiago Island. Invasive ductal carcinoma was the most common type, found in 93% of cases. Over half of the tumors were poorly differentiated, and 57% were diagnosed at advanced stages (III and IV). Subtype distribution mirrored sub-Saharan patterns, with 24% triple negative and 11% human epidermal growth factor receptor 2 positive. Among patients with potentially curable BC, 61.4% received adequate therapy that followed the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA), including radiotherapy treatment, although this was performed abroad. The median follow-up calculated by reverse Kaplan-Meier was 33.7 months (IQR, 20.5-52.8 months). Patients treated according to stage-appropriate and phenotype-specific recommendations achieved better outcomes (79.9% 3-year survival). CONCLUSION: This study emphasizes the importance of early diagnosis and adoption of the NCCN Harmonized Guidelines for SSA. Access to radiotherapy abroad, necessitated by the absence of local radiotherapy facilities, was correlated with improved survival. These findings underscore the feasibility of improving outcomes in low-resource settings through standardized treatment frameworks
Impact of federated data with local differential privacy for human mobility modeling
Get PDFAbstract
With increasing awareness of the privacy risks posed by mobile phone location data, researchers need ways to use mobility data while offering stronger privacy guarantees to the individuals included in this data. A promising approach to this challenge is the creation of privacy-preserving mobility insights from decentralized location data using Local Differential Privacy (LDP). However, mobility data generated with LDP, based on the introduction of noise by individual mobile devices, is limited by the volume of noise required to achieve individual privacy. In this paper, we provide a fully reproducible model of the accuracy of mobility networks generated with LDP compared to mobility network data generated with more traditional privacy mechanisms: Central Differential Privacy (CDP) and K-anonymity. Using a simulated mobile phone mobility dataset informed by real-world travel patterns in the USA, we explore the trade-off between privacy and data utility provided by different parameters in a federated system with LDP. We also explore the impact of spatial and temporal aggregation on data accuracy, showing that long-standing considerations regarding the appropriate units of analysis for geographic data play a key role in determining the utility of federated mobility data with LDP. Our paper facilitates an in-depth understanding of the trade-offs between privacy and data utility entailed by the future adoption of a federated approach which uses LDP to generate insights from decentralized mobility data
Understanding the development and analyzing the implementation of the Tokyo 2020 and Beijing 2022 Playbooks to mitigate COVID-19 spread: recommendations for future Games.
No full textObjectives: To examine how decision-makers managed the planning process of the Tokyo 2020 and Beijing 2022 Olympic Games, identifying challenges and lessons from planning events during a respiratory pandemic.
Design:Multi-method qualitative case study.
Methods: This study conducted a document review of Olympic Playbooks, which outline the COVID-19 countermeasures for Tokyo 2020 and Beijing 2022, and key informant interviews with 12 participants who were directly involved in planning one or both Games. Findings were analyzed using inductive and deductive coding strategies.
Results: Content analysis of the Olympic Playbooks highlighted mitigation strategies and measures such as bubble approaches, regular testing programs, quarantine and isolation measures, masking and vaccination. Analysis of interviews identified four themes that represent challenges encountered during the development and implementation of the Playbooks for Tokyo 2020 and Beijing 2022. Themes include navigating complexities of multi-stakeholder environments; ensuring feasibility and equity; responding to uncertainty and opposition; and strengthening operational systems for the event and within the host country. These themes reflect the complexities of organizing a global mass gathering during a respiratory pandemic and contribute to the overarching theme of negotiating public health priorities amid uncertainty and complexity.
Conclusions: Synthesizing insights based on individual experiences from high-profile events such as the Olympics provides a unique perspective into balancing the requirements for hosting mass gatherings under normal conditions and under epidemic or pandemic contexts. Findings highlighted the importance of evidence-informed planning, transparent decision-making, sustained stakeholder engagement and investing in operational data and surveillance systems
Intravenous iron for anaemia in pregnancy: A quantitative study of acceptability and feasibility of its integration into routine antenatal care practice in Nigeria.
Get PDFBACKGROUND: Anaemia in pregnancy (AIP), defined as a haemoglobin concentration of less than 11g/dl, is a significant global health issue, especially in resource-constrained settings. Of all the causes of AIP, iron deficiency anaemia is the commonest, accounting for approximately half of cases. While oral iron treatment is standard according to the WHO recommendation, poor adherence is a concern. Intravenous (IV) iron is an alternative treatment, especially in cases where oral iron is challenging to utilise. However, this intervention is yet to be integrated into routine antenatal care. This study aimed to assess skilled health personnels' (SHPs) perceptions of the acceptability and feasibility of IV iron in managing AIP in Lagos and Kano based on SHP characteristics and changes over time. METHODS: This was a repeated cross-sectional study embedded within a randomised controlled trial (RCT) conducted in 11 healthcare facilities in Lagos and Kano states, Nigeria. All SHPs trained in implementing IV iron were invited to participate in the study. Data were collected using the Acceptability and Feasibility of Intervention measure (AIM and FIM) survey tools between the RCT baseline in August 2021 and the endline in May 2023. Analysis was done using descriptive statistics, independent and Paired T-tests and Analysis of variance (ANOVA) in Stata. RESULTS: Of the 60 SHPs invited at baseline (pre-implementation), 53 (88%) completed the survey. At endline (post-implementation), 39 of the 46 SHPs involved in IV iron implementation responded (85%). When comparing groups, baseline AIM scores differed significantly by state (p = 0.001), though this was not sustained at endline. No other significant differences were seen by cadre or facility for AIM, and FIM did not differ significantly by state, cadre, or facility at either time point. Among the 20 SHPs who completed both surveys, the AIM score increased from baseline 16.8/20 (Standard deviation, SD = 2.0) to endline (18.5, SD = 2.0) (p = 0.002). FIM scores also increased over time, 17.1/20 (SD = 2.3) versus 18.2/20 (SD = 1.7) (p = 0.088). CONCLUSION: Post-implementation, IV iron was perceived as highly acceptable and feasible with no differences across cadre, state, or facility levels. While acceptability significantly improved over time, feasibility also increased, though not statistically significantly at the 0.05 level
Reduction in overtreatment of gonorrhoea and chlamydia through point-of-care testing compared with syndromic management for vaginal discharge: a modelling study for Zimbabwe.
No full textBACKGROUND: Zimbabwe's national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea (Neisseria gonorrhoeae (NG)), chlamydia (Chlamydia trachomatis (CT)), trichomoniasis (Trichomonas vaginalis (TV)) and bacterial vaginosis (BV). The performance of this approach depends on its clinical interpretation and implementation. Here, we investigate the potential relative impact of an NG/CT/TV point-of-care (POC) test on undertreatment, overtreatment and disease burden in the context of different implementations of syndromic management of women with VDS.
METHODS: We created an agent-based model with an age- and risk-stratified sexual network and modelled co-circulation of NG, CT and TV along with HIV and BV. We estimated symptomatic proportions and care-seeking rates under three different scenarios around the implementation of treatment guidelines, corresponding to all, most or half of women being treated for NG+CT upon presentation with VDS. For each implementation scenario, we estimated disease burden and over/undertreatment rates assuming continuation of the standard of care with/without a POC NG/CT/TV test available over 2027-2040.
RESULTS: Under a treat-all interpretation of the syndromic management guidelines, we estimate that 70%-80% of antibiotics for NG/CT would currently be given to women without these infections. Overtreatment would fall to less than 5% if a sensitive POC test for NG/CT/TV were available. However, if the implementation of the guidelines implies that only half of women seeking care for VDS are treated, then a POC test would also reduce undertreatment and disease burden, with >500 000 additional women correctly treated for NG and ~1.5 million correctly treated for CT and TV, and 24%/15% reductions in the number of women with NG/CT by 2040.
CONCLUSION: Improved data on the functioning of syndromic management in practice would help refine the estimates of the health impact and the overall value proposition of a highly sensitive POC diagnostic for NG/CT/TV. However, even without such data, our analysis demonstrates the potential for such a diagnostic to reduce overtreatment by >90% relative to plausible assumptions regarding the standard of care
Is nitazene-related mortality underestimated? Findings from an in vivo and ex vivo rat study and pharmacoepidemiological analysis of coroner-reported deaths.
Get PDFINTRODUCTION: Nitazenes are potent synthetic opioids. Following reports questioning their post-mortem stability, nitazene-related deaths may have been underestimated in the United Kingdom. We investigated this using a rat model and regional coronial data, and also present national pharmacoepidemiologic trends in nitazene-related deaths.
METHOD: In vivo/ex vivo study: Anaesthetised Wistar rats (n = 12) received intravenous nitazene (metonitazene, N-desethyl isotonitazene, or N-pyrrolidino etonitazene). Rats were euthanised 15 min post-administration if cardiorespiratory arrest had not already occurred (n = 8). Blood and urine were collected, with repeat blood samples taken following cadaver refrigeration (4 °C) for one week. All samples were immediately frozen (-80 °C). Upon defrosting, half were analysed immediately by liquid chromatography tandem mass spectroscopy with half stored at 4 °C for 1 month before analysis.
PHARMACOEPIDEMIOLOGY: Nitazene deaths were extracted from the National Programme on Substance Use Mortality in March 2025 along with all deaths from the Birmingham & Solihull coronial area (2019-2023). Descriptive analyses were conducted along with exponential smoothing models to compare observed and forecasted deaths in Birmingham & Solihull in 2023.
RESULTS: In vivo/ex vivo study: A small fraction of the nitazene detected in the immediate post-mortem blood sample remained in the post-mortem day 7 blood sample that had been refrigerated for 1 month.
PHARMACOEPIDEMIOLOGY: In Birmingham and Solihull, non-nitazene drug deaths rose 33% in 2023 compared to 2019-2022 (predicted n = 107, actual n = 142). By March 2025, 285 deaths with nitazene detections were reported to the National Programme on Substance Use Mortality, with small clusters in 2021 (n = 23) and 2022 (n = 15) before markedly increasing in 2023 (n = 131). Twelve nitazenes were detected with the predominant nitazene shifting over time (2021: isotonitazene; 2022: N-pyrrolidino etonitazene; 2023: N-desethyl isotonitazene). Coroners deemed nitazenes causative in 90% of cases (n = 256/285).
CONCLUSIONS: Nitazene-related deaths have increased in England, Wales, and Northern Ireland, and may have been underestimated due to post-mortem instability. Urgent public health action is required to reduce nitazene-related harms
Management of People with Asthma in Primary Care by Smoking Status: A Cohort Study
Get PDFBackground: Previous studies suggest that cigarette smokers with chronic respiratory disease may be managed differently. However, evidence is limited on whether smoking status impacts asthma management.
Methods: Data from the UK Clinical Practice Research Datalink (CPRD) Aurum were used to define a cohort of adults (aged over 18) diagnosed with asthma between January 1, 2010, and March 31, 2021. Start of follow-up was defined at first recorded asthma diagnosis. End of follow-up was March 31, 2021, or earlier if patients died or left the general practice. The exposure was the most recently recorded cigarette smoking status prior to asthma diagnosis, categorised as never, ex, or current smokers. Two outcome measures were used to assess asthma management: i) a record of at least one inhaled corticosteroid (ICS) prescription in the first year of follow-up and ii) asthma annual review visits over the follow-up period. Logistic and negative binomial regression models were applied, respectively, adjusting for potential confounders. An interaction with sex was tested to account for differences in asthma management in males and females.
Results: Among 241,624 adults with asthma (59.6% female, mean age 50.8), current smokers were less likely to receive ICS than never smokers (OR 0.94, 95% CI 0.91–0.96), while ex-smokers were more likely (OR 1.09, 95% CI 1.07–1.11). A sex interaction showed males were less likely to receive ICS than females among never smokers. Current smokers also had lower annual review rates (IRR 0.83, 95% CI 0.82–0.84), whereas ex-smokers had rates similar to never smokers (IRR 0.99, 95% CI 0.98–1.00). Males had lower review rates than females among never smokers only.
Conclusion: Cigarette smoking status influences asthma management. Findings highlight the importance of considering smoking status in planning and tailoring asthma care