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Seroprevalence of antibodies against diphtheria, tetanus, and pertussis over a 12-year period in children in Kilifi, Kenya (2009-2021).
Full text linkOBJECTIVES: In Kilifi, pentavalent coverage remains below the 90% target, with no reported diphtheria or tetanus cases and sporadic pertussis. However, absence of disease does not guarantee immunity. To characterize age-specific gaps and waning protection not captured by routine surveillance, we conducted serial seroprevalence studies of diphtheria, pertussis, and tetanus. METHODS: We analyzed randomly selected participants from multiple cross-sectional surveys within the Kilifi Health and Demographic Surveillance System. Immunoglobulin G antibodies were measured using a fluorescent bead-based multiplex immunoassay applying protective thresholds ≥0.011 IU/ml for diphtheria and tetanus. Pertussis antibodies were grouped by time since infection. Bayesian multilevel regression with post-stratification adjusted estimates for population structure and assay performance; associations with age and year were assessed using logistic regression. RESULTS: Diphtheria seroprotection was low; only 5% of children had long-term seroprotection, with full protection ranging from 11% to 34% and minimal seroprotection from 40% to 52%. Minimal seroprotection increased over time (τ = 0.68, P = 0.04). Tetanus protection was higher, with long-term seroprotection ranging from 10% to 39% and susceptibility <1%; trends were not significant. Older age was associated with lower seroprevalence. Among adults, <1% had long-term diphtheria seroprotection vs 36% for tetanus. Pertussis circulation was minimal, with 5% of children and <1% of adults, with antibody concentrations consistent with recent infection. CONCLUSIONS: Although conventional serological thresholds suggest immunity gaps, particularly, for diphtheria, no diphtheria or tetanus outbreaks have occurred in Kilifi over the past decade. This indicates that antibody concentrations below standard thresholds may not equate to immediate susceptibility, but they do reflect a narrower margin of population immunity. Although this has not yet translated into disease, it could become relevant if transmission conditions change, underscoring the need to sustain high vaccination coverage and sensitive surveillance. Serology should, therefore, be viewed as a complementary tool, useful for tracking emerging vulnerability and informing future booster decisions if susceptibility increases
The Use of Puppetry-Based Approaches in Dental and Oral Health Promotion for Children: A Scoping Review of Interventions.
No full textBACKGROUND: Puppetry is a well-established three-dimensional art form of media that has been commonly utilized to tell stories and communicate messages. Its application in educational entertainment has become widespread and gained recognition. AIM: This scoping review aimed to explore puppetry-based approaches in promoting dental and oral health for children. METHODS: A comprehensive search of eight databases was conducted using PRISMA-ScR guidelines, focusing on studies published up to August 2024. RESULTS: Ten studies were included in the review. A game-centered educational approach significantly enhanced children's dental knowledge and skills. Human models with mirror feedback were most effective, while giant tooth-brushing models and animal puppets had the lowest imitation rates. Puppet theater improved urban preschoolers' oral health but had no effect on rural children. Hand puppets, pop-up books, and animated videos significantly enhanced toothbrushing skills. Storytelling with hand puppets improved knowledge and attitude more than role-playing. Puppet shows and animated videos yielded notable posttest improvements in oral health knowledge and skills. CONCLUSION: Puppetry-based education appears to be an effective strategy for improving oral health knowledge, attitudes, and behaviors among children, particularly in school and clinical settings
Effective care for mothers and their babies during humanitarian crises.
Full text linkAlthough global maternal and neonatal mortality have declined over recent decades, progress has stalled in contexts affected by conflict, fragility and displacement.(1–3) The 29 countries with United Nations humanitarian responseplans or flash appeals at the start of 2025 accounted for slightly less than one third of global births but contributed an estimated 58% of maternal deaths, 41% of stillbirths and 39% of newborn deaths. (2–4) These figures likely underestimate the burden in acute crises, where data are usually scarce
Patterns of care and outcomes following external ventricular drain placement: Insights from the England HES administrative data set
Full text linkObjectives: To evaluate the outcomes of patients undergoing external ventricular drain (EVD) insertion in England, focusing on the timing of EVD relative to index neurosurgical procedures, and to assess the implications for benchmarking and performance monitoring between neurosurgical centres.
Methods: We conducted a retrospective cohort study using Hospital Episode Statistics. Adult patients (≥16 years) undergoing EVD insertion between April 2013 and March 2020. Outcomes included 90-day mortality, length of stay (LOS), and emergency readmission within 30 days. Multivariable logistic regression was used for mortality and readmission, with adjustment for age, admission method, comorbidity (RCS Charlson index), and neurosurgical clinical category. A quantile regression model was performed with LOS as the outcome.
Results: The cohort comprised 10,239 patients. Crude 90-day mortality was 26.7 % overall, highest in the EVD-only group (43.2 %) and lowest when EVD was performed with an index procedure (19.7 %). Mortality rose with age, comorbidity, emergency admission, and was highest in Oncology, Vascular, and General & Trauma categories. The final risk-adjustment model showed good discrimination (AUC 0.71) and reduced apparent inter-unit variation in mortality.
Conclusions: Our findings demonstrate that treating all EVD insertions as a single cohort obscures clinically meaningful differences in patient trajectories and leads to misleading comparisons of outcomes. Although the absence of detailed severity markers in administrative data means that conclusions about quality of care must be interpreted cautiously, this study illustrates how carefully constructed, clinically meaningful cohorts can transform the interpretation of common neurosurgical procedures
Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya: an embedded, pragmatic, individual-level, randomised, controlled, adaptive platform trial.
Full text linkBACKGROUND: In Meru county, Kenya, only 46% of people identified with an eye problem during screening go on to access eye care services at local clinics, with younger adults (aged 18-44 years) being the least likely to receive eye care. This study aimed to test whether provision of additional information was associated with better access to eye services, compared with standard care. METHODS: We developed enhanced counselling and SMS reminders with lay input and tested this bundled intervention against standard care using a pragmatic, two-arm, open-label, randomised controlled trial, embedded within Meru's ongoing eye screening programme. All consenting referred adults were enrolled. The primary outcome was the proportion of referred younger adults who accessed their local clinic following referral. We used Bayesian methods and Monte Carlo simulations to generate the posterior probability distribution of the effect difference between the groups every 7 days. Participants were continually recruited until one of two stopping rules were met: there was a greater than 95% probability that either one group was more effective (stopping for superiority), or that the difference between the groups was less than 1% (stopping for equivalence). This completed trial was registered with ISRCTN (11329596). FINDINGS: The trial ran from May 21 to June 20, 2024. A total of 7356 individuals had been screened and referred. Of these, 2321 consented to participate and were randomly assigned to a group (1140 in the control group and 1181 in the intervention group). All 2321 participants had complete follow-up data (ie, 14 days had elapsed since their appointment date). Our testing algorithm stopped the trial after 30 days based on analysis of outcome data from 879 younger adults. 147 (32·1%) of 458 younger adults in the control group had accessed care versus 164 (39·0%) of 421 younger adults in the intervention group, resulting in a 98·6% posterior probability that the intervention group was superior among younger adults. INTERPRETATION: This trial found evidence that an intervention bundle with enhanced counselling and SMS reminders, as suggested by an underserved population, increased access to care. This embedded, adaptive, equity-focused approach has broad applications, aligned with the principle of proportionate universalism. FUNDING: National Institute for Health Research (NIHR; using the UK's Official Development Assistance funding) and NIHR-Wellcome Partnership for Global Health Research. TRANSLATION: For the Swahili translation of the abstract see Supplementary Materials section
Perceptions of academic leaders in low- and middle-income countries about the role of WFME in enhancing the quality of medical education
Full text linkDespite the significant proportion of medical schools located in low- and middle-income countries (LMICs), little is known about how educational leaders in these contexts perceive various roles of the World Federation for Medical Education (WFME) and its connection with the Educational Commission for Foreign Medical Graduates (ECFMG). This article aims to explore how the role of WFME is perceived by medical educators and accrediting body members in LMICs, including WFME Standards for Basic Medical Education (SBME), the recognition programme, and the challenges and motivations in adopting SBME and seeking WFME recognition. This qualitative study employed semi-structured interviews with ten senior medical educationalists and members of national accreditation bodies from Pakistan, Sri Lanka, the Philippines, and Indonesia. Thematic analysis was conducted using an inductive approach to identify key themes regarding perceptions of WFME as an organization, its recognition programme, and its standards. Eleven themes emerged from the analysis, the most prominent of which was a considerable conceptual uncertainty about WFME’s role and authority among participants. The relationship between WFME and ECFMG was frequently misunderstood, with recognition often viewed primarily as a mechanism to facilitate graduate mobility rather than to improve educational quality. While WFME standards were perceived as sufficiently broad to allow contextual adaptation, participants identified significant challenges including resource constraints and political pressures when implementing standards and pursuing recognition. This study demonstrates that the pursuit of WFME recognition by accreditation agencies in LMICs appears to be driven more by external pressures than by conviction about its intrinsic value for quality improvement. Greater clarity about WFME’s role, improved communication about the recognition process, and more explicit attention to the needs and contexts of LMICs could enhance the relevance and impact of these global medical education initiatives
Robust mission-driven responses to infectious disease threats delivered by the Abbott pandemic defense coalition.
Full text linkOBJECTIVES: Emerging infectious disease outbreaks present a continuous threat globally, and enhanced capacity to detect and mitigate these pathogens is urgently needed.
DESIGN: The Abbott Pandemic Defense Coalition (APDC) launched in 2021 as a first of its kind global public-private partnership dedicated to early detection, characterization, and response to emerging disease threats with the mission to reduce the burden of existing epidemics and the risk of future pandemics. The APDC has the capacity to both detect emerging infectious agents and respond by rapidly developing and deploying prototype diagnostics to assist in assessing the magnitude of the threat.
RESULTS: To date, the APDC network, with sites on 5 continents, has evaluated over 39,000 specimens from enrolled patients leading to the identification and characterization of 6 outbreaks and 23 previously unknown viruses that affect humans. The network has also trained 128 scientists in epidemiology, diagnostics, sequencing, and bioinformatics. As a result, the APDC has published 113 manuscripts, which are highlighted herein.
CONCLUSIONS: As emerging pathogens present increasing challenges to public health in a closely connected global community, the APDC is uniquely positioned to continue to serve a key role in pandemic preparedness
Empirical Comparison of Exposure Set Definitions in the Prevalent New‐User Design
Full text linkABSTRACT
Purpose
Prevalent new‐user (PNU) designs aim to provide a wider assessment of treatment effects by incorporating users of a newer study drug who previously received the comparator. Similarity in terms of prior use of the comparator is accounted for via exposure sets based on time in study, prior prescription number, or a hybrid incorporating both plus calendar time. Given a current lack of consensus, we examine choice of exposure set definition using a study investigating upper gastrointestinal bleeding (UGIB) risk between users of non‐steroidal anti‐inflammatory drugs (NSAIDs) and cyclooxygenase‐2 inhibitors (COX‐2is).
Methods
We identified a cohort of individuals with osteoarthritis initiating NSAIDs or COX‐2is between 2000 and 2004 from the UK Clinical Practice Research Datalink. Considering prescription‐based, time‐based, and hybrid exposure set definitions, we estimated time‐conditional propensity scores (TCPS) using conditional logistic regression and matched COX‐2i users 1:1 to NSAID users. Analyses estimated the hazard ratio (HR) of UGIB bleed comparing COX‐2i and NSAID users overall, in the incident new‐user and prevalent new‐user subgroups.
Results
We identified 100 185 individuals who received a prescription for either COX‐2is or NSAIDs; 25 742 patients were incident new‐users of COX‐2is and 17 952 were PNUs. Prescription‐ and time‐based exposure sets resulted in the highest proportion of COX‐2i users successfully matched (86% vs. 76% using hybrid definition). We observed variability in the point estimates obtained under the different exposure set definitions; however, conclusions remained consistent.
Conclusions
Given the potential for differences in the matched cohorts and substantive results obtained under different exposure set definitions, we encourage increased use of sensitivity analyses in PNU studies to explore the robustness of results to this decision
Examining the effects of climate and environmental hazards on vector and water-borne diseases in Eastern Uganda.
Full text linkBACKGROUND: Environmental hazards like floods, droughts and landslides pose serious public health and wellbeing consequences for populations, especially vulnerable communities in countries with low adaptive capacity. Empirical evidence from peer-reviewed literature and official climate change assessments indicates that, alongside high interannual climate variability, Uganda has experienced observable climate change over the past 50 years. This changing and increasingly variable climate poses challenges to population health in diverse ways, including through the transmission of infectious diseases. This study explored local perceptions of the impact of climate variability and change on the prevalence of infectious diseases like typhoid fever, malaria, and diarrhoeal diseases in three districts: Amudat, Bududa, and Katakwi in Eastern Uganda. Relatively few integrated and empirical studies have been conducted in Uganda to assess the specific climate-related health risks faced by local communities.
METHODS: A cross-sectional survey of 341 respondents was conducted to collect data from households. Data were collected using Kobo software, exported, cleaned and analysed with SPSS 28.0.
RESULTS: Populations in the three study districts perceived drought, floods, and landslides as significant hazards, though with varying levels of exposure, frequency, and severity. Strong associations were found between environmental hazards and occurrences of infectious diseases. Floods, significantly increased the reported prevalence of malaria (Chi-Square = 12.901, p 0.242) or typhoid fever (Chi-Square = 4.739, p > 0.192). Landslides were significantly associated with diarrheal diseases (Chi-Square = 7.846, p 0.457) or typhoid fever (Chi-Square = 3.277, p > 0.351). Most respondents experienced the negative interactive effects of multiple environmental hazards on their health status. The increased prevalence of diarrhea was attributable to floods, drought, and landslides; cases of typhoid fever were increased by floods rather than by drought or landslides. Malaria was more influenced by floods.
CONCLUSION: Environmental hazards affected population health in the three districts by increasing the risk of waterborne diseases, such as diarrhea, during severe droughts and landslides. Floods exacerbated waterborne and vector-borne diseases by creating ideal conditions for mosquito breeding and water contamination. There is an urgent need for multihazard-targeted interventions, including improved access to water, sanitation, and hygiene (e.g., regular handwashing with soap, safe water access and use, boiling water, proper sanitation, community WASH sensitization supported by local public health outreach), as well as disaster preparedness strategies, to reduce the health burdens of environmental hazards and enhance community resilience in these regions
Designing causal evaluations of analytics-prompted interventions in higher education: three case studies of interventions designed to improve wellbeing
Full text linkLearning analytics systems are increasingly used in higher education to monitor student engagement and identify those at risk of poor wellbeing. However, there is limited causal evidence on the effectiveness of student support interventions prompted by analytics. Drawing on three case studies from universities in England, this paper documents how randomised controlled trials can be feasibly designed and implemented within university settings to rigorously assess analytics-prompted interventions. It highlights some key considerations that should be reflected in the design of causal evaluations of interventions prompted by analytics, such as developing theories of change to practically inform the selection of outcomes. It also discusses the suitability of different trial designs, depending on whether new or existing interventions are being evaluated, evaluation pre-registration, and the value of complementing statistical studies of intervention’s effects with implementation and process evaluations