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Principles and priorities for integrated tuberculosis screening and care: A modified Delphi consensus exercise.
Get PDFTuberculosis predominates in communities with multiple health and socioeconomic vulnerabilities. Tuberculosis diagnosis presents an opportunity for expanded health services to tuberculosis-affected households. We conducted a modified Delphi process to ascertain if and how expanded services should be offered to people with tuberculosis and their households. Purposively invited panellists were identified through professional networks and included researchers, service providers, policymakers and members of tuberculosis-affected communities. Panellists completed two online survey rounds. Round one sought to establish consensus on the perceived value of integration and capture diverse views on service integration priorities through free-text responses. Round two explored broad consensus statements (consensus defined as ≥75% agreement) developed from round one responses using Likert scales and country-specific priorities. Free-text responses were analysed using inductive thematic analysis. The percentage of panellists agreeing with each statement was calculated as a proportion of all responses, overall and by pre-specified subgroups of professional categories and WHO region. In round one, 223 panellists from 44 countries indicated strong support for expanded and better integrated services for people with tuberculosis (98% agreement), and their household contacts (84%). In round two, 324 people from 68 countries reached consensus on key motivations for service integration. These included improved tuberculosis treatment and other health outcomes among people with tuberculosis, and increased tuberculosis screening and preventive treatment uptake among contacts. Almost all (>99%) panellists agreed that people with tuberculosis should be routinely screened for relevant non-tuberculosis conditions, but only 69% thought this was appropriate among household contacts. There was consensus (93%) that population-wide tuberculosis screening should be integrated with other disease screening. Multiple, often context-specific, considerations for implementation were highlighted. Integrated tuberculosis screening and care is highly valued by global tuberculosis experts. This international consensus provides a strong mandate for research evaluating the feasibility and effectiveness of integrated tuberculosis service delivery and further policy and guideline development
Are men clients, catalysts or controllers of family planning?
Get PDFBACKGROUND: Family planning (FP) has moved from being used as a tool for population control to promoting individuals' and couples' reproductive rights. The narrative surrounding FP focuses on how providing modern contraception empowers women to control their fertility and space their children. However, the role of men in the decision-making process of women's access, and use of FP services is under-examined. Although international health organisations insist that FP programmes ensure free choice for both men and women, most programmes primarily target women. This paper explores the role of men in FP programmes and services in the Global South. METHODS: We conducted a qualitative study with 31 professionals from the international FP community, including academics, NGO workers, FP advocates, government officials, and international funding representatives. Interviews were conducted virtually and transcribed verbatim. Thematic analysis was applied to the dataset. RESULTS: Participants did not have clear or consistent opinions about the role of men in FP service provision. Yet, all emphasised the need to prioritise women's reproductive health needs within FP programmes. Almost all reflected on men's role in the decision-making process around FP, emphasising how power dynamics between men and women in heterosexual relationships can limit women's autonomy. Some argued that men should have no role in FP programmes, as they were described as "controllers of" women's reproductive choices. Some participants reflected described men as "catalysts" and encouraged their engagement in programmes to support women in accessing, using, and continuing FP services. Others argued that men should be viewed as "clients" requiring FP services themselves. While different roles for men were discussed, no consensus emerged on a single approach. Participants also described tensions between women-centered policies at higher levels and the social norms impacting care at the community level. CONCLUSION: International organizations recommend targeting both men and women in FP programmes, but most programs continue to focus on women. These findings explore the roles men play in FP decision-making and identify barriers to engaging men in FP programmes. They highlight the need for culturally sensitive, gender transformative approaches to address gender norms and ensure reproductive rights for all
Economic Evaluation of Breast Cancer Screening in China: A Systematic Review of Costs and Cost-Effectiveness.
Get PDFOBJECTIVES: This study systematically reviewed evidence on the cost and cost-effectiveness of breast cancer screening programs in China to support the development of structured, population-based screening initiatives and guide future economic evaluations. METHODS: A comprehensive search was conducted across Web of Science, CINAHL, PubMed, Embase, Medline, Google Scholar, PsycINFO, Cochrane, Scopus, and China National Knowledge Infrastructure for studies published up to June 2025. Eligible studies reported costs or cost-effectiveness of breast cancer screening in China. Data extraction followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and study quality was assessed using the Consensus Health Economic Criteria extended checklist. RESULTS: Seventeen studies met the inclusion criteria, examining mammography, ultrasound, and clinical breast examinations. The studies varied in screening strategies, cost components, and analytic methods. Eighty percent concluded that breast cancer screening was cost-effective compared with no screening, typically at thresholds between 1 and 3 times China's gross domestic product (GDP) per capita (US$13 300-39 900 per quality-adjusted life-years) in 2024. Population-based programs are generally cost-effective for women aged around 35 to 74 and have shown favorable results mainly in urban or economically developed regions. Recommendations varied by target population, screening tools, screening delivery models, intervals, and uptake. Ten articles were rated as good or excellent, 5 as moderate, and 2 as low quality. CONCLUSIONS: This review summarizes evidence to inform the development of regionally adapted, cost-effective screening policies and support evidence-based decision making in breast cancer control. It also identifies methodological inconsistencies and limited rural evaluations, emphasizing the need for more robust and context-specific economic analyses
Epidemiology of Schistosoma haematobium infection and microhaematuria among schoolchildren in a setting of sustained mass drug administration in Banfora, Burkina Faso.
Get PDFBACKGROUND: Limited evidence exists regarding the current epidemiology of Schistosoma (S.) haematobium infection following decades of mass drug administration implementation in many areas of Burkina Faso, including the Cascades region, which is predominantly a riverine community with a high risk of schistosomiasis. This study aimed to determine the prevalence and correlates of S. haematobium infection and microhaematuria among schoolchildren in the municipality of Banfora, southwestern Burkina Faso. METHODS: An analytical cross-sectional study was conducted in November 2024 among schoolchildren aged 5-15 years in the Banfora municipality. Sociodemographic and water contact data were collected using a pre-tested structured questionnaire. Each consenting child provided a freshly voided urine sample, which was examined for the presence of S. haematobium eggs and microhaematuria using the urine filtration technique and urine multistix reagent test strips, respectively. Correlates of S. haematobium infection and microhaematuria were determined using multivariable logistic regression. RESULTS: The mean age of the children was 8.79 ± 2.22 years. Of the 300 school children tested, 11 (3.67 %) were found to be infected with S. haematobium eggs. The geometric mean intensity of S. haematobium infection was 14.94 eggs/10 mL of urine (95 % CI: 4.96-44.98), and 27.27 % of the infected participants (3/11) had a heavy infection. The prevalence of microhaematuria was 13.33 % (40/300). Being a boy was the main risk factor for S. haematobium infection (adjusted OR: 11.0, 95 % CI: 2.5-48.2), while having a urinary tract infection was significantly associated with S. haematobium infection (adjusted OR: 59.6, 95 % CI: 6.9-515.7). Risk factors for microhaematuria included living in rural areas (adjusted OR: 8.3, 95 % CI: 2.4-28.6) and S. haematobium infection (adjusted OR: 31.3, 95 % CI: 5.9-165.8). CONCLUSIONS: Our findings show that S. haematobium infection is hypoendemic in the Banfora municipality. However, the high prevalence of heavy infections is a particular concern, and targeted treatment strategies and complementary measures, including health education, should prioritize school-aged children living in rural areas
Tree pollen and asthma-related hospital admissions in England: a national case time series analysis.
Get PDFOBJECTIVE: Evidence linking pollen exposure to asthma exacerbations is limited and inconsistent across regions, pollen types, and age groups. We assessed the association between pollen concentrations and asthma-related hospital admissions across England at high spatial resolution. MATERIALS AND METHODS: We use unplanned asthma admissions records (2008-2022) from Hospital Episode Statistics, linked to 10-km gridded data on alder and birch pollen. Tree pollen exposure was categorised as low, medium, or high. Age-specific case time series analyses were conducted using conditional Poisson regression, controlling for temperature and air pollutants (PM2.5 and NO2). Analyses were restricted to January-August, when tree pollen is present. RESULTS: Elevated asthma admission risk was associated with both pollen types, with a non-linear exposure-response that increased sharply at low levels and attenuated at higher exposures. For alder pollen, relative risks (RRs) across all ages were 1.014 (95%CI: 0.998, 1.031) for low, 1.026 (1.007, 1.046) for medium, and 1.019 (0.995, 1.044) for high exposure. For birch, RRs were 1.016 (0.996, 1.037), 1.041 (1.019, 1.06), and 1.032 (1.005, 1.060), respectively. Risks were mostly limited to children, with medium alder pollen exposure associated with RRs of 1.047 (0.993, 1.105) and 1.112 (1.066, 1.159), and birch with RRs of 1.131 (1.066, 1.201) and 1.079 (1.029, 1.131) in 0-4 and 5-14-year-olds, respectively. No evidence of association was found in older groups. CONCLUSION: Moderate tree pollen levels are associated with increased asthma admissions in younger populations in England. Further work is needed to understand group and individual susceptibility
Seroprevalence of antibodies against diphtheria, tetanus, and pertussis over a 12-year period in children in Kilifi, Kenya (2009-2021).
Get PDFOBJECTIVES: 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.
Get PDFAlthough 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
Get PDFObjectives: 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.
Get PDFBACKGROUND: 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