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A bibliometric assessment of the progress, challenges, and gaps in vaccine uptake studies in Africa
Get PDFProblem considered: In Africa, vaccine hesitancy persists despite increasing demand, recent efforts to establish local vaccine manufacturing, and continued calls and programmes to scale up production. This study presents a bibliometric analysis of research on vaccine uptake and hesitancy in Africa, aiming to reveal historical trends, identify knowledge gaps, and inform targeted policies and interventions.
Methods: We retrieved and analysed 1,355 studies from the PubMed® database using a defined search strategy. Data were analysed to evaluate trends in publication volume, study design, authorship, institutional affiliations, and countries of collaborations.
Results: Research output in Africa has grown tremendously since 2010, reaching its peak after 2020. Original research comprised over 78 % of publications, while randomised controlled trials (RCT) and systematic reviews (SR) were comparatively rare. The top three journals were PLOS ONE (123), BMC Public Health (104), and Vaccines (Basel) (100). Frequently used keywords included “vaccination,” “COVID-19,” “vaccine hesitancy,” “child,” “Nigeria,” and “Uganda.” Thematic clusters centred around diseases (HIV, COVID-19, HPV, polio, HBV), target groups (children, adolescents, mothers, healthcare workers), sociocultural aspects (knowledge, attitudes, beliefs), and countries (Nigeria, Kenya, South Africa). Most productive authors included Charles Wiysonge (30 publications), Rosemary Burnett (11), and Moses Mukosha (10). South Africa led the contributors, followed by the United States of America (USA) and the United Kingdom (UK). Institutional collaborations were limited. Conclusion: Gaps remain in evidence synthesis and inter-institutional collaborations, especially in Africa. Advancing African-led research, fostering regional partnerships, and strengthening the policy relevance of scientific findings are essential to improve vaccine uptake and equity
A qualitative study of peer education experiences and oral pre-exposure prophylaxis use among adolescent girls and young women at high risk of HIV acquisition in Kampala, Uganda.
Get PDFINTRODUCTION: Oral pre-exposure prophylaxis (PrEP) use remains low among adolescent girls and young women (AGYW) at high HIV risk in Eastern and Southern Africa. Most peer-led interventions involve brief interaction, however peer education offering extended engagement may foster peer learning. This study explored experiences of a peer education intervention among AGYW who engaged in sex work (young FSWs) in Kampala, Uganda and examined how it influenced PrEP use.
METHODS: From January 2023 to February 2024, we conducted in-depth interviews (IDIs) with AGYW aged 14-24, purposively sampled from a randomized trial assessing the effect of peer education on PrEP uptake and adherence. We conducted 18 baseline IDIs to assess prior PrEP knowledge and peer education experiences, and 17 follow-ups to explore experiences of the intervention. IDIs were audio-recorded, transcribed, coded (NVivo 14) using an inductive approach. Baseline IDIs were analysed thematically and follow-ups interpreted using the situated Information-Motivation-Behavioural Skills (sIMB) model of behaviour change.
RESULTS: At baseline, AGYW had varying PrEP knowledge, no prior peer education experience and negative community perceptions hindered PrEP use. All those uninterested in PrEP at baseline did not initiate it. After the intervention, participants reported improved knowledge, motivation, and behavioural skills, though contextual barriers persisted. Peer education conveyed accurate information and dispelled myths. Motivation to use PrEP stemmed from HIV risk awareness, positive experiences and attitudes regarding PrEP use, peer influence and peer-led psychosocial support. AGYW gained behavioural skills to incorporate PrEP in daily routines, use it discreetly and maintain adherence when travelling. Non-disclosure of PrEP use was commonly used to mitigate barriers to PrEP use. Persistent contextual barriers included high mobility, concurrent use or prior negative experiences with other oral medication, stigma, partner disapproval and partner violence. Peer leader competence and confidentiality were initial concerns although no incidents were reported. AGYW preferred accessing PrEP at private, nearby facilities providing adequate health education.
DISCUSSION: Integration of peer education into PrEP programs is recommended, alongside strategies addressing contextual barriers-such as improving access in remote areas, adequate counselling when taking other oral medications, community education, partner violence prevention, and subsidies for long-acting PrEP for those unable to maintain daily use
Artificial intelligence in psychiatry: transforming diagnosis, personalized care, and future directions
No full textThe integration of artificial intelligence (AI) into psychiatric care is rapidly revolutionizing diagnosis, risk stratification, therapy customization, and the delivery of mental health services. This narrative review synthesized recent research on ethical issues, methodological challenges, and practical applications of AI in psychiatry. A comprehensive literature search was conducted with no limitation to publication year using PubMed, Scopus, Web of Science, and Google Scholar to identify peer-reviewed articles and grey literature related to the integration of AI in psychiatry. AI enhances early identification, predicts relapses and treatment resistance, and facilitates precision pharmacopsychiatry by leveraging data from machine learning, natural language processing, digital phenotyping, and multimodal data integration. This review highlights the advancements in the integration of AI in psychiatric care, such as chatbot-mediated psychotherapy, reinforcement learning for clinical decision-making, and AI-driven triage systems in resource-constrained environments. However, there are still serious concerns about data privacy, algorithmic bias, informed consent, and the interpretability of AI systems. Other barriers to fair and safe implementation include discrepancies in training datasets, underrepresentation of marginalized groups, and a lack of clinician preparedness. There is a need for transparent, explainable, and ethically regulated AI systems that enhance, rather than replace, human decision-making. A hybrid human-AI approach to psychiatry is recommended to address these limitations, while interdisciplinary studies, strong validation frameworks, and inclusive policymaking are needed to guarantee that AI-enhanced mental health treatment continues to be effective, fair, and reliable
Advancing Equity: Principles for Climate-Resilient Disability Inclusive Water, Sanitation and Hygiene
Get PDFIntroduction:
Access to water, sanitation and hygiene (WASH) is crucial for health, but billions lack access. People with disabilities face extra barriers, worsening health outcomes. Climate change heightens these challenges by disrupting water, sanitation, and hygiene, often leading to harmful coping strategies. Most climate action plans overlook disability needs, highlighting the need for guidance on disability inclusion in climate-resilient WASH.
Our study:
The ‘Inclusive Pathways Towards Climate-Resilient WASH’ study, led by the London School of Hygiene & Tropical Medicine in partnership with icddr,b and World Vision, investigated the effects of climate hazards on WASH access for people with disabilities in Bangladesh. Using mixed methods, a literature review, and participatory workshops, the team co-developed principles for climate-resilient disability inclusive WASH.
Building the evidence:
Our scoping review examined climate change impacts on WASH services in low- and middle-income countries, focusing on disability inclusion. WASH services are highly vulnerable to climate-related disruptions, yet evidence on impacts specific to people with disabilities is scarce. In Bangladesh, extreme weather severely disrupted WASH services, with 30% of water points and 13% of latrines damaged, leaving nearly half of affected people with disabilities unable to access alternatives. Many reduced toilet use due to safety, privacy, and physical challenges, while incontinence and mobility issues increased vulnerability. Hygiene was compromised as polluted floodwater replaced tube wells, heightening health risks. Inadequate disaster relief, inaccessible shelters, and poor preparedness worsened outcomes. Climate-resilient disability services and inclusive disaster relief are crucial for safety, dignity, and health.
The Principles:
Participatory workshops in Gaibandha, Satkhira, and Dhaka brought together people with disabilities, caregivers, Organisations of Persons with Disabilities, and sector experts to develop six principles collaboratively and suggested activities for climate-resilient, disability-inclusive WASH interventions. These principles, designed for practitioners, prioritise the meaningful inclusion of people with disabilities and their caregivers. They provide a blueprint for enhancing disability inclusion in existing climate-resilient WASH efforts. While the activities are not prescriptive, practitioners should select those relevant to their context and create additional ones as needed. This report provides research findings and presents the principles, explaining their purpose and how to use them
Multiplication rate variation of malaria parasites from hospital cases and community infections.
Get PDFThe significance of multiplication rate variation in malaria parasites needs to be determined, particularly for Plasmodium falciparum, the species that causes most virulent infections. To investigate this, parasites from cases presenting to hospital in The Gambia and from local community infections were culture-established and then tested under exponential growth conditions in a standardised six-day multiplication rate assay. The multiplication rate distribution was lower than seen previously in clinical isolates from another area in West Africa where infection is more highly endemic. Multiplication rates were higher in cultured isolates derived from hospital cases (N = 23, mean = 2.9-fold per 48 h) than in those from community infections (N = 11, mean = 1.8-fold)(Mann-Whitney P < 0.001). There was a positive correlation between levels of parasitaemia in peripheral blood of sampled individuals and multiplication rates of the isolates in culture (Spearman's rho = 0.45, P = 0.017). There was no significant difference between isolates containing single parasite genotypes or multiple genotypes at the time of assay, suggesting that parasites do not modify their multiplication rates in response to the presence of different genotypes. It will be important to uncover the mechanisms of this intrinsic multiplication rate variation, and to also investigate the epidemiological distribution and potential associations with infection phenotypes in other populations
G-formula with multiple imputation for causal inference with incomplete data.
Get PDFG-formula is a popular approach for estimating the effects of time-varying treatments or exposures from longitudinal data. G-formula is typically implemented using Monte-Carlo simulation, with non-parametric bootstrapping used for inference. In longitudinal data settings missing data are a common issue, which are often handled using multiple imputation, but it is unclear how G-formula and multiple imputation should be combined. We show how G-formula can be implemented using Bayesian multiple imputation methods for synthetic data, and that by doing so, we can impute missing data and simulate the counterfactuals of interest within a single coherent approach. We describe how this can be achieved using standard multiple imputation software and explore its performance using a simulation study and an application from cystic fibrosis
Health Systems in Action (HSiA) Insights – Kyrgyzstan
Get PDFKey points
● Kyrgyzstan’s health system provides a state guaranteed package of services but there are gaps
in population coverage and the scope of publicly
funded care is limited.
● The COVID-19 pandemic disrupted access to
essential health services and led to excess
mortality, but less so than in many other European
countries, and maternal mortality increased only
marginally in the first year of the pandemic.
● Government spending on health as a share
of total public spending has declined, with an
increasing share of government spending going
to other sectors.
● Most patients have to make co-payments for
inpatient care and only 50% of the so-called
basic price of a limited list of (some 70) outpatient
medicines is covered.
● Private out-of-pocket (OOP) spending accounted
for 40.7% of health spending in 2021. This reliance
on OOP payments can lead to catastrophic and
impoverishing health spending.
● Despite efforts to ensure access to health services,
there are still marked disparities in provision
between rural/mountainous areas and urban areas,
and barriers linked to cost and gaps in mandatory
health insurance coverage.
● Rates of routine childhood vaccinations used to be
traditionally high but have been impacted by the
COVID-19 pandemic.
● Access to diagnosis and treatment for HIV/AIDS and
tuberculosis (TB) remain public health concerns.
● Kyrgyzstan faces high rates of premature mortality
due to noncommunicable diseases (NCDs).
● The population is at risk from high blood pressure,
dietary risks, air pollution and smoking, with men
more likely to engage in behavioural risk factors
(such as smoking and alcohol consumption).
● Rates of health workers per population have
declined and the ageing and migration of the health
workforce are major concerns
Value of hospital administrative data linked to national cancer registry records to identify metastatic disease at time of primary diagnosis in colorectal cancer patients: a study using national data in England.
Get PDFBACKGROUND: Routinely collected data are increasingly being used for cancer research and health service evaluation. For both purposes, accurately identifying metastatic disease at diagnosis is essential. We developed an approach to identify metastatic disease at time of primary diagnosis according to national hospital administrative data (HAD) in patients identified with colorectal cancer (CRC) in the English national cancer registry (CR). METHODS: A national cohort of CRC patients diagnosed between 2013 and 2018 in England identified in CR data were linked to HAD. Metastatic disease was assumed to be present at diagnosis according to HAD if at least one of a set of pre-specified diagnostic ICD-10 codes appeared in a record of a hospital admission between one month before and six months after CRC diagnosis date. RESULTS: Of 186,236 patients, 40,421 (21.7%) had metastatic cancer according to HAD, 42,843 (23.0%) according to CR data, 49,827 (26.8%) according to either data source, and 33,437 (18.0%) according to both. Metastatic information was missing in CR data in 14,065 patients and 1,930 of these (13.7%) had metastatic cancer according to HAD. 1-year mortality was 59.3% (95%-CI: 58.8 - 59.8%) in patients with metastatic disease and 7.4% (7.2 - 7.5%) in patients without if HAD and CR data agreed. Mortality fell between these results if HAD and CR data disagreed. High mortality was seen in patients with missing metastatic data in the CR: 74.4% (72.4 - 76.3%) in patients with metastatic disease and 45.2% (44.3-46.1%) in patients without metastatic disease according to HAD. CONCLUSIONS: HAD should be linked to CR data to provide more accurate information on metastatic CRC at diagnosis including sites of metastasis. Linkage to HAD increased the number of patients identified with metastatic CRC by 14%, compared to CR data alone. Patients with metastatic disease at diagnosis in either data source had mortality outcomes expected for patients with metastatic cancer. CRC patients with missing metastasis data in CR data are likely to have metastatic disease and linkage to HAD provides important prognostic information
Effect of prenatal multiple micronutrient supplementation on birth weight in Ethiopia: protocol for a pragmatic cluster-randomised trial.
Get PDFINTRODUCTION: This programme effectiveness study responds to the need for evidence of the effect on birth weight of switching from iron-folic acid supplementation to multiple micronutrient supplementation as part of routine antenatal care in Ethiopia. A 2019 meta-analysis reported a mean increase of 35 g in birth weight among newborns of women who took multiple micronutrient supplements in pregnancy compared with those who took iron-folic acid. Responding to that evidence, the government of Ethiopia decided to implement a 21 district pilot of the use of multiple micronutrient supplementation in routine antenatal care and requested an evaluation of implementation outcomes, including on birth weight. METHODS AND ANALYSIS: A pragmatic, facility-based, randomised trial is being conducted in 42 districts over five regions of Ethiopia between January 2023 and December 2024. Districts have been randomised to one of the two arms, either to retain iron-folic acid supplementation as part of routine antenatal care or switch to multiple micronutrient supplementation. During the study period, the birth weights of all eligible babies born in enrolled health facilities in these 42 districts are continuously recorded alongside data on maternal receipt and use of either multiple micronutrient or iron-folic acid supplementation. We hypothesise that newborns of women resident in the 21 multiple micronutrient supplementation districts will have higher mean birth weight than newborns of women resident in the 21 iron-folic acid supplementation districts. Facility surveys involving pregnant women and healthcare workers at baseline, midline and endline contribute to a process evaluation and cost and cost-effectiveness evaluation. ETHICS AND DISSEMINATION: The study received ethical approval from the review boards at the Ethiopian Public Health Institute (EPHI-IRB-455-2022) and the London School of Hygiene & Tropical Medicine (LSHTM ref 28021). Results from this pragmatic trial will be used by the government of Ethiopia in assessing success of the multiple-micronutrient supplements pilot and for decision making about subsequent scale-up. Dissemination of findings will also inform global decision making, particularly in settings where a transition from iron-folic acid to multiple micronutrient supplementation is being contemplated at scale. TRIAL REGISTRATION NUMBER: NCT05708183
Evolution of intimate partner violence impacts from cash transfers, food transfers, and behaviour change communication: Mixed-method experimental evidence from a nine-year post-programme follow-up in Bangladesh.
Get PDFCash or food transfers can reduce intimate partner violence (IPV), but knowledge gaps remain on how impacts evolve over time, and the role of complementary 'plus' activities and contextual factors. We conducted a mixed-method analysis of how the Transfer Modality Research Initiative in Bangladesh affected IPV over time. The programme was implemented from 2012 to 2014, following a randomised controlled trial (RCT) design, across Northern and Southern Bangladesh. Intervention arms included monthly cash or food transfers, with or without complementary nutrition behaviour change communication (BCC). We estimate post-programme impacts on IPV using quantitative data collected in 2014-2015, 2018, and 2022, and combine this with qualitative data collected in 2023 to explore how and why IPV impacts evolved over time and the role of contextual factors. In the North, combining cash with BCC led to sustained IPV reductions in each post-programme round, while cash alone reduced IPV in 2022 but not the previous two rounds; food transfers showed no post-programme impacts. In the South, combining food with BCC led to post-programme IPV reductions in 2014-2015; no intervention sustained IPV reductions thereafter. Sustained IPV reductions are primarily driven by improved household economic security and emotional well-being. Other pathways - family relationships (including in-laws' roles), women's empowerment, and social and community support - contributed to changing couples' relationships during the programme but became less salient after the programme ended. Contextual factors, including demographic changes, climate-related changes, external projects and norms condoning IPV appear to influence the sustainability of impacts. Results suggest that 'plus' programming was key to sustaining IPV impacts soon after the interventions, but less so by nine years post-programme, as economic security increasingly drove impacts. More mixed method research is needed from the outset to unpack if and how pathways to IPV reduction can be sustained in different contexts over time