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Projecting long-term excess risks of major infectious diseases associated with future extreme weather events in Thailand.
Full text linkClimate change is postulated to impact infectious disease transmission, yet few studies have characterised the excess risks of infectious diseases associated with extreme weather events. To address this, we conducted a study estimating and projecting the impacts of extreme heat and precipitation on the incidence of major infectious diseases in Thailand. We developed, fitted and validated an analytical framework to model province-level disease cases and their relationship with extreme weather indicators based on historical data. We used generalised additive models to delineate the relationship between monthly extreme heat days, standardised precipitation index and incidence rates of seven infectious diseases (dengue, malaria, Japanese encephalitis, melioidosis, leptospirosis, pneumonia, influenza) across Thailand's provinces. Disease-specific models were fitted to historical surveillance data and used to project future disease incidence across 4 Shared Socioeconomic Pathways (SSP) based on MIROC6 climate projections. Historically, extreme heat was associated with an increase in all infectious disease incidences except malaria and leptospirosis. We projected that dengue risk declines in most future climate change scenarios, except SSP245 where extreme heat drives a significant rise in Northern and Central Thailand from 2021-2060. Nationwide dengue risk is expected to decrease by 24.9% (95%CI:9.68%,40.0%) during future periods of extreme weather from 2061-2080 compared to historical baselines. Influenced by heat and dry weather in Northeastern and Central regions, influenza risk is expected to increase under SSP245 in 2021-2060, then decrease with extreme precipitation. Influenza risk in Nakhon Ratchasima is expected to increase by 36.8% (95%CI:9.83%,63.8%) in 2021-2040 under SSP245. Localised public health interventions are necessary to address climate change impacts
Group psychosocial interventions for anxiety, depression, and post-traumatic stress disorder in children and adolescents in low- and middle-income countries: A realist systematic review and meta-analysis of randomised controlled trials.
Full text linkGroup psychosocial interventions can be a scalable treatment for depression, anxiety, and post-traumatic stress disorder (PTSD) in low- and middle-income countries (LMICs) but effects are heterogeneous. Little is known about how intervention mechanisms and context interact to generate different outcomes in different populations. We conducted a realist systematic review, combining traditional systematic review methods with analysis of intervention mechanisms and contextual factors to further understanding of complex interventions. This involved: (i) a scoping review to build initial theory and inform data extraction and analysis; (ii) systematically searching six databases for randomised controlled trials (RCTs) of group psychosocial interventions for participants aged 0-19 years in LMICs (21 November 2022, updated 26 April 2024); (iii) extracting data on outcomes, contextual factors, and intervention mechanisms to build hypotheses about how context interacts with mechanisms to generate outcomes (context-mechanism-outcome configurations; CMOCs); (iv) narratively synthesising CMOCs into wider programme theories about how and why psychosocial interventions work; (v) meta-analyses and meta-regressions to assess trends and test CMOCs. We included 38 RCTs with data for 6,086 participants (52% female, mean age 13). These data informed 14 programme theories including theories that interventions work best when adapted for participant cognitive level, incorporating age-appropriate activities, accounting for local gender-specific issues, and being culturally adapted. Pooled post-intervention effect sizes were -0.72 (95% CI -1.01 to -0.42, p < 0.001) for depression, -0.90 (95% CI -1.57 to -0.23, p = 0.014) for anxiety, and -0.71 (95% CI -1.05 to -0.38, p < 0.001) for PTSD. The only significant results in meta-regressions were larger effect sizes for older children and in populations without exposure to conflict for depression symptoms only. Socio-demographic and contextual factors may influence how interventions work and help to explain the heterogeneity of effects. More high-quality RCTs with moderation and mediation analyses are needed to explore the transferability of these interventions.PROSPERO registration: CRD42022364043
Transmission dynamics of Klebsiella pneumoniae in a neonatal intensive care unit in Zambia before and after an infection control bundle.
Full text linkKlebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts
Exploring masculinities when migration aspirations are thwarted: the affective contours of young Uzbek men in Uzbekistan
Full text linkDrawing from case studies of three young Uzbek men who made every attempt to migrate but experienced
thwarted aspirations, this chapter maps the affective contours of Uzbek men in relation to voluntary immobility
to shed light on the reproduction of hegemonic masculinities in Uzbekistan. Since gaining independence from
the Soviet Union in 1991, Uzbekistan’s economic challenges have fuelled a growing desire among Uzbeks,
particularly men, to seek better opportunities abroad. Uzbek men often see migrating abroad for work as an
essential rite of passage into manhood, even though the challenges they encounter overseas can jeopardise
their sense of masculinity. This chapter draws on 13 months of fieldwork in Uzbekistan to explore the varying
interpretations of (non-)migration in relation to hegemonic masculinities among young Uzbek men. Central to
the analysis is the mapping of the affective contours of young Uzbek men who agentically navigate their
thwarted aspirations and negotiations around (non-)migration in relation to filial responsibilities, material
aspirations and gendered nationalism. At the core of Uzbek manhood is the fulfillment of filial responsibilities,
wherein material aspirations and exchanges play an integral role in achieving this familial duty. Moreover,
gendered nationalism intersecting with recent Islamic revival greatly reshapes how Uzbek men perceive
themselves and genderise transnational processes. Uncovering the voluntary immobility of Uzbek men could
advance our knowledge of contemporary Uzbek society and post-Soviet transitions and contribute to our
understanding of the complexities of masculinities in the Global South
Regulatory frameworks for cell-based food and precision fermentation-derived products
Full text linkThis Legal Paper draws on existing frameworks such as the Codex Alimentarius, World Trade Organization agreements, and other agreements, to highlight gaps and challenges in regulating new food technologies. It also addresses the legal perspective on broader societal and ethical implications, particularly concerning sustainable development, human rights, and environmental sustainability. The Legal Paper explores observed approaches in regional and national legislation applicable to cell-based and precision fermentation-derived foods, highlighting that current national regulatory frameworks for food safety, particularly those addressing new food sources and production systems or genetically modified foods (where present), generally would apply to cell-based food and precision fermentation-derived products. While in some countries food safety authorities need to clarify which provisions from food legislation apply to cell-based and precision fermentation-derived products and which do not, in other countries, reforms and updates to legislation may be necessary
Do occupational aspirations of children help to explain ethnic differences in labour market outcomes?
Full text linkAcross the UK’s ethnic groups there is substantial variation in labour market outcomes, driven in part by differences in occupational concentration. Yet we lack insight into whether these outcomes may be shaped, in part, by differences in preferences deriving from group-level cultural socialisation. We shed light on this question using the nationally representative Millennium Cohort Study. We study the occupational aspirations of girls and boys prior to school completion, matching these aspirations to job characteristics drawn from the Labour Force Survey across the two dimensions of value and gender-typicality. We estimate growth curve models tracking the value and gender-typicality of the aspired job from early childhood into adolescence, and test how far trajectories are consistent with theoretical expectations about the influence of group-level characteristics. We find that differences between ethnic groups are small; but those that exist do not support the contention that preferences are shaped by cultural socialisation in the ways theorised. Minority girls aspire to higher-paid occupations than their majority counterparts, and this is the case for those both from more and from less traditional and disadvantaged communities. We conclude there is a need to revisit cultural accounts of labour market outcomes among the children of immigrants
Early assessment of maternal bleeding: development and validation of a prognostic model predicting death and near miss.
Full text linkBACKGROUND: Bleeding after childbirth is a leading cause of mortality. Most deaths are in low-income and middle-income countries. Early identification of women at high risk of life-threatening bleeding is vital to guide the use of life-saving interventions. The aim of this study was to develop and validate a prognostic model to predict death and near miss from bleeding after childbirth and to use it to a create simple clinical score to identify women's level of risk at admission. METHODS: This observational prognostic study used multilevel logistic regression with data from 22 low-income, middle-income, and high-income countries. We used individual patient data from four randomised controlled trials (WOMAN, WOMAN-2, TRAAP, and TRAAP2 trials) that assessed the effect of tranexamic acid administration on maternal death and blood loss after birth, vaginally or by caesarean. The predicted outcome was death or near miss based on the WHO near miss approach to life-threatening postpartum bleeding. Maternal death included all deaths within 24 h of birth. Near miss included laparotomy, hysterectomy, or interventional radiology within 24 h of birth. The model included a random effect for country and trial and underwent internal-external cross-validation. A simple score for clinical use was developed from the coefficient of the regression equation, and the clinical value of the prognostic model and score was assessed by decision curve analysis. FINDINGS: We included data on 43 450 women enrolled in the four trials. Death or near miss occurred in 1291 women (3·0%). The model predicting death or near miss included age, baseline systolic blood pressure, pre-birth anaemia, caesarean birth, placental disorders, hypertensive disease during pregnancy, and whether the birth being studied was a stillbirth. By use of internal-external cross-validation, the pooled area under the receiving operator curve (AUROC) for the model was 0·82 (95% CI 0·78-0·87). Our simple clinical score to identify women at very low (risk unlikely), low, intermediate, high, or very high risk of death or near miss had an AUROC of 0·80 (0·76-0·84). Discrimination was heterogeneous between countries, with low AUROC (0·58 [0·48-0·68]) in the only high-income country included in the cross-validation (France). The model and the score presented a clinical value with a positive net benefit for a wide range of risk of death or near miss. INTERPRETATION: We developed a prognostic model and a simple score that can be used at hospital admission to quantify the risk of life-threatening bleeding in women giving birth. This score can be used to inform the need for early tranexamic acid administration in women giving birth in low-income and middle-income countries. FUNDING: The Gates Foundation
Prevalence and outcomes of intrinsic capacity impairments assessed using the WHO Integrated Care for Older People (ICOPE) framework in The Gambia, South Africa, and Zimbabwe: a cross-sectional study.
Full text linkBACKGROUND: Despite rising longevity across Africa, the epidemiology of intrinsic capacity (combination of mental and physical capacities) impairments (ICIs) is understudied. We aimed to determine the prevalence of ICIs and associated sociodemographic and lifestyle factors, pain, functional limitations, and health-related quality of life (HRQoL) across three African countries.
METHODS: This population-based cross-sectional study recruited adults aged 40 years and older in five settings: rural (n=1052) and urban (n=1218) Gambia, rural (n=948) and urban (n=968) South Africa, and urban Zimbabwe (n=1110). Researcher-administered questionnaires and physical assessments quantified ICIs. Pain was assessed using the Brief Pain Inventory, functional limitations using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and HRQoL using the 5-level EQ-5D. Setting-specific associations between sociodemographic and lifestyle factors and ICIs were meta-analysed. Differences in pain, function, and HRQoL scores were computed according to ICI number.
FINDINGS: The 5296 adults had a mean age of 61·0 (SD 12·9) years; 2823 (53·3%) were female and 2473 (46·7%) were male. Prevalence of two or more ICIs was 62·4% (59·4-65·3) in rural Gambia, 57·6% (54·8-60·4) in urban Gambia, 67·6% (64·5-70·6) in rural South Africa, 72·1% (69·2-74·9) in urban South Africa, and 64·8% (61·9-67·6) in urban Zimbabwe. Having two or more ICIs was more common in those aged 55-69 years (pooled sex-adjusted odds ratio [OR] 1·79 [95% CI 1·51-2·11]) and 70 years and older (7·21 [5·01-10·37]), female individuals (pooled age-adjusted OR 1·73 [95% CI 1·35-2·22]), those who were underweight (pooled age-adjusted and sex-adjusted OR 4·72 [3·41-6·54]), those with lower wealth index (1·38 [1·20-1·58]), those with food insecurity (1·92 [1·17-3·17]), and those who reported current or former tobacco use (1·47 [1·18-1·83]). Overall mean values were 3·95 (SD 10·64) for pain score, 14·17 (18·36) for WOMAC score, and 0·83 (0·11) for HRQoL. Compared with no impairment (n=554 [10·5%]), having two or more ICIs was associated with 2·34-fold (95% CI 1·92-2·84) greater functional limitation, 2·44-fold more pain (1·86-3·20), and lower HRQoL (mean difference -0·06 [-0·07 to -0·05]).
INTERPRETATION: In both rural and urban African settings, common ICIs necessitate urgent interventions to maximise functional ability and reduce the effect on quality of life. Individuals most at risk include women, those aged ≥55 years, and people with low socioeconomic status.
FUNDING: National Institute for Health Research (NIHR), NIHR-Wellcome Partnership for Global Health Research, and Medical Research Council Musculoskeletal Functional Ability in sub-Saharan Africa.
TRANSLATIONS: For the Shona and isiZulu translations of the abstract see Supplementary Materials section
The role of parents and caregivers in motivating adolescents with HIV to participate in a long-acting injectable ART clinical trial in South Africa and Uganda.
Full text linkIn this paper, we describe the central role of caregivers in shaping adolescent engagement with long-acting injectable antiretroviral therapy (LAI-ART) within the Long-Acting Treatment for Adolescents (LATA) trial conducted in South Africa and Uganda. Adolescents' participation in HIV care is embedded within emotional, moral, and cultural relationships rather than individual decision-making. Drawing on the bioecological model of human development and the adolescent well-being framework, we conceptualise caregiver support as an evolving relational process that fosters adolescents' connectedness, competence, optimism, and autonomy - psychosocial attributes critical to sustained treatment adherence. Our findings reveal that caregivers provide emotional anchoring, interpretive guidance, and motivational reinforcement, while adolescents' growing agency reshapes caregiving dynamics toward collaborative partnership. By addressing disclosure-related guilt and emotional burdens among caregivers, we advance a relational model of adolescent-centred HIV care. We call for interventions that recognise caregivers as co-participants essential to improving treatment uptake, adherence, and long-term well-being
Principles and priorities for integrated tuberculosis screening and care: A modified Delphi consensus exercise.
Full text linkTuberculosis 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