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Toward an Electronic Pregnancy Registry in The Gambia: Linking up Maternal and Newborn Health Data Using the Smart Paper Technology.
Get PDFSmart Paper Technology, an innovative paper-to-digital system implemented at Bundung Maternal and Child Health Hospital in The Gambia links maternal and newborn health information with immunization records. In 9 months, Smart Paper Technology facilitated over 3500 mother-child connections, replacing traditional paper-based registers and ensuring DHIS2 interoperability. This pilot enhances reporting and data availability, advancing maternal vaccine safety surveillance in resource-limited settings
Sexual Health Behaviors and Outcomes Among Middle-Aged and Older Disabled Adults in Britain.
Get PDFBACKGROUND: Sexual health is crucial for well-being, yet research often overlooks middle-aged and older adults, as well as those with disabilities. This study explores the sexual health of disabled middle-aged and older adults in Britain.
OBJECTIVE: We aim to explain sexual behaviors and outcomes among disabled adults aged 45-74 in Britain.
METHODS: We conducted a secondary quantitative analysis using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a British population-representative survey. The study did not focus on a specific type of disability but rather included people who consider themselves to have a long-standing illness that limits their activity. The analysis incorporated variables on sexual behaviors and outcomes: bivariate analyses and multiple logistic regressions stratified by sex compared behaviors and outcomes by disability status.
RESULTS: Of 7082 participants included, 1906 were classified as being with limiting disability status. Adjusting for sociodemographic differences, compared to nondisabled individuals, those with limiting disability status adults were less likely to engage in sex in the last 4 weeks (aOR: 0.60, CI: 0.51-0.71) or be in a steady relationship (aOR: 0.69, CI: 0.59-0.80) and were more likely to report poorer sexual health outcomes, including having experienced coerced sex attempts (aOR:1.83, CI:1.48-2.27), had coerced sex (aOR: 1.64, CI:1.33-2.01), had their sex life affected by health in the last year (aOR: 5.08, CI:4.27-6.05), and sought help for their sex lives (aOR:1.73, CI:1.38-2.17).
CONCLUSIONS: Middle-aged and older disabled adults in Britain are less likely to be sexually active, yet more likely to experience negative sexual health outcomes. The increased health-seeking behaviors and their vulnerability highlight the necessity for tailored sexual health services, extending into middle age and older adulthood
Sero-prevalence of measles and rubella immunoglobulin G serum antibody in individuals 1-30 years old in England in 2018: implications for subsequent outbreaks prediction.
Get PDFPURPOSE: Measles outbreaks have occurred across England since mid-2023. We estimated measles and rubella antibody seroprevalence among individuals in 2018 in English regions outside London, and estimated the effective reproduction number (Re) for measles to predict the potential for outbreaks.
METHODS: Using validated enzyme-linked immunosorbent assays, anti-Measles and anti-Rubella IgG antibodies were measured in residual sera from 3758 1-30-year-olds born after introduction of measles-mumps-rubella vaccination who submitted samples to clinical laboratories outside London. The measles Re was calculated using seronegatives defined by the manufacturer's cutoff, mixture modelling, and vaccination coverage data.
RESULTS: Using the manufacturer's cutoffs, the overall proportion seronegative to measles was 9.2% (95% confidence interval 8.3-10.1), and 10.3% (9.4-11.3) had equivocal results. The respective estimates for rubella were lower at 5.2% (4.6-6.0) and 5.4% (4.7-6.1). For both viruses, equivocal proportions increased with age, consistent with antibody waning. Mixture modelling for measles identified a common seronegative distribution across age groups, with lower proportions seronegative than using the manufacturer's cutoff. Re for measles using the manufacturer's seronegative cutoff (~ 150 mille international units/mL) was 1.00, versus 0.38 and 0.51 using the mixture model and vaccination coverage, respectively.
CONCLUSIONS: Re for measles estimated from seroepidemiology using an antibody cut-off similar to that considered a correlate of protection for measles was a more accurate predictor of recent measles resurgences outside London than those estimated using mixture modelling of seronegatives or coverage data. Seroepidemiological studies are a useful adjunct to coverage data in monitoring population immunity and in predicting the potential for measles outbreaks
Novel and unscrutinized immune entities of the zebrafish gut.
Get PDFThe zebrafish model offers a unique opportunity to study gut immunity due to its diverse applicability within several fields of research, combined with an evolutionarily conserved immune system, transparency, and genetic tractability. This review highlights recent advances in understudied immune cell types in the zebrafish gut, emphasizing their potential to illuminate immune processes of the vertebrate immune system. The biological function of the gut is highly conserved in zebrafish, which makes them a relevant model to study intestinal immune cells with advanced molecular and imaging techniques that enable in vivo visualization of immune mechanisms and cell trajectories. Rodent and pig models have successfully contributed to our understanding of many aspects of the immune system, while zebrafish have so far been underestimated in their potential role in furthering our knowledge in this field. We suggest how future study directions can help elucidate the complex nature of gut immunity and highlight similarities between mammalian and zebrafish immune systems. Provided that immune cell functions are conserved, zebrafish can offer great opportunities for translational studies and have an important impact in improving human health
Quality of mental health care for forcibly displaced children and adolescents in the WHO European region: A scoping review of barriers and facilitators.
Get PDFForcibly displaced children and adolescents in the World Health Organization (WHO) European Region have high mental health needs, yet few manage to access mental health services, and those who do may encounter inadequate care. This scoping review aimed to identify and synthesize the available evidence on barriers and facilitators to quality mental health care for forcibly displaced children and adolescents in the WHO European Region. We applied the PRISMA guideline extension for scoping reviews, searching five scholarly databases and grey literature published between 2004 and 2025. A total of 7,327 records were screened, with 18 articles included. We used the WHO Quality Standards for Child and Youth Mental Health Services as an analytical framework to map the evidence. The identified studies represented only 7 out of 53 countries in the WHO European Region. Most studies employed qualitative research designs, with a lack of quantitative evidence using quality indicators. Available evidence revealed multiple, intersecting barriers to quality mental health care, including restrictive health care policies, service constraints and a lack of provider competence. Facilitators included the presence of community-based support, networks of interconnected services, task shifting and evidence-based scalable interventions. Major gaps remain in both the data and in the methods used to generate evidence for improving quality of mental health care for forcibly displaced children and adolescents in the WHO European Region. Our review highlighted the discrepancy between the care provided and the recommended WHO Quality Standards for Child and Youth Mental Health Services. There is a need for more targeted efforts to assess and improve the quality of mental health care for forcibly displaced children and adolescents
Barriers to Breast Cancer Care for Women Presenting at District and Regional-Level Hospitals in Ghana: Findings From the African Breast Cancer-Disparities in Outcomes Ghana Study.
Get PDFPURPOSE: The WHO Global Breast Cancer Initiative (GBCI) aims to improve breast cancer (BC) survival through early stage at diagnosis, prompt diagnostic evaluation, and appropriate multimodality treatment. Care pathway analysis helps to evaluate delay and dropouts through this process. Little is known about the BC care pathway of women first presenting at lower level of health systems in Africa.
METHODS: Between March 2023 and February 2024, we prospectively recruited 243 women age ≥18 years in eight (six district, one regional and teaching) hospitals who, owing to breast symptoms, were referred for breast biopsy in the Oti and Volta regions of Ghana. We determined the percentages of biopsy uptake (study paid if needed), histology results receipt, survival, and treatment initiation and explored how patient-, family-, and health system-related factors influenced care pathways.
RESULTS: Of the 243 women referred, 53 (21.1%) did not have biopsy taken for health system-related (n = 22, 41%) and participant-related (n = 26, 59%) reasons. Among 190 women who had a biopsy, 102 (54%) were malignant. The median time from first visit (recruitment) to obtaining biopsy results was 14 days (IQR, 9-27). Among malignant cases, 61% (62/102) were stage III/IV (GBCI pillar 1) and 65 (64%) of 102 initiated treatment (GBCI pillar 3) with a median time from first visit to treatment initiation of 76 days (IQR, 36-131). Thirty-seven (36%) women whose biopsies were malignant did not initiate treatment because of participant-related (19 [51%]) and health system-related (12 [32%]) factors. The 1-year survival was 76% (95% CI, 66 to 84).
CONCLUSION: In a unique study of women from lower levels of the health system in Ghana, we observed large gaps in biopsy uptake and treatment access, but excellent pathology turnaround times
Addressing survey fatigue bias in longitudinal social contact studies to improve pandemic preparedness
Get PDFAbstract
Social contact surveys are an important tool to assess infection risks within populations, and the effect of non-pharmaceutical interventions on social behaviour during disease outbreaks, epidemics, and pandemics. Numerous longitudinal social contact surveys were conducted during the COVID-19 era, however data analysis is plagued by survey fatigue, a phenomenon whereby the average number of social contacts reported declines with the number of repeat participations and as participants’ engagement decreases over time. Using data from the German COVIMOD Study between April 2020 to December 2021, we demonstrate that survey fatigue varied considerably by sociodemographic factors and was consistently strongest among parents reporting children contacts (parental proxy reporting), students, middle-aged individuals, those in full-time employment and those self-employed. We find further that, when using data from first-time participants as gold standard, statistical models incorporating a simple logistic function to control for survey fatigue were associated with substantially improved estimation accuracy relative to models with no survey fatigue adjustments, and that no cap on the number of repeat participations was required. These results indicate that existing longitudinal contact survey data can be meaningfully interpreted under an easy-to-implement statistical approach addressing survey fatigue confounding, and that longitudinal designs including repeat participants are a viable option for future social contact survey designs
Scoping review of evidence-based practice guidelines for the evaluation and care of young children with developmental disabilities in LMIC settings: evidence for action.
Get PDFINTRODUCTION: Childhood disability is increasingly prevalent, particularly in low-income and middle-income countries, as more children survive worldwide. Global practice guidelines are essential to address the need for timely identification, evaluation and management of children with developmental disabilities, particularly in resource-limited settings. This scoping review aims to summarise recent evidence-based practice guidelines for the assessment and care of children aged 0-5 years at risk or with developmental disabilities and identify those practice guidelines that are suitable for use across both global and resource-limited settings.
METHODS: We searched PubMed, Scopus, CINAHL as well as websites for professional associations using Google to identify evidence-based practice guidelines for specific developmental disabilities with established global prevalence estimates. We identified additional literature through snowballing. Practice guidelines were included if they were published between September 2012 and June 2024, were in English, and demonstrated a systematic process of reviewing available evidence, which then provided information on the detection, diagnosis, treatment and management of children under five with developmental disabilities. Three reviewers independently screened results by title, abstract and full text. Study characteristics and outcome data were extracted, and results were narratively synthesised.
RESULTS: 43 practice guidelines met the eligibility search criteria. Few evidence-based practice guidelines were generated from resource-limited settings (n=3, 7.0%). Of these, two were published in Malaysia and one from Cameroon. Most of the practice guidelines focused on both assessment and management (n=20, 46.5%), with some addressing only assessment (n=9, 20.9%) or management of the conditions (n=14, 32.6%).
CONCLUSIONS: Practice guidelines focusing on the identification and support of children with developmental disabilities, chiefly published within high-income settings, are available to be selectively adapted and utilised across similar localities globally. All young children with developmental disabilities worldwide have the right to access equitable, timely and quality health and developmental care services
Association between Charlson Comorbidity Index and positive blood cultures at a tertiary-care hospital in Indonesia.
Get PDFBlood culture (BC) tests are a scarce resource in low- and middle-income countries (LMICs); therefore, prioritization based on likelihood of positive results might be beneficial. We aimed to determine whether comorbidities in the Charlson Comorbidity Index (CCI) were associated with positive BC tests among patients with suspected hospital-acquired bacteremia. We analysed a retrospective cohort from health records at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia from 2015-2018. We applied multivariable logistic regression to identify associations between CCI score and the outcome of the first BC taken two calendar days after admission, adjusting for confounders. The primary analysis considered BCs positive for all pathogens. Of 3,875 adult patients who had their first BCs taken two calendar days after hospital admissions, 786 (20.3%) had their first BCs positive for any pathogen. Those included 371 patients who had their first BCs positive for Staphylococcus aureus (n = 133; 35.9%), Acinetobacter spp. (n = 84; 22.6%), Klebsiella. pneumoniae (n = 58; 15.6%), Escherichia coli (n = 63; 17.0%) and Pseudomonas aeruginosa (n = 33; 8.9%). There was no association between increasing CCI score and positive BC (OR 1.01, 95%CI: 0.96-1.06, p = 0.69) after adjustment for age, sex and other potential confounders. There was some indication that antibiotic use prior to BC test acted as an effect modifier between CCI score and positivity of BC (p = 0.17). In this single-hospital study, no significant association was observed between CCI score and positive BC taken two calendar days after hospital admission. We suggest that other factors need to be investigated to guide BC testing, and that improving diagnostic and antibiotic stewardship, including increasing resources for BC testing prior to antibiotics among hospitalized patients are needed in LMICs
Maternal and gestational factors associated with congenital anomalies among live births: a nationwide population-based study in Brazil from 2012 to 2020.
Get PDFBackground: Congenital anomalies are structural and/or functional alterations that contribute significantly to an increase in morbidity and mortality risk observed in children around the world. These disorders are complex, and their occurrence is influenced by a variety of factors, including socioeconomic conditions that play a significant. Understanding these factors is essential to informing targeted preventive strategies for children with congenital anomalies. Thus, this study investigated the socioeconomic and biological factors associated with congenital anomalies in Brazil.
Methods: We conducted a population-based study using linked data (the birth information system (SINASC) and mortality information system (SIM)), in Brazil from 2012 to 2020. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression based on a hierarchical model. Initially, a bivariate analysis was carried out to estimate the crude effect of factors associated with congenital anomalies in live births. It was followed by a multilevel framework with three models, in which Model 1 included distal variables, Model 2 added an intermediate variable, and Model 3 incorporated all variables.
Results: Of the 26,107,682 live births included in this study, 144,291 (0.6%) had congenital abnormalities. Black mothers had higher odds of having children with congenital anomalies (OR 1.16; CI 95% 1.14-1.19) than white mothers, and those without prenatal appointments had an increased chance of having children with congenital anomalies (OR 1.47; CI 95% 1.39-1.56) compared to those who started prenatal care in the first months of pregnancy. Maternal age, more than 40 years (OR 2.26; CI 95% 2.20-2.33), and multifetal gestation (OR 1.49; CI 95% 1.45-1.54) were factors associated with a greater chance of live births with congenital anomalies.
Conclusions: Our findings indicate that the likelihood of congenital anomalies is highest among live births from the most socially and economically disadvantaged women in Brazil, mainly those who did not have access to adequate prenatal care. In addition, biological characteristics such as advanced maternal age and multifetal pregnancy have also been shown to increase the chances of an affected birth. Understanding the risk factors for the occurrence of births affected by congenital anomalies allows the implementation of actions to reduce exposure to modifiable risk factors, before and during pregnancy