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Modelling the effect of a nutritional shock on tuberculosis in India.
Get PDFBACKGROUND: Environmental or social changes and shocks that reduce access to adequate nutrition have potential consequences for tuberculosis (TB), as undernutrition is a major driver of TB incidence and poor TB treatment outcomes. METHODS: We developed a transmission model of TB in India with an explicit body mass index (BMI) strata linked to disease progression and treatment outcomes, calibrated to country-specific TB estimates. We projected nutritional shock scenarios affecting supply chains, similar to those experienced at the beginning of the war in Ukraine, using the LandSyMM food system model, compared to a continuation of previous food system trends. Within each scenario, increases in food, fertiliser, and energy prices were linked to changes in the population BMI distribution by food availability and prices. We estimated the impact on TB incidence and mortality in India between 2022 and 2035 of these nutritional shock scenarios compared to maintenance of prior trends. RESULTS: The worst-case scenario, involving sustained increases in food, fertiliser, and energy prices, predicted that shocks increasing undernutrition could result in a 5.0% (95% uncertainty interval = 4.4, 5.9) and 4.9% (4.2, 5.9) increase in TB incidence and mortality respectively in India in 2035 compared to continuation of previous food system trends. In this scenario, an additional 1.1 million (0.9, 1.3) TB episodes and 177.5 thousand (144.7, 224.3) TB deaths were predicted to occur between 2022 and 2035. CONCLUSIONS: Shocks affecting the population-level BMI distribution could lead to changes in the burden of TB disease. Our findings suggest that the impact of crises on TB disease may be underestimated if the impacts of external shocks on nutrition are not explicitly considered
Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.
Get PDFBACKGROUND: Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review and meta-analysis aimed to examine the impact of these regimens, synthesising data from recent clinical trials and observational studies. METHODS: We searched multiple databases, including Medline and Scopus, for studies published from 2012 to February 2024. Eligible studies included clinical trials and cohort studies involving adults diagnosed with DR-TB treated with Bdq-based all-oral regimens lasting up to 12 months. Primary outcomes were treatment success rate (TSR) and incidence of serious adverse events (SAEs). We also compared efficacy and safety with longer oral or injectable regimens in control groups. Meta-analyses were conducted to pool event rates and risk ratios (RRs). Subgroup analyses and meta-regression were performed to identify potential sources of heterogeneity. RESULTS: Data from 12 studies involving 1902 DR-TB patients across 11 countries were analysed. The pooled TSR was 83% (95% CI 77% to 89%), with mortality, treatment failure and loss to follow-up (LTFU) rates of 5% (3-8), 4% (2-6) and 4% (2-6), respectively. Subgroup analyses showed no significant differences in TSR by DR-TB type or HIV status. The incidence rate of SAE was 19% (13-24), with prolonged corrected QT interval (QTc) in 5% (2-8) of cases. Compared with the control regimens, all-oral Bdq-based shorter regimens significantly improved treatment success (RR 1.22, 1.04-1.43) but reduced mortality (RR 0.73, 0.69-0.99), treatment failure (RR 0.33, 0.32-0.62) and QTc prolongation (RR 0.39, 0.21-0.73). CONCLUSIONS: All-oral Bdq-based shorter regimens have improved treatment outcomes and significantly advanced DR-TB management. We urge policymakers, clinicians and stakeholders to expand access to and expedite the implementation of these regimens
Parental Stress, Depression, Anxiety, and Participation in Neonatal Care in a Referral Brazilian NICU over Different Phases of the COVID-19 Pandemic.
Get PDFBackground/Objectives: During the COVID-19 pandemic, neonatal care units had to change protocols, and little is known about its impact on parents' mental health. This study aimed to evaluate parental stress, depression, anxiety, and participation in neonatal care in a Brazilian neonatal intensive care unit (NICU) and observe changes over two different periods of the COVID-19 pandemic. Methods: Cross-sectional study comparing stress, depression, anxiety, and participation in neonatal care levels between two time periods: T1, high COVID-19 incidence (May 2020 to July 2020 and March 2021 to June 2021) and T2, low COVID-19 incidence (August 2020 to February 2021 and July 2021 to December 2021). High COVID-19 incidence was considered more than 40 confirmed COVID-19-related deaths/day. Validate tools used were the Parental Stressor Scale in NICU (PSS:NICU); the Edinburgh Postnatal Depression Scale (EPDS); the Edinburgh Postnatal Depression Scale-Anxiety subscale (EPDS-A); the State-Trait Anxiety Inventory (STAI); and the Index of Parental Participation (IPP). Stress level was pre-defined as the primary outcome. Results: 106 parents (98 mothers, 8 fathers) and 111 newborns were included. Overall, 51.9% of parents had a PSS:NICU score ≥ 3 (relevant stress level), 28.3% had an EPDS-A ≥ 6 (indicating anxiety), and 33.0% had an EPDS > 13 (indicating depression). At least one condition was present in 69 (65%) parents, while the three conditions were simultaneously observed in 17 (16%) parents. No significant differences were observed in the frequencies of stress, depression, or anxiety between the two periods. However, median stress occurrence level (SOL) was higher in T1 when compared to T2 (3.24 vs. 2.68; p = 0.02), mainly due to "Parental role alteration" (3.80 vs. 3.17; p = 0.046). The level of parental participation was not different between the two time periods (p = 0.23). Correlations between stress and both depression and anxiety scores were weak. Parental participation was not significantly correlated to other scores. Conclusions: Elevated levels of stress, depression, and anxiety were observed among NICU parents during both high and low COVID-19 incidence periods. High COVID-19 incidence seems to have particularly influenced stress levels related to parental role alteration. These findings highlight the importance of regularly assessing parental mental health in NICU settings
School Meals Case Study: Colombia [Estudio de caso sobre alimentación escolar: Colombia]
Get PDFEste estudio de caso sobre los programas de alimentación escolar forma parte de una colección liderada por la Comunidad de Práctica "Buenos Ejemplos" del Consorcio de Investigación para la Salud y la Nutrición Escolar. El estudio de caso sobre la alimentación escolar en Colombia tiene como propósito documentar la organización, financiamiento y monitoreo del programa nacional de alimentación escolar en todo el país. Los objetivos de este estudio de caso incluyen presentar una introducción al perfil del país, describir el diseño e implementación de los programas de alimentación escolar, detallar sus procesos de monitoreo y evaluación, y resaltar lecciones aprendidas, buenas prácticas y desafíos. Este estudio de caso se presenta como un documento de trabajo y puede actualizarse para reflejar cambios y circunstancias en evolución. La Comunidad de Práctica "Buenos Ejemplos" apoya la generación de evidencia dentro del Consorcio de Investigación para la Salud y la Nutrición Escolar, que es el brazo de generación de evidencia de la Coalición para la Alimentación Escolar. El objetivo del Consorcio de Investigación es llevar a cabo estudios independientes en diversos sectores y generar evidencia sólida, convincente y aplicable sobre los beneficios de los programas de alimentación escolar, con el fin de respaldar la toma de decisiones basada en evidencia en políticas y prácticas de salud y nutrición escolar.
This school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The School Meals Case Study of Colombia serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
Examining the resilience of mobile youth in KwaZulu-Natal, South Africa: a qualitative inquiry through the lens of protection and risk.
Get PDFBACKGROUND: The last few decades have seen a demographic shift in the age of migrants with more young people involved, especially with regards to internal migration. Socio-economic deprivation, limited resources and adversities contribute to many young people leaving rural areas in low- and middle-income countries in search of a better life in urban settings. This move often requires an adaptation process and resilience to the adversities young people face while still in the challenging developmental life stage of adolescence, exposing them to health and physical risks. METHODS: As part of Lending a Hand support intervention, we conducted repeat in-depth interviews with 20 young people that had recently relocated from other rural villages to a peri-urban setting in uMkhanyakude district, KwaZulu-Natal in South Africa. Data were analysed thematically using inductive and deductive approaches and managed in NVivo software. RESULTS: The participants shared that there were alarming rates of teenage pregnancies in their local area and attributed this to younger girls dating older men for economic gain, which also exposed them to infectious diseases. Some vulnerabilities described by young people included coming from a single parent home, experiencing psychological distress, and living far away from the support of family. Other young people were able to use community-based resources as well as adaptive emotion regulation strategies that offered protective support such as church, school, and peer networks around them. CONCLUSIONS: The accessibility and availability of protective resources offered support and provided strength to young people. This fostered resilience for these young people and in a way incorporated aspects of the collectivist communities they live in. Considering resources that are easily available in resource limited settings is important as young people may be more comfortable and confident to access and use. These protective factors may help curb some of the impact of the risks that they are exposed to
Progress and inequality in child immunization in 38 African countries, 2000-2030: A spatio-temporal Bayesian analysis at national and sub-national levels.
Get PDFBACKGROUND: Monitoring progress and inequality in childhood immunization coverage at both national and sub-national levels is essential for refining equity-oriented health programs and ensuring equitable access to care towards achieving global targets in African countries. METHODS AND FINDINGS: Using approximately 1 million records from 104 nationally representative Demographic and Health Surveys (DHS) conducted in 38 African countries (2000-2019), we estimated childhood immunization coverage for key indicators (BCG, MCV1, DPT3, Polio3, and Full immunization), stratified by socioeconomic status. Variations of Bayesian spatio-temporal analysis using Besag, Besag-York-Mollié (BYM) and BYM2 models were employed to assess and project the trends from 2000 to 2030. We evaluated the probability of achieving Universal Health Coverage (80% coverage) and Immunization Agenda (90% coverage) by 2030, at national and sub-national levels. Finally, we conducted a comprehensive inequality analysis using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) to assess changes over the study period. Childhood immunization coverage improved significantly across most African countries from 2000 to 2019. However, projections suggest that 12 countries are unlikely to achieve global targets for full immunization by 2030 at the national level if current trends continue. Notably, high-Socio-Demographic Index (SDI) countries such as South Africa, Egypt, and Congo Brazzaville are projected to miss immunization targets across all sub-national regions. While socioeconomic inequalities were widespread in 2000, they are projected to decline or stabilize in 36 countries by 2030, with Eswatini, Morocco, Rwanda, and Burkina Faso expected to eliminate disparities. In contrast, Nigeria and Angola are projected to face increasing inequalities or persistent large gaps. Regional disparities in both coverage and inequality remain pronounced, particularly in Central and Western Africa, where coverage remains low and inequality remains high despite overall national-level improvements. The analysis was limited to DHS surveys 2000-2019, excluding more recent data during the COVID-19 period and potentially overestimating trends in data-sparse settings. CONCLUSIONS: This study highlights both progress and persistent challenges in childhood immunization coverage, along with inequalities across 38 African countries. Persistent regional disparities and socioeconomic inequalities require multifaceted strategies that account for demographic, geographic, economic, and political factors to ensure equitable immunization. Greater efforts are needed to close these gaps and support global health goals for the African nations
T cell responses in repeated controlled human schistosome infection compared to natural exposure.
Get PDFIn Schistosoma-endemic regions a lack of natural sterilizing immunity means individuals are repeatedly infected, treated and reinfected. Due to difficulties in tracking natural infection, kinetics of host immune response during these reinfections have not been elucidated. Here, we use repeated (3x) controlled-human-Schistosoma mansoni infection (CHI) to study how antigen-specific T cells develop during reinfection (NCT05085470 study). We compared these responses to naturally infected endemic Ugandan individuals (HALLMARK study). A mixed Th1/Th2/regulatory CD4+ T cell response develops in repeated CHI. Adult-worm-specific responses after repeated CHI were similar to endemic-natural infection. However, endemic participants showed differential responses to egg- and cercariae-antigens. Repeated CHI with sequential exposure to cercariae of different sexes (male-female-male) revealed an elevated CD4+ T cell cytokine response to adult-worm and egg-antigens. Our findings demonstrate that single-sex schistosome infection elicits adult-worm-specific T cell cytokine responses that reflect endemic-natural infection. This study advances our understanding of the immunology of schistosome (re)infection in the human host
Dioptric blur is not fully reflected by VEP-based visual acuity estimates.
Get PDFPURPOSE: Objective estimation of visual acuity (VA) based on visual evoked potentials (VEPs) has become an established technique for cases where psychophysical VA might be unreliable. Refractive errors and improper accommodation could undesirably affect the outcome of VA measurements. Consequently, it is of interest whether a VA reduction due to dioptric blur is reflected by VEP-based estimation of VA. METHODS: We degraded vision in 19 participants to nearly 1.0 logMAR by using either plus lenses or a filter that creates Gaussian blur. For both types of degradation, we compared the outcomes of objective VEP-based VA testing to standard psychophysical VA. For comparison, we also obtained psychophysical grating VA. RESULTS: With Gaussian blur, both values, VEP-based VA and psychophysical Landolt-C VA, were nearly identical. With dioptric blur, VEP-based VA was better than psychophysical Landolt-C VA in all participants by an average of 0.37 logMAR with some interindividual variability. Psychophysical grating VA was only relatively mildly affected by blur with no sizable differential effect of blur type. CONCLUSION: VEP-based estimation of VA does not reveal the full amount of VA reduction in the case of dioptric blur. On the one hand, this decreases VEP-based methods' susceptibility to incorrect refraction and mis-accommodation, which are not normally the targeted causes of VA reduction. On the other hand, it reduces the accuracy in quantifying refraction-related impairments of vision with VEPs
Maternal and perinatal outcomes of Somali migrant women in comparison to host populations in the Global North: a systematic review and meta-analysis.
Get PDFBACKGROUND: The enduring conflict in Somalia has precipitated significant humanitarian crises, including severely weakened health systems and poor health indicators. The situation has led to almost two million Somalis living abroad, often as refugees or asylum seekers in more high-resource settings in the Global North. To understand outcomes of care of pregnant women and their babies in host countries, this systematic review and meta-analysis aims to synthesise existing evidence on adverse maternal and perinatal outcomes among Somali migrant women compared to host populations. METHODS: We conducted a comprehensive search across multiple electronic databases, including PubMed, Scopus, CINAHL Plus, and the Directory of Open Access Journals, using tailored keyword combinations. No language or date restrictions were applied, and the search concluded on June 30, 2024. Following data extraction and quality assurance using the STROBE Checklist, we conducted a meta-analysis for outcomes with sufficient data, using a random-effects model to account for heterogeneity across populations. Subgroup analyses were conducted by host country, with heterogeneity assessed using I2 and τ2 statistics. Potential publication bias was evaluated through Egger's test and funnel plots. The results provide pooled estimates of maternal and perinatal outcomes. RESULTS: Across all databases, 116 articles were retrieved, with 17 meeting the eligibility criteria. From these articles, pregnancy-related data from 1978 to 2018 on 55,119 Somali migrant women and 5,190,459 women from the host population was extracted. Somali migrant women, compared to host populations, had significantly increased odds of emergency caesarean section (CS) (pooled OR 2.54, 95%CI: 2.22-2.86), non-progressing/induced labour (pooled OR 1.25, 95%CI: 1.19-1.31). Their babies had higher odds of small for gestational age (SGA) (pooled OR 2.03, 95%CI: 1.89-2.17), neonatal morbidity (pooled OR 1.51, 95%CI: 1.40-1.61), and neonatal mortality (pooled OR 1.39, 95%CI: 1.25-1.54). Conversely, Somali migrant women had lower odds of assisted instrumental delivery (OR 0.72, 95%CI: 0.66-0.78), post-partum depression (OR 0.27, 95% CI: 0.12-0.63), preterm birth (OR 0.92, 95%CI: 0.88-0.96), and low birth weight (OR 0.87, 95% CI: 0.80-0.94) compared to host populations. CONCLUSION: Significant disparities in maternal and perinatal outcomes between Somali migrant women and host populations exist. Though more research is needed, available evidence points to the need for more culturally aware obstetric services that address the specific needs of Somali migrant women