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Gender-Equitable Access to Tuberculosis Care and Prevention in Malawi: A Political Economy Analysis: A Political Economy Analysis
No full textMen constitute about 57% of all tuberculosis (TB) cases in Malawi. With Malawi remaining a highly burdened TB country, having registered 181 cases per 100,000 population in 2018, addressing the gender disparities in TB becomes a critical imperative in the nation's ongoing efforts to achieve the END TB global goals. To understand political and economic factors that affect gender-equitable TB programming in Malawi, we conducted a qualitative political economy analysis (PEA) that involved policy and stakeholder analysis guided by a modified Rapid Outcome Mapping Approach. Data for the PEA were analyzed using an inductive thematic analysis approach, and a force field analysis was further conducted to understand the driving and restraining forces that influence stakeholder involvement in gender-responsive TB control. Findings for the PEA showed that despite the established role of gender in the development and control of TB in most of the documents, the prevailing policies fail to address the gender-TB dynamics explicitly. Furthermore, policy planning and execution are fragmented, leading to poor policy cohesion and a lack of adequate consideration for gender-specific health issues. We further found that Malawi has various stakeholders with varying levels of interest and influence, capable of advancing gender-responsive TB programming. The current level of stakeholder engagement, though, faces significant challenges such as poor engagement with grassroots structures, despite such engagement having already proven effective in the control of HIV in the country. There is, therefore, a need to integrate gender-sensitive approaches into existing policy frameworks in Malawi and to strengthen collaboration among stakeholders in advancing gender-equitable TB services
Incorporating findings from a vaccine refusal study to develop a community play to improve understanding of maternal vaccines in rural Kilifi, Kenya
Full text linkInnovative approaches are urgently needed to address the growing concern of vaccine hesitancy. Used effectively, community theatre has the potential to promote health knowledge and attitude change as it encourages community dialogues and information sharing. We used research findings from a vaccine hesitancy study to develop a community play on maternal vaccines. The development of the script for the play was an iterative process between a local community theatre group and the research team. Outreaches in three community open spaces were held. Evaluation comprised notes and observations from outreaches and group discussions among community audiences. Discussions were recorded, transcribed and translated to English and analysed using thematic approach. We produced an entertaining and culturally relevant performance that conveyed key messages about maternal vaccines in a clear and accessible manner in the local language. Community feedback highlighted its effectiveness in dispelling rumours and correcting misinformation while enhancing knowledge and understanding of maternal vaccination. Community members appreciated that it was informative and educational, demonstrating how research-based theatre can serve as an innovative tool for public health communication. Researchers working in comparable contexts may adapt this approach to address vaccine hesitancy in their own settings.</p
Process evaluation of an integrated community-based intervention to improve family planning, sexual reproductive Health, and wellbeing among Syrian refugee women and girls in Lebanon during active conflict
Full text linkBackground: This study presents the first process evaluation of an integrated family planning, sexual reproductive health, and wellbeing community-based intervention among Syrian refugee women and girls in Lebanon. This intervention, known as the Self-Efficacy and Knowledge (SEEK) intervention, was developed by the World Health Organization as a low-resource and low-intensity initiative, and led by trained paraprofessionals (community health workers). Methods: The intervention was implemented between September and December 2024, a period marked by active conflict in Lebanon. A mixed-methods process evaluation was conducted, triangulating data from satisfaction surveys, field observations, and semi-structured interviews with participants, health workers, and program staff. Quantitative data were analyzed using SPSS, and qualitative data were analyzed using qualitative content analysis. Data collection tools assessed satisfaction, feasibility, fidelity to content, logistical and contextual barriers. Results: The evaluation revealed high participant satisfaction, with over 90% of participants rating session quality as good or excellent. Participants valued the program’s relevance, paraprofessionals community alignment, and the inclusion of interactive and visual aids. Paraprofessionals expressed satisfaction with the training and delivery process but, along with attending psychologists and midwives, reported the need for more soft-skills training and presentation skills. Logistical challenges included child care needs, transportation barriers, and the necessity of flexible scheduling. The war on Lebanon posed major implementation hurdles, requiring adaptive strategies such as remote coordination and increased reliance on leadership of local staff. Cultural and gender norms affected engagement, particularly around SRH content, with participants recommending greater involvement of men and household decision-makers. The presence of local women committees, research assistants, and field coordinators was key to maintaining trust, communication, and retention of participants. Conclusions: This evaluation demonstrates that SEEK is feasible, acceptable, and adaptable even in the context of active conflict. Its community-led design supported engagement and delivery, underscoring the importance of flexible and locally grounded implementation strategies in fragile settings.</p
Editorial: Tips for early career researchers (ECRs) in searching the literature and in academic publishing
Full text linkImplementation strategies and outcomes of intravenous iron use for treatment of anaemia during and after pregnancy in low- and middle-income countries: A scoping review
Full text linkThere is sufficient evidence of the efficacy of Intravenous (IV) over oral iron in treating anaemia in pregnancy and postpartum. However, poor implementation can lead to little or no benefit. The objectives of this scoping review are to map and synthesise evidence related to implementation strategies and implementation outcomes of IV iron use for treating anaemia in pregnancy and the postpartum in low- and middle-income countries (LMICs). This scoping review was conducted in accordance with the Joanna Briggs Institute’s methodology for conducting scoping reviews. Electronic databases were searched to identify relevant literature sources published up until June 2025. Two independent reviewers conducted screening using the Covidence software. Descriptive statistics was used to synthesise data and findings were reported narratively. Synthesis of implementation strategies was guided by the Expert Recommendations for Implementing Change compilation. Our search yielded 4,589 publications, 20 were included in the review. Ten studies used implementation strategies, mostly “assessment for readiness and identification of barriers and facilitators” (40%; 4/10) and “promotion of adaptability” (30%; 3/10). Fourteen studies mentioned the assessment of implementation outcomes; most assessed were acceptability (42.9%; 6/14) and fidelity (35.7%; 5/14). Only five studies used any theory, model, framework (TMF) or validated measures in the implementation of strategies or assessment of outcomes. In conclusion, there is limited implementation research on the use of IV iron for the treatment of anaemia in pregnancy and the postpartum in LMICs. Critically, the use of TMFs and validated measures are deficient in current sources of evidence. More rigorous assessments of the implementation of IV iron for obstetric anaemia in LMICs are required to guide practice, policy and uptake
Drug-Coated Balloon Angioplasty vs Up-Front Stenting for De Novo CAD: 3-Year Follow-Up of REC-CAGEFREE I Trial
Full text linkBackground: Owing to the absence of a metallic scaffold, percutaneous coronary intervention (PCI) with drug-coated balloons (DCBs) may cause less chronic inflammation and potentially reduce late complications compared with drug-eluting stents (DES). However, in the REC-CAGEFREE I study, the strategy of DCB angioplasty with rescue stenting failed to achieve noninferiority to intended DES implantation for treating de novo lesions at 2 years. Objective: This study sought to investigate the 3-year outcomes of the REC-CAGEFREE I trial and assess the mid-term effects of DCBs compared with DES. Methods: REC-CAGEFREE I was an open-label, randomized, noninferiority trial conducted across 43 sites in China. After successful lesion predilation, 2,272 patients with de novo coronary artery disease (regardless of target vessel diameter) were randomly assigned (1:1) to paclitaxel-coated balloon angioplasty with the option of rescue stenting (DCB arm) vs up-front deployment of second-generation thin-strut sirolimus-eluting stents (DES arm). The primary outcome was the device-oriented composite endpoint (DOCE; including cardiovascular death, target vessel myocardial infarction [TV-MI], and clinically and physiologically indicated target lesion revascularization [CPI-TLR]) assessed in the intention-to-treat population. The extended follow-up is ongoing and will continue for up to 10 years. Results: From February 5, 2021, to May 1, 2022, 1,133 patients were randomly assigned to the DCB arm and 1,139 to the DES arm. The median diameter of devices was at 3.00 ± 0.46 mm. Rescue DES implantation after unsatisfactory DCB angioplasty was performed in 106 patients (9.4%). At 3 years, the DOCE occurred in 92 patients (8.2%) in the DCB arm and 56 (5.0%) in the DES arm (difference: 3.21%; 95% CI: 1.17%-5.26%; P = 0.002). Landmark analyses showed that the rates of difference in the DOCE at 0 to 1, 1 to 2, and 2 to 3 years were 1.69% (95% CI: 0.32%-3.06%), 1.10% (95% CI: −0.13% to 2.32%), and 0.58% (95% CI: −0.51% to 1.66%), respectively (Ptrend = 0.023). Conclusions: In patients with de novo coronary artery disease, DCB angioplasty with rescue stenting was associated with a higher rate of the DOCE compared with up-front DES implantation regarding the DOCE at 3 years.</p
Research capacity strengthening in fragile and shock-prone settings: Insights from a research consortium
No full textIntroductionResearch capacity strengthening (RCS) is acknowledged as a critical element for improving health systems through contextually-embedded research findings and recommendations. However, RCS remains a critical gap in the field of Health Policy and Systems Research (HPSR), especially in fragile and shock-prone settings facing unique challenges that further constrain research capacity. The ReBUILD for Resilience (ReBUILD) consortium, operating in Lebanon, Myanmar, Nepal, and Sierra Leone, sought to strengthen HPSR capacity across individual, organizational, and community levels. This paper reflects on the RCS approaches of the ReBUILD consortium, analyzing strategies and lessons learned.MethodsA mixed-methods approach was applied including surveys, discussions, progress reports, and meeting minutes. Data was collected iteratively at different stages of the RCS design and implementation.ResultsBased on needs and assets assessment, the RCS strategy was embedded in the consortium’s operations and adapted to local needs. Southern partners and early career researchers increasingly led initiatives, while mentorship and practical learning were emphasized. Efforts focused on strengthening individual skills and knowledge and expanded to the organizational level. Community members were trained and actively contributed to research design and implementation. Gender, equity and safeguarding were systematically integrated. The consortium’s work led to increased research outputs, policy influence, and improved local processes.ConclusionsFindings from ReBUILD’s RCS approach demonstrate that context-specific, values-driven, and multi-level strategies can effectively strengthen resilient research ecosystems in fragile and shock-prone settings. This study proposes an adapted conceptual framework for RCS that emphasizes flexibility, equity, and shared leadership as key to sustainable research capacity development
Tracking the spatial and longitudinal dynamics of mixed infections of urogenital and intestinal schistosomiasis, inclusive of Schistosoma mattheei, in two sentinel rural communities from southern Malawi
Full text linkThe World Health Organization's 2030 neglected tropical disease roadmap aims to eliminate schistosomiasis as a public health problem with preventive chemotherapy (PC) as a foundational stratergy; however, mixed infections of Schistosoma haematobium with zoonotic species, inclusive of putative hybrids, present a potential challenge. We sought to address the importance of mixed species infections through a 2-year, longitudinal epidemiological investigation at two villages in southern Malawi (Samama and Mthawira). Participants (approx. 2000) were sampled at baseline (BL), a 12-month follow-up (FU1) and a 24-month follow-up (FU2). PC was provided annually (BL-FU1) and biannually (FU1-FU2). Urine samples underwent microscopical examination and circulating cathodic antigen (CCA) rapid-diagnostic testing, with egg-patent urine filters undergoing additional molecular screening for five non-S. haematobium species using real-time polymerase chain reaction (rtPCR). Prevalence of schistosomiasis by microscopy was statistically higher in Samama than Mthawira (±0.0563, p-value = 1.3 × 10 -11), as was mixed infections with Schistosoma mattheei, by rtPCR (± 0.17, p-value = 3.84 × 10 -10). By FU2, PC reduced the prevalence of S. haematobium and Schistosoma mansoni, but that of S. mattheei remained relatively stable, rising by 0.98% at Samama (± 0.19, p-value = 0.41) and decreasing by 0.43% at Mthawira (± 0.39, p-value = 0.33). We conclude that treatment alone will not be sufficient for control of zoonotic S. mattheei, but additional interventions will be required. This article is part of the Royal Society Science+ meeting issue 'Parasite evolution and impact in action: exploring the importance and control of hybrid schistosomes in Africa and beyond'.</p
Maternal and neonatal outcomes after infection with monkeypox virus clade I during pregnancy in DR Congo: a pooled, prospective cohort study: a pooled, prospective cohort study
No full textBackground Monkeypox virus (MPXV) has been linked to vertical transmission, but systematic data are scarce. We aimed to describe the sociodemographic, clinical, and virological characteristics and assess the frequency and determinants of adverse outcomes in pregnant women with MPXV clade I infection. Methods In this prospective cohort study, we pooled data from three cohort studies (MBOTE-SK, PREGMPOX, and Uvira mpox) and one randomised controlled trial (PALM007) conducted in the South Kivu, Maniema, and Sankuru provinces of DR Congo between Dec 29, 2022, and June 20, 2025. Pregnant women and adolescent girls with a PCR-confirmed diagnosis of mpox were followed up throughout hospitalisation for mpox, delivery, and until discharge during the postpartum period. We extracted data on sociodemographic characteristics, MPXV exposure, clinical and obstetric presentation, and laboratory results. In a univariable analysis, we examined factors associated with the following adverse outcomes: spontaneous or missed abortion (<20 weeks of gestation), stillbirth (≥20 weeks of gestation), preterm birth (<37 weeks of gestation), live birth of a neonate with macroscopic mpox-like lesions, early (first 7 days) neonatal death, congenital anomaly, or maternal death (during pregnancy or discharge postpartum). Findings We collected data from 89 pregnant women in the first (25 [28%]), second (31 [35%]), and third (33 [37%]) trimesters across all four studies: MBOTE-SK (36 [40%]), PREGMPOX (24 [27%]), PALM007 (25 [28%]), and Uvira mpox (four [4%]). All participants recovered from mpox; no maternal deaths were reported. During hospitalisation for mpox, fetal loss was reported in 17 (19%) women. Final pregnancy outcomes were known for 69 (78%) participants; adverse outcomes were reported in 35 (51%) women (95% CI 38–63), including fetal loss in 31 (45%; 95% CI 33–57; 16 [52%] spontaneous abortions, four [13%] missed abortions, and 11 [35%] stillbirths). Of the 38 live births, four neonates had congenital mpox-like lesions; one infant died a few hours after birth. No preterm births or congenital abnormalities were recorded. MPXV infection during the first trimester was associated with a higher risk of adverse pregnancy outcomes than during the second (risk ratio [RR] 0·6 [95% CI 0·4–0·9]) and third (0·2 [0·1–0·4]) trimesters (p=0·0008). Adverse outcomes were also associated with high viral load in skin lesions (PCR cycle threshold ≤30; RR 3·5 [95% CI 1·0–12·3]; p=0·045), direct sexual contact with the index case (1·6 [1·1–2·4]; p=0·026), positive HIV status (2·0 [1·4–2·9]; p=0·0002), and the presence of genital lesions (1·9 [1·1–3·2]; p=0·025). Interpretation MPXV clade I infection in pregnancy is associated with a high risk of fetal loss and congenital infection, particularly during the first trimester. Targeted preventive and clinical strategies are urgently needed to protect pregnant women and their infants in settings that are endemic and epidemic for mpox. Funding The European and Developing Countries Clinical Trials Partnership, the Belgian Directorate-General Development Cooperation and Humanitarian Aid, the Swiss National Science Foundation, the Research Foundation–Flanders, the Gates Foundation, the Intramural Research Program of the National Institutes of Health, and the National Cancer Institute.</p
Safety and efficacy of adjunct dexamethasone in adults with herpes simplex virus encephalitis in the UK (DexEnceph): a multicentre, observer-blind, randomised, phase 3, controlled trial
No full textBackgroundHerpes simplex virus (HSV) encephalitis is characterised by inflammation and swelling of the brain, resulting in death or severe neurocognitive sequelae. HSV encephalitis is treated with the antiviral aciclovir but still has substantial mortality and morbidity. Adjunct corticosteroids are sometimes used, but whether they improve the outcome is unclear. We aimed to establish the safety and efficacy of adjunct corticosteroids in HSV encephalitis.MethodsIn this multicentre, observer-blind, randomised, phase 3 trial, adults with HSV encephalitis admitted to 53 hospitals in the UK were randomly assigned to receive intravenous dexamethasone (10 mg, four times daily for 4 days) plus intravenous aciclovir (10 mg/kg three times daily for at least 14 days; dexamethasone group), or intravenous aciclovir alone (control group). Eligible patients aged 16 years or older had suspected encephalitis (a febrile illness with new onset seizure, new focal neurological signs or alteration in consciousness, cognition, personality, or behaviour), with positive HSV type 1 or type 2 PCR test in CSF. Participants were randomly assigned by the trial team at the recruiting site, using a secure web-based randomisation programme. The primary outcome was verbal memory score at 26 weeks, measured by the Wechsler Memory Scale (WMS)-IV auditory memory index. Analyses of primary and secondary outcomes were performed according to the modified intention-to-treat principle, and safety analyses were based on whether participants received at least one dose of the study drug. Trial neuropsychologists assessing the primary outcome, and statisticians involved in the study's primary outcome, were masked to treatment group allocation. The trial is registered with the International Standard Randomised Controlled Trial Number Registry, ISRCTN11774734, and EudraCT, EudraCT2016-004835-19, and is completed.FindingsBetween Sept 22, 2016, and Feb 2, 2022, 94 patients with HSV encephalitis were recruited, 47 (20 [43%] female and 27 [57%] male) to the dexamethasone group, and 47 (24 [51%] female and 23 [49%] male) to the control group. Dexamethasone was initiated a median 7 (IQR 4–8) days after hospital admission. Seven patients withdrew consent, and six were lost to follow-up. Thus, 81 were included in the modified intention-to-treat analysis (39 in the treatment group and 42 in the control group). The primary outcome, verbal memory score at 26 weeks, did not differ significantly between the groups (71 [SD 26] in the dexamethasone group, and 69 [SD 25] in the control group; adjusted difference 1·77 [95% CI –9·57 to 13·12; p=0·76). There were 27 adverse events involving 18 (38%) participants in the control group, and 25 adverse events involving 18 (40%) participants in the dexamethasone group. The most common serious adverse events were seizures requiring readmission to hospital (affecting one [2%] patient in the dexamethasone group and one [2%] patient in the control group) and thrombotic events, including deep vein thrombosis (affecting one [2%] patient in the dexamethasone group) and pulmonary embolism (affecting one [2%]patient in the dexamethasone group). There were no treatment-related deaths.InterpretationIn adults with HSV encephalitis, dexamethasone plus aciclovir had a satisfactory safety profile but did not improve verbal memory score compared with aciclovir alone. Given the established role of corticosteroids in other inflammatory encephalitides, our findings suggest that their early use in suspected encephalitis is unlikely to be harmful. Future studies should assess more targeted immunomodulatory approaches in HSV encephalitis.FundingNational Institute for Health and Care Research.Research in contex