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Impact of a community-led intervention on the uptake of childhood vaccines in Liverpool: A protocol for a synthetic control evaluation
Full text linkIntroduction: Vaccines are our best defence against infectious diseases, yet uptake of childhood immunisation programmes has consistently declined in the UK, with growing concerns around socioeconomic inequalities. Liverpool, in particular, demonstrated some of the lowest uptake rates in England since 2019. In response, the Health Equity Liverpool Project (HELP) implemented a hyper-localised community-led initiative between September 2023 and June 2024 to tackle vaccine hesitancy. Activities included outreach events and school-based engagement across nine sites within Liverpool. Despite promising qualitative evidence, the intervention’s impact on childhood vaccine uptake has not yet been quantified. We aim to evaluate the population level impact of the HELP intervention on the uptake of five childhood vaccines (first and second doses of the measles, mumps, and rubella vaccine (MMR1, MMR2), 6-in-1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b (Hib) and hepatitis B), pneumococcal conjugate vaccine booster dose (PCV), and rotavirus vaccine) using synthetic control methods. Methods and Analysis: We will analyse publicly available quarterly vaccine uptake data (between April 2019 and March 2025) from the Cover of Vaccination Evaluated Rapidly (COVER) programme for general practices (GPs) in England. The intervention group will be defined as practices located within a 1 km radius of the intervention sites. A synthetic control group will be constructed using non-intervention GPs matched on pre-intervention vaccine uptake, and linked demographic, socioeconomic, and healthcare capacity covariates. Primary outcomes are the uptake of MMR1 and MMR2 vaccines. Secondary outcomes include the uptake of 6-in-1, PCV, and rotavirus vaccines. Average treatment effects will be estimated as the post-intervention difference in uptake between intervention and synthetic control groups. Sensitivity analyses will examine spillover effects, alternative spatial definitions of exposure, the biasing effect of concurrent interventions, and the feasibility of analysis at small area neighbourhood level.Ethics and Dissemination: This study will be conducted as part of the ReCITE project, which has received ethical approval from the Liverpool School of Tropical Medicine Research Ethics Committee (Reference: 24-018) and is funded by the UK Arts and Humanities Research Council (Project Number: AH/Z505341/1). Findings will be shared with the project funder and submitted for publication in a peer-reviewed journal.<br/
Dynamic interactions between Schistosoma haematobium, Schistosoma mattheei and Schistosoma mansoni underscore the complex polyparasitism of intestinal schistosomiasis in southern Malawi
Full text linkSchistosomiasis is prevalent among school-aged children (SAC) in Mangochi District, Malawi, where both intestinal and urogenital forms are endemic. In 2024, we identified schistosomiasis cases predominantly associated with excretion of Schistosoma haematobium × Schistosoma mattheei ova in the faeces of two individuals from Samama village, Mangochi District. In this expanded cross-sectional study, we characterize the prevalence and species composition of Schistosoma infections among 247 SAC in Samama, using genus- and species-specific molecular diagnostics. We also present follow-up data from the two previous cases, showing natural mixed-species re-infection six months after treatment. Schistosomiasis prevalence among SAC was 62.3%. Schistosoma spp. DNA was detected in 50.6% of faecal samples and Schistosoma spp. ova were observed on 34.8% of urine filters. Species-specific assays detected S. haematobium, S. mattheei and S. mansoni DNA in 36.8%, 14.4% and 18.4% of faecal samples from children with intestinal schistosomiasis. Triple-species infections were identified in 10 children by faecal and urine testing. Notably, detection of S. haematobium DNA in faeces was strongly associated with S. mattheei co-infection (p = 0.006), highlighting potential cross-species interactions. Our findings underscore the need to integrate molecular diagnostics alongside routine testing strategies for enhanced surveillance of polyparasitic infections in zoonotic transmission zones across Africa. 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
Medical oxygen and respiratory support requirements for patients hospitalised with COVID-19 in 23 low-income and middle-income countries: a prospective, observational cohort study
Full text linkBackground: The COVID-19 pandemic highlighted a global shortage of, and inequity of access to, medical oxygen. Understanding patient outcomes and the capacities of health facilities to provide respiratory support including oxygen is key to matching need and demand. We report results from a global study including 23 low-income and middle-income countries. Methods: For this prospective, observational cohort study, consecutive patients aged 12 years or older with suspected or confirmed COVID-19 and evidence of respiratory distress were prospectively recruited within 24 h of hospital admission. Hospitals from 23 low-income and middle-income countries were included, representing all WHO regions. Baseline demographic and clinical data were collected, and daily follow-ups were recorded for in-hospital outcomes and respiratory support types. At the facility level, we assessed sources of oxygen and electricity, infrastructural and staffing capacity for critical care provision, and the capabilities of the facility for advanced respiratory support. The primary outcome was 30-day in-hospital mortality. This study was registered on ClinicalTrials.gov (NCT04918875). Findings: Between Jan 24 and Nov 22, 2022, 56 sites took part. Of 53 726 patients screened, 3070 were enrolled. 1814 (61·6%) of 2947 patients had two or more underlying medical conditions and initially received oxygen through nasal cannula or non-rebreather face masks with reservoir. Invasive mechanical ventilation was most frequently used in patients recruited in the Americas (75 [26·4%] of 284 patients) and in the Eastern Mediterranean (90 [18·0%] of 499 patients). The overall mortality was 649 (23·4%) of 2779 patients, varying by region from 53 (10·5%) of 506 patients in South-East Asia to 286 (37·6%) of 760 patients in Africa. Mortality was associated with the maximum level of respiratory support received: from 17 (8·6%) of 198 patients who received no oxygen, 99 (38·4%) of 258 patients for non-rebreather reservoir bags, and 205 (62·9%) of 326 for invasive ventilation. Interpretation: The availability and use of oxygen support options in low-income and middle-income countries are highly variable but appear significantly less in the African region. Mortality might be associated with a lack of access to oxygen, which varied across WHO regions but was highest in Africa. Despite many lessons learned from the COVID-19 pandemic, inequity in access to medical oxygen remains a challenge that WHO and partners must address in the post-pandemic era to avoid preventable deaths. Funding: UNITAID.</p
Evaluating a Culturally Tailored Digital Storytelling Intervention to Improve Trauma Awareness in Conflict-Affected Eastern Congo: Quasi-Experimental Pilot Study
Full text linkBackground: Posttraumatic stress disorder (PTSD) is highly prevalent in conflict-affected regions like eastern Democratic Republic of Congo; yet, cultural stigma and lack of psychoeducation limit public understanding and help-seeking behaviors. Objective: This study evaluates the effect of a short, culturally adapted animated video on mental health perception, knowledge, and attitudes toward trauma. Methods: A community-based quasi-experimental pre-post design was implemented among 239 participants from South Kivu. The intervention involved viewing a 3-minute animated psychoeducational video portraying locally relevant PTSD symptoms and resilience strategies. Perception, knowledge, and attitude scores were measured before and after the intervention, alongside PTSD prevalence and video appreciation. Results: Out of 239, 40% (n=96) of the participants screened positively for PTSD. Post intervention, significant improvements were observed in perception (P=.01), knowledge (P<.001), and attitudes (P=.001) toward trauma. Appreciation was high; 82% (n= 195) expressed empathy for the characters, and 74% (n= 176) were likely to share the video. Linear regression showed that having PTSD symptoms (β coefficient=3.29, SE=1.09; P=.003), years of education (β coefficient=0.54, SE=0.08; P<.001), empathy toward the portrayed situations (β coefficient=5.07, SE=0.56; P<.001), perceived acquisition of new knowledge (β coefficient=2.58, SE=0.59; P<.001) and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) predicted stronger positive effect. A multiple linear regression including all predictors revealed that PTSD symptoms (β coefficient=1.93, SE=0.90; P=.03), years of education (β coefficient=0.47, SE=0.07; P<.001), empathy toward the portrayed situations (β coefficient=3.50, SE=0.55; P<.001), and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) remained significant predictors of video impact. Age and perceived acquisition of new knowledge were not significant in the multivariate model. This model accounted for 44.6% of the variance in video impact scores (R2=0.446, F6,231=30.99, P<.001). Conclusions: This study highlights the effectiveness of culturally grounded, low-cost digital media for improving mental health literacy in postconflict settings. Video-based tools may serve as scalable components of trauma-informed care and public health communication in low-resource, high-need areas.</p
Navigating the trials of a trial: lessons from ProRIDE on recruitment, retention, and follow-up in rural Africa
Full text linkThe ProRIDE randomized clinical trial (RCT) started participant recruitment in February 2022, successfully enrolling 2,000 infants within an 11-month period and achieving a follow-up rate of 97% at six months of age. This narrative article describes critical components of the research protocol, the composition of the research team, community sensitization efforts, and the local performance of the study. The research initiative was conceptualized by a collaborative group of scientists from both high- and low-income countries, and its successful implementation was contingent upon the active involvement and participation of a rural, low-income community. Based on previous study findings in Tanzania, which consistently indicated a high prevalence of severe infections related to multidrug-resistant bacteria, the research team recognized the urgent need for preventive strategies aimed at reducing the incidence of sepsis and severe bacterial infections. Given the scarcity of data from rural areas and the imperative for inclusivity, the rationale for conducting this RCT in a rural context was compelling. We believe that a key factor in the successful completion of this trial was the intentional design of a simple, straightforward, and practical intervention, and study framework. Caregivers administered the study medication at home, thereby mirroring real-world therapeutic practices and enhancing the generalizability of the findings. To ensure adherence to the one-month intervention regimen, the research team conducted a day-seven home visit to confirm proper administration of the investigational product and address any associated early challenges. During this interaction, the field workers reiterated the instructions for the proper application of the product, thereby serving as a reminder to the caretaker regarding its correct usage. Additionally, a thorough planning phase was undertaken prior to the study's commencement, involving extensive collaboration between the researchers from Norway, Muhimbili University of Health and Allied Sciences, Tanzania, and the leadership at Haydom Lutheran Hospital. Through a series of meetings and discussions, the research team in Norway and Tanzania identified specific areas requiring enhancement, particularly in laboratory infrastructure and the training of personnel in blood culture techniques and antimicrobial susceptibility testing. Despite facing numerous challenges both prior to and during the trial, this RCT successfully recruited 2,000 participants within 11 months. This accomplishment can be attributed to the strong collaboration and teamwork exhibited throughout the process. The insights gained from this study may be of particular interest to researchers and scientists aiming to conduct investigations involving infants and children in low-income settings. Trial registrations This trial is registered with ClinicalTrials.gov, NCT04172012. November 21, 2019.</p
Introduction of confidential enquiry into maternal deaths in Ethiopia: Implementation and methodological considerations
Full text linkBackground: Despite having high maternal mortality, no recent confidential enquiry into maternal deaths (CEMD) has been implemented in Ethiopia. This paper outlines the introduction of the CEMD, major findings, and key methodological considerations. Methods: We embedded this CEMD in the ongoing Ethiopian Obstetric Surveillance System (EthOSS), a regional system that monitors a range of major obstetric conditions in eastern Ethiopia. Multiple methods (both qualitative and quantitative) were used to collect, analyse and report the data. A multidisciplinary committee was established and trained on principles and methodology of CEMD by international experts. The CEMD committee conducted two plenary CEMD sessions to review maternal deaths reported from April 1, 2021, to March 31, 2022, from 13 hospitals in the EthOSS consortium. Each case was assessed for causes, contributing factors, delays in care using the three-delays model, preventability, and recommendations for improving care. Results: Out of 70 maternal deaths, in 59 there was enough information to enable a review by the committee; 27/59 (46%) and 15/59 (25%) were caused by obstetric haemorrhage and hypertensive disorders of pregnancy respectively. In 55/59 (93%), at least one of the three delays was identified: delay one (seeking care) in 48 (81%), delay two (reaching an appropriate facility) in 52 (88%), and delay three (receiving adequate care) in 54 (92%). The review indicated that almost all reported deaths could have been prevented with better care. Conclusions: Almost all the maternal deaths in the region were considered preventable. Training for improving providers’ clinical skills, improving availability of blood and basic supplies, strengthening postpartum monitoring, and referrals were recommended for saving lives through reducing preventable maternal deaths.</p
Availability, acceptability and adoption of decision aids for HIV prevention and contraception for young people a scoping review protocol
No full textINTRODUCTION: Young people face challenges in accessing information on HIV and sexual and reproductive health services, with corresponding suboptimal uptake. Decision aids can provide information and decisional support to improve young people's engagement with health interventions. However, they have not been widely implemented among young people. The availability of different choices for HIV and pregnancy prevention means that it is important to implement interventions that facilitate informed choices for these methods. We describe a protocol for a scoping review that aims to explore the availability, acceptability and use of decision aids for HIV prevention and contraception for young people. METHODS AND ANALYSIS: We will identify relevant studies from the following electronic databases from inception to current date: PubMed, Scopus and Global Health; and grey literature databases, namely medRxiv and Open Access Theses and Dissertations. Eligible studies will report on HIV prevention and/or contraception decision aids and be written in English. Data extraction will be done by two reviewers independently using templates, with discrepancies resolved by consensus. Analysis will be done narratively, and separate for HIV prevention and contraception decision aids. Analysis will also include determination of the suitability of each decision aid for use by young people aged 15-24 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews will be employed to present results. ETHICS AND DISSEMINATION: This review does not require ethics approval. The findings from this work will be disseminated through peer-reviewed publications and presentations at local and international conferences. </p
Identifying community pharmacists’ preferences for attributes of public health interventions in Kenya a discrete choice experiment
Full text linkCommunity pharmacies are increasingly recognized as access points for public health interventions (PHIs) such as vaccination, family planning services, and disease screening. In Kenya, evidence suggests the feasibility of pharmacy-delivered PHIs; however, the uptake remains inconsistent. This is partly attributed to poor programme design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DCE) to investigate community pharmacists’ preferences for attributes of PHIs delivered in community pharmacies in Kenya. We constructed a Bayesian efficient design and conducted a DCE survey among 663 community pharmacy providers in Makueni, Nairobi, and Kisumu counties in Kenya from January 2025 to March 2025. Panel multinomial mixed logit, generalized multinomial logit, and latent class models were used in the analysis. We also estimated willingness to pay (WTP) and willingness to accept (WTA) estimates using cost and profit margins as the monetary estimates, respectively. We found that community pharmacists were willing to offer PHIs with a low preference for opting out (β = −3.5723, P < 0.01). Preferences for PHIs significantly increased with higher profit margins (β = 0.028, P < 0.01) and decreased with higher cost of equipment (β = −0.00023, P < 0.01). There were higher preferences for PHIs that require moderate training (β = 0.266, P < 0.01) and extensive training (β = 0.141, P < 0.05) compared to no additional training and lower preferences for PHIs with complex interventions compared to simple interventions (β = −0.323, P < 0.01). The WTP estimates showed that providers were willing to pay Khs. 11 738 (USD 90) for moderate training and Kshs. 7327 (USD 56) for extensive training. Moreover, the WTA estimates showed that providers were willing to accept a 10.9% increase in profit margin in order to deliver complex interventions. In addition to this, a three-class latent class model revealed preference heterogeneity among the respondents. These findings can be used to inform the design of PHIs to enhance uptake and acceptability among providers.</p
Versatile HIV Rev-dependent reporter cell system for stringent and sensitive quantification of viral reservoirs, neutralizing antibodies, and restriction factors
Full text linkDetecting and measuring HIV reservoirs, neutralizing antibodies, and restriction factors are important for HIV cure research and the development of new therapeutics and vaccines. Here we describe the development and validation of several HIV Rev-dependent indicator cell lines for these purposes. These reporter cells derive from different T-lymphoblast cell lines, including Molt4-CCR5, SupT1-CCR5, CEM-SS, A3R5, and from the adherent TZM cell platform based on HeLa clone JC53. These cells express CD4, CXCR4, and various levels of CCR5. We compared these cell lines for responsiveness to both X4 and R5-tropic viruses, and confirmed that reporter expression in these cells is not affected by stimulation from mitogens but is responsive to HIV Tat and Rev, reducing non-specific reporter induction from the leaky LTR promoter. To validate the sensitivity of the Rev-dependent reporter cell systems, we conducted a viral dilution assay with three primary HIV-1 clade C swarms from an adult in Malawi. We also validated the systems for quantifying antibody neutralization and screening restriction factors; these systems are also sensitive for viral outgrowth assays for quantifying viral reservoirs in clinical and basic research settings. Given that the systems can measure HIV accurately in complex environments with mitogens or other substances, they can be used for versatile applications, such as quantifying latent reservoirs, testing inhibitory compounds, conducting neutralizing antibody assays, and identifying new restriction factors.</p
Housing modifications for heat adaptation, thermal comfort and malaria vector control in rural African settlements
Full text linkThe rapid increase in global temperatures coupled with persistent malaria transmission presents substantial health burdens in sub-Saharan Africa. Here this randomized pilot field study assessed the feasibility of sustainable housing modifications via passive cooling approaches and vector proofing. Forty houses were randomly allocated to four arms: cool-roof, cross-ventilation, mat-ceiling or control. Doors, windows and eaves of the intervention houses (not control) were screened for malaria mosquito vectors. Indoor temperature and humidity were monitored continuously to assess Heat Index (HI), predicted mean value and psychrometric charts. The HI in cool-roof houses was the lowest (daytime −3.3 °C, P < 0.001; nighttime −2.4 °C, P < 0.01). Mat-ceiling houses lowered daytime HI but increased nighttime HI compared to control. No differences in HI were observed for cross-ventilation houses. Screening reduced the number of female Anopheles funestus mosquitoes by 77% and the number of Culex mosquitoes by 58% compared to control houses. Eighty-five percent of the households expressed willingness to use their resources for housing intervention. Cool-roofs combined with vector proofing is an effective, practical and sustainable housing modification for heat adaptation and for reducing indoor mosquito numbers in rural African households.</p