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Exploring the intersectional psychosocial impact of epilepsy in Nepal:a gender lens approach
Get PDFIntroduction: Epilepsy impacts multiple aspects of the lives of people living with epilepsy (PLWE). We explored the psychosocial impact of the disease on the lives of PLWE in Nepal and the intersectionality of impacts with gender. Methods: In-depth interviews were conducted between March 2023 and June 2023 with twenty participants (10 male and 10 female) receiving treatment for epilepsy at Kathmandu Medical College (KMC) and Nepal Epilepsy Association (NEA). A rich account of the participants’ lived experiences was explored through probing and intuition. Data were explored using thematic analysis. Results: Stigma associated with epilepsy was the most common factor affecting the quality of life (QoL) of PLWE. The psychosocial impacts of epilepsy included limited employment and educational opportunities, limited socializing, inability to drive vehicles, inability to engage in sports and activities such as swimming. Epilepsy and anti-seizure medication (ASM) had marked effects on the sexual and reproductive health (SRH) of the participants. Women living with epilepsy (WLWE) reported more SRH problems than men. Participants adopted various coping mechanisms to deal with the disease. A greater proportion of male participants mentioned actively adopting coping mechanisms to improve their QoL with epilepsy. Epilepsy affected the interpersonal relationships of PLWE, especially spousal relationships and friendships. The negative impact on spousal relationships was more severe for women than for men living with epilepsy. Access to effective ASM mitigated many of the most severe impacts for PLWE. Conclusion: Social factors, specifically stigma associated with epilepsy, have important multidimensional effects on the QoL of PLWE. Seizure control through appropriate ASM is a critical factor in obtaining high QoL. Experiences of PLWE are strongly gendered. Women report more psychosocial and biological (reproductive) impact of the disease, while men are more proactive in adopting active coping mechanisms to deal with the disease. Establishing strong psychosocial support systems is critical to improving QoL of all PLWE.</p
A whole blood assay for antibody dependent phagocytosis of Plasmodium falciparum infected erythrocytes
Get PDFBackground: Antibodies are used to protect against Plasmodium falciparum malaria. One antibody target, the variant surface antigens, is expressed on infected erythrocytes (IEs). Antibodies to these antigens can either block IE sequestration in the tissues, facilitate natural killer cell-mediated killing, or opsonise IEs for phagocytic clearance by neutrophils and monocytes. Methods: We developed a high-throughput assay to measure antibody-dependent neutrophil phagocytosis (ADNP) and antibody-dependent cellular phagocytosis (ADCP, by blood monocytes) in the same sample of fresh whole blood. Results: Here we show that immune plasma mediates ADNP and ADCP in a concentration-dependent manner. Uptake is greater in the presence of complement proteins and is largely dependent on the expression of P. falciparum Erythrocyte Membrane Protein 1 located on the IE surface. Plasma from pregnant Papua New Guinean women with and without placental malaria shows that ADNP and ADCP are associated with protection from placental malaria. ADNP, but not ADCP, using IEs expressing IT4VAR19 (a PfEMP1 variant that binds to endothelial protein C receptor through a DC8 domain cassette) is higher at hospital presentation in children with uncomplicated malaria than in severe malaria. In pregnant women, ADNP and ADCP in whole blood are strongly correlated with one another (Spearman’s rho = 0.90), but not with ADNP or ADCP using purified neutrophils and monocytes in the absence of complement proteins.Conclusions: The whole blood assay is a powerful new tool to assess functional antibodies that may protect against P. falciparum malaria. It allows simultaneous measurement of phagocytosis of opsonised IEs by monocytes and neutrophils.</p
Long-Term Outcomes of BAV-0 Patients Compared With BAV-1 and TAV Patients After TAVR
Get PDFBackground: Differences in long-term clinical outcomes following transcatheter aortic valve replacement (TAVR) in different anatomical subtypes of aortic valve stenosis (AS), specifically tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV) of types 0 (BAV-0) and 1 (BAV-1), are not well understood. Objectives: The authors sought to report and compare the long-term clinical outcomes among patients with different anatomical subtypes of AS undergoing TAVR. Methods: We conducted an international retrospective cohort study involving patients who underwent TAVR for severe AS at 3 large, high-volume heart centers in China, Germany, and Denmark before October 2018. Five-year follow-up ended on October 30, 2023, and the primary endpoint was all-cause mortality. Results: A total of 2,553 AS patients (BAV-0: n = 134; BAV-1: n = 305; TAV: n = 2,114) who underwent TAVR more than 5 years ago were included. The mean age of this cohort was 79.9 ± 6.8 years, and the median Society of Thoracic Surgeons score was 3.6% [Q1-Q3: 2.4%-5.4%]. The median follow-up time was 3.24 years (Q1-Q3: 1.25-5.00 years). At 5 years, BAV-1 (adjusted HR: 2.38 [95% CI: 1.32-4.28]; P = 0.004) and TAV (adjusted HR: 3.02 [95% CI: 1.71-5.31]; P < 0.001) had a higher risk for all-cause mortality after TAVR compared with BAV-0. BAV patients who were treated with balloon-expandable valves had a higher long-term all-cause mortality (41.7% [28.5%-52.5%] vs 23.6% [17.9%-28.8%]; HR: 1.63 [95% CI: 1.05-2.51]; P = 0.028) compared with those with self-expanding valves. Conclusions: Among patients with severe AS undergoing TAVR, BAV-0 was associated with a better long-term prognosis compared with TAV and BAV-1.</p
Gender disaggregation of the TB care cascade in Nigeria::a four-year retrospective study 2018–2021
Get PDFThe global TB burden shows significant gender disparity with men and women facing distinct challenges in accessing comprehensive care for TB. A full understanding of the gender dimensions of the TB epidemic is crucial for appropriate policy interventions and we therefore explored gender differences in the TB service cascade in Nigeria.A retrospective gender-based analysis of the TB care cascade was conducted covering the four-year period between 2018–2021. We obtained sex-disaggregated service utilisation data for adults (aged ≥15 years) in 14 states through the monitoring and evaluation systems of the TB control programme. Using a care cascade framework, we present numbers accessing care at each step and gaps for men and women including TB/HIV collaborative services.Overall, amongst men, 12.3 million visited health facilities, 6 million were screened for TB and 833,483 were identified as presumptive cases, of which 79% were tested for TB. For women, 12.3 million visited facilities, 6.9 million screened and 664,130 identified as presumptive cases, of which 76% were tested. Men exhibited a higher screening gap, whereas women had a higher testing gap, with variations in treatment outcomes across both genders.The TB surveillance system screened more women and diagnosed more men with the disease, with significant missed opportunities and gaps along the continuum of care for both men and women. Targeted policy interventions are required to strengthen surveillance, data systems and to reduce gender inequity across the TB care cascade in Nigeria
Effect-based and (non-)target chemical analyses reveal concerning levels of emerging contaminants in urban streams in Sub-Saharan Africa
No full textWater contamination by micropollutants is a global issue, yet there is limited information from low-income regions. To address this, we evaluated surface water quality in rapidly growing Sub-Saharan area of Malawi lacking wastewater treatment. Integrated assessment of passive sample extracts representing wet and dry seasons combined effect-based approach with in vitro bioassays, target and non-target chemical analyses (NTS). It revealed specific contamination profiles characterized by high concentrations of numerous pollutants, frequent exceedances of Predicted No-Effect Concentrations, and concerning levels of certain insecticides (chlorpyrifos, pirimiphos-methyl) and pharmaceuticals (sulfamethoxazole, trimethoprim, diclofenac). Proposed threshold values were exceeded for estrogenicity, androgenicity, aryl hydrocarbon receptor-mediated activity, thyroid hormone receptor agonism, and transthyretin (TTR) binding inhibition (highest effect-based trigger value exceedance, over 600-fold), which indicates risks to aquatic life. The combination of TTR pull-down assay, NTS, and bioassays enabled the isolation and identification of active compounds, including previously unreported TTR ligands 4-hydroxychlorothalonil (pesticide metabolite) and chlorothiazide (diuretic). Linear alkylbenzene sulfonates and related features contributed most significantly to TTR binding inhibition. This study introduces novel analytical approaches to address challenging groups of surfactants occurring in technical mixtures containing multiple branched isomers. The results underscore the added value of implementing effect-based assessment in understudied regions and the challenges posed by transformation products and technical mixtures lacking standards and reference spectra in NTS libraries. Our findings emphasize the need to expand MS/MS spectral libraries by incorporating metabolites and transformation products. The study highlights the impacts and risks of untreated wastewater discharges in regions affected by climatic and socio-economic pressures.</p
1206 genomes reveal origin and movement of Aedes aegypti driving increased dengue risk
Get PDFThe emergence and global expansion of Aedes aegypti puts more than half of all humans at risk of arbovirus infection, but the origin of this mosquito and the impact of contemporary gene flow on arbovirus control are unclear. We sequenced 1206 genomes from 73 globally distributed locations. After evolving a preference for humans in Sahelian West Africa, the invasive subspecies Ae. aegypti aegypti (Aaa) emerged in the Americas after the Atlantic slave trade era and expanded globally. Recent back-to-Africa Aaa migration introduced insecticide resistance and anthropophily into regions with recent dengue outbreaks, raising concern that Aaa movement could increase arbovirus risk in urban Africa. These data underscore developing complexity in the fight against dengue, Zika, and chikungunya and provide a platform to further study this important mosquito vector.<br/
Quantifying intra-urban socio-economic and environmental vulnerability to extreme heat events in Johannesburg, South Africa
No full textUrban populations face increasing vulnerability to extreme heat events, particularly in rapidly urbanising Global South cities where environmental exposure intersects with socioeconomic inequality and limited healthcare access. This study quantifies heat vulnerability across Johannesburg, South Africa, by integrating high-resolution environmental data with socio-economic and health metrics across 135 urban wards. We examine how historical urban development patterns influence contemporary vulnerability distributions using principal component analysis and spatial statistics. Environmental indicators (Land Surface Temperature (LST), vegetation indices, and thermal field variance) were combined with socioeconomic and health variables (including indicators on crowded dwellings and healthcare access, self-reporting of chronic diseases) in a comprehensive vulnerability assessment. Principal Component Analysis revealed three primary dimensions explaining 56.6% (95% CI: 52.4–60.8%) of the total variance: urban heat exposure (31.5%), health status (12.8%), and socio-economic conditions (12.3%). Built-up areas showed weak but significant correlations with heat indices (ρ = 0.28, p < 0.01), while higher poverty levels demonstrated moderate positive correlations with LST (ρ = 0.41, p < 0.001). The spatial analysis identified significant clustering of vulnerability (Global Moran's I = 0.42, p < 0.001), with distinct high-vulnerability clusters in historically disadvantaged areas. Alexandra Township showed the highest vulnerability(HVI score: 0.87, LST: 29.8 °C ± 0.4 °C, NDVI: 0.08 ± 0.02), with factors characterising the high vulnerability in that area including limited healthcare access and extreme heat exposure. Northern suburbs formed a significant low-vulnerability cluster (Mean HVI = 0.23 ± 0.07, p < 0.001), benefiting from greater vegetation coverage and better healthcare access. These findings demonstrate how historical planning decisions continue to shape contemporary environmental health risks, with vulnerability concentrated in areas of limited healthcare access and high extreme heat exposure. Results suggest the need for targeted interventions that address both environmental and social dimensions of heat vulnerability, particularly focusing on expanding healthcare access in identified hotspots and implementing community-scale green infrastructure in high-risk areas. This study provides an evidence-based framework for prioritising heat-resilience initiatives in rapidly urbanising Global South cities while highlighting the importance of addressing historical inequities in urban adaptation planning.</p
Unravelling the nuances: A scoping review on fatherhood and men’s participation in antenatal care in rural Sub-Saharan Africa
Get PDFMen’s participation in antenatal care (ANC) in sub-Saharan Africa (SSA) is shaped by diverse conceptions and experiences of fatherhood. However, most discussions rely on biomedical models that typically view men’s participation narrowly as a strategy to increase ANC uptake in mainstream health facilities, often marginalizing culturally specific forms of participation. We aimed to consolidate the existing literature on the complex nuances of how attitudes, knowledge, variations in involvement, and decision-making dynamics influence men’s participation in ANC in rural SSA.MethodsFollowing the scoping review methodology developed by Arksey and O’Malley, wesearched ten databases (African Index Medicus, Africa Journals Online, CINAHL,Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, Sociology Collection,Social Sciences Abstract, Social Sciences Citation Index) for peer-reviewed articles fatherhood and men’s participation in ANC in a rural setting in SSA. We applied no language restrictions.ResultsWe identified 7665 articles, full-text reviewed 797 articles, and included 77 articles that reported 58 qualitative, 6 quantitative, and 13 mixed-methods studies conducted in 15 SSA countries. We identified nine themes under three categories addressing our review’s objective: 1) three themes described men’s attitudes and knowledge around participating in ANC; 2) four themes depicted variations in men’s participation in ANC throughout pregnancy; and 3) two themes described how men’s participation in ANC was shaped by largely collaborative communal decision-making structures in rural SSA.ConclusionWhile heterogeneous, the existing body of evidence highlights contextually-valid and socioculturally meaningful nuances that reflect the lived realities of fatherhood and men’s participation in ANC across rural SSA. Policymakers and practitioners should leverage these nuances as strengths, and further research should employ Afrocentric approaches to better understand these issues.published between January 1st, 2000, and October 31st, 2024. We includedonly studies that systematically analyzed primary or secondary data to examin
An evaluation of screening methods for the detection of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in environmental samples from healthcare settings
No full textAbstractAimsExtended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) infections are increasingly problematic, leading to worse treatment outcomes and higher healthcare expenditure. This study evaluated laboratory workflows for the detection of ESBL-E in healthcare environments. We aimed to optimise workflows for organism yield, detection accuracy and practical feasibility to support future surveillance and transmission studies, which are needed to inform targeted interventions to interrupt the spread of drug-resistant organisms.Methods and ResultsWe sampled sinks, toilets, shower drains, shower heads, and high-touch surfaces, within six healthcare facilities in Liverpool, UK. We then assessed recovery of ESBL-producing Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp) using two swab types (foam and polyester), two pre-enrichment broths (Buffered Peptone Water and Tryptic Soy Broth), two incubation times (4 and 18 hours) and four selective agars (CHROMagar ESBL, cefotaxime-supplemented MacConkey, Membrane Lactose Glucuronide Agar and Simmons Citrate Agar with Inositol).Pre-enrichment for 18 hours significantly increased recovery of third-generation cephalosporin resistant Gram-negatives, compared to 4 hours. The choice of selective agar impacted the number of ESBL-Ec and ESBL-Kp detected and the number of samples requiring additional species confirmation. We found CHROMagar ESBL and cefotaxime-supplemented Membrane Lactose Glucuronide Agar performed best overall, demonstrating the highest yield and detection accuracy (i.e. colour of colonies matched their confirmed species) of ESBL-Ec and ESBL-Kp.ConclusionsPre-enrichment for 18 hours in Buffered Peptone Water, followed by plating onto cefotaxime-supplemented Membrane Lactose Glucuronide Agar, was the most effective screening method in our context, having a high detection efficacy, whilst maintaining a scalable and accessible cost
Costs and cost-effectiveness of community health worker programmes focussed on non-communicable diseases in low- and middle-income countries (2015–2024): a scoping literature review
Get PDFBackground Non-communicable diseases (NCDs) are the leading cause of death and morbidity worldwide, responsible for 7 out of 10 deaths, 86% occurring in low- and middle-income countries (LMICs). As the NCD burden on health systems increases, community health workers (CHWs) have become increasingly involved in NCD care provision and management. This study updates a 2015 review to synthesise and critically analyse the recent evidence base on the cost-effectiveness and affordability of CHW programmes addressing NCDs in LMICs. Methods A scoping review searched 10 databases and the grey literature for original studies published between August 2015 and July 2024. Recognised search terms related to ‘Community Health Workers’ and ‘Economic Evaluation(s)’ in LMICs were used. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form and analysed using Microsoft Excel. Results We identified 20 studies with 52 different scenarios covering five areas: cardiovascular disease including hypertension (n=22 scenarios); human papillomavirus and cervical cancer screening (n=13); diabetes (n=12); mental health (n=4); and behavioural risk factors (n=1). Of the 44 scenarios assessing cost-effectiveness, 35 scenarios suggest that CHW programmes are cost-effective. 11 studies compared CHW programmes against an alternative (usual care) to generate an incremental cost-effectiveness ratio, evaluated against the country’s gross domestic product per capita. Methodological heterogeneity across studies and inconsistencies or data gaps in reporting (most importantly the lack of CHW salary information) limits the usefulness of the data. Few studies assessed affordability, despite being equally relevant to decision-making. Conclusions More studies including economic evaluations (particularly for NCDs not found in our review), along with more robust and consistent reporting are needed.</p