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Evaluating the impact of two next-generation long-lasting insecticidal nets on malaria incidence in Uganda: an interrupted time-series analysis using routine health facility data
Get PDFIntroduction Malaria remains a significant public health challenge globally, particularly in sub-Saharan Africa, where progress has stalled in recent years. Long-lasting insecticidal nets (LLINs) are a critical preventive tool against malaria. This study investigated the effectiveness of newer-generation LLINs following a universal coverage campaign in Uganda.Methods Health facility data collected 36 months prior to LLIN distribution and 24 months after LLIN distribution were used from 64 sites that took part in a cluster-randomised trial comparing two newer-generation LLINs (pyrethroid-piperonyl butoxide and pyrethroid-pyriproxyfen). Using an interrupted time-series approach, we compared observed malaria incidence with counterfactual scenarios if no LLINs were distributed, adjusting for precipitation, vegetation, seasonality and care-seeking behaviour. Analyses were also stratified by LLIN type and study-site level estimates of transmission intensity.Results Overall, malaria incidence decreased from 827 cases per 1000 person-years in the predistribution period to 538 per 1000 person-years in the postdistribution period. Interrupted time-series analyses estimated a 23% reduction in malaria incidence (incidence rate ratio [IRR]=0.77, 95% CI 0.65 to 0.91) in the first 12 months following distribution relative to what would be expected had no distribution occurred, which was not sustained in the 13–24 month post-distribution period (IRR=0.97, 95% CI 0.75 to 1.28). Findings were similar when stratified by LLIN type. In the first 12 months following distribution, LLIN effectiveness was greater in the high-transmission sites (IRR=0.67, 95% CI 0.54 to 0.86) compared with the medium- (IRR=0.74, 95% CI 0.59 to 0.92) and low-transmission sites (IRR=0.87, 95% CI 0.56 to 1.32).Conclusion This study demonstrated a modest reduction in malaria incidence following the distribution of newer-generation LLINs that was sustained for only 12 months, highlighting the need for improved strategies to maintain net effectiveness. Adjusting the frequency of universal coverage campaigns based on local malaria transmission intensity may enhance control efforts.</p
Increasing breastfeeding initiation and duration in women with a body mass index ≥ 30 kg/m 2: developing an intervention from theory to acceptability
Get PDFBackgroundBreastfeeding has many health benefits for both mother and child, but rates of initiation and duration amongst women with a BMI ≥ 30 kg/m2 are low. Few interventions aiming to increase breastfeeding in this group have been successful; likely because existing interventions do not target psychological factors. Therefore, this study aimed to design and explore the acceptability of a newly developed psychological intervention to increase breastfeeding initiation and duration in women with a BMI ≥ 30 kg/m2.MethodsThe Medical Research Council’s Complex Intervention Development Framework was followed to design the intervention. A ‘breastfeeding workbook’ was developed, based on literature and psychological theory, and filled with tailored information and activities. A Patient and Public Involvement group of women with a BMI ≥ 30 kg/m2 who had breastfed, health professionals and researchers were consulted throughout the process, selecting the intervention content, format and delivery methods. Thirteen women with a BMI ≥ 30 kg/m2 then reviewed the workbook and took part in in-depth qualitative interviews to assess its acceptability. Thematic analysis was conducted, informed by the Theoretical Framework of Acceptability version 2.ResultsThe findings reveal the intervention is acceptable to the target population; women believe the intervention shows promise for increasing breastfeeding initiation and duration, is representative of their experiences, is accessible, and aligns with their belief system. They valued that the intervention provided realistic expectations of breastfeeding, options to overcome the challenges of breastfeeding in the real-world and supported them to breastfeed without inducing stigma or shame regarding their weight or infant feeding practices. Suggestions for improvement are also included, such as incorporating audio and video content as alternatives to written text and translation options.ConclusionsAn acceptable, psychological intervention was developed to increase breastfeeding initiation and duration in women with BMIs ≥ 30 kg/m2. These findings can inform maternity and breastfeeding care, future research directions and intervention development.</p
Allelic variation in a cluster of epsilon glutathione S-transferase genes contributes to DDT and pyrethroid resistance in the major African malaria vector Anopheles funestus
Get PDFBackground: Insecticide resistance in malaria vectors is a serious challenge to malaria control and elimination. Elucidation of the role of detoxification genes in resistance is necessary to develop targeted strategies to reduce malaria burden. Glutathione S-transferase epsilon clusters (GSTe genes) are upregulated in DDT- and pyrethroid-resistant Anopheles funestus mosquitoes across Africa. However, except for GSTe2, the molecular mechanisms behind this upregulation remain unclear. Here, we established that overexpression and allelic variation of GSTe genes contribute to insecticide resistance in African malaria vector An. funestus s.s. Methods: Transcriptomic and genomic analyses of GSTe genes were conducted, followed by in silico structural analysis, and functional characterization of GSTe3, GSTe4 and GSTe6 using metabolic assay and transgenic expression in Drosophila flies. Results: Transcriptomic and genomic analyses reveal changes in gene expression and genetic diversity of GSTes cluster in An. funestus across Africa. Cloning of cDNAs of GSTes from different regions of Africa detected allelic variants under selection, including A17D26T158-GSTe3, L135H191A189-GSTe4 in West/Central Africa, and T169S201 E210-GSTe6 present only in West/Southern Africa. Furthermore, in silico analysis of BN-GSTe3, MWI-GSTe3, BN-GSTe4, MWI-GSTe4, CMR-GSTe6 and, BN-GSTe6 alleles revealed that allelic variations increase the binding cavity in the active site of these GSTes with stronger affinities observed towards DDT and permethrin. All recombinant GSTes significantly metabolize DDT (41–63%) and permethrin (13–25%). Additionally, BN-GSTe4 (L135H191A189-GSTe4) variant significantly metabolizes deltamethrin (28.75%), compared to the wild-type allele (15.99%; p < 0.05). Transgenic expression of the GSTes in Drosophila melanogaster flies revealed reduced DDT mortalities in flies expressing the selected alleles (39–55%; p˂0.001), compared to control group (98%). Similar resistance patterns were observed toward permethrin and deltamethrin. Conclusion: These findings established the role of GSTes in conferring cross-resistance to pyrethroids and DDT, highlighting the role of these genes in metabolic resistance in An. funestus, which complicates malaria control using the above key insecticides.</p
Paediatric anaemia in rural Kenya and the role of travel time to emergency care services
Get PDFBackground: Access to emergency care (EC) services is crucial for severe anaemia outcome. Limited information exists on the association between travel times to EC services and the presentation and severity of anaemia upon hospital admission. Here, we investigate the association between travel time and presentation of severe anaemia (compared to mild/moderate anaemia) at admission in western Kenya. Methods: Data from January 2020 to July 2023 from Busia County Referral Hospital were assembled for paediatric admissions aged 1–59 months residing in Busia County. Travel time from a patient's village to the hospital was calculated using a least cost path algorithm. Anaemia severity was categorised as mild (Hb ≥ 7–<10 g dl−1), moderate (Hb ≥ 5–<7 g dl−1) and severe (Hb < 5 g dl−1). We fitted a geostatistical model accounting for covariates to estimate the association between travel times to EC services and severe anaemia presentation. Results: Severe anaemia admissions had the highest median travel time of 36 min (IQR: 25,54) (p-value: <0.001). Compared to children living within a 30 min travel time to the hospital, the adjusted odds ratio (AOR) of severe anaemia presentation relative to mild/moderate anaemia was 2.44 (95% CI: 1.63–3.55) for those residing within 30-59 min. For travel times of 60–89 min, the AOR was 3.55 (95% CI: 1.86–6.10) and for ≥90 min, the AOR was 3.41 (95% CI: 1.49–7.67). Conclusion: Travel time is significantly associated with the severity of paediatric anaemia presentations at hospitals. Addressing disparities in travel times such as strategic bolstering of lower-level facilities to offer EC services, is crucial for implementing new interventions and optimizing existing hospital-linked interventions to enhance healthcare delivery.</p
The role of pharmacists in ensuring rational antibiotic therapy within the interdisciplinary team
Get PDFThe irrational use of antibiotics is one of the biggest threats to public health, as recently highlighted in the documents from the World Health Organization. It includes both the choice of an inappropriate drug, dose, form, or length of therapy for the patient, and a lack of attention to the global cost of treatment. One of the effects of excessive and irrational use of antibiotics worldwide is the increasing number of antibiotic-resistant microorganisms. The growing number of bacterial illnesses and deaths caused by this type of pathogens is of great significance, making the consequences of incorrect antibiotic use both medical and economic. In the rationalization of pharmacotherapy, the significant role of medical staff, including pharmacists, who have extensive knowledge in the field of antibiotic therapy, is emphasized. The main goal of the rational management of antimicrobial drugs should be to improve patient treatment outcomes and minimize the medical and economic consequences of antibiotic use. Antibiotic therapy rationalization programs are needed in all healthcare facilities, both in open care and in hospital settings. Educational interventions that target primary care physicians and physicians prescribing antibiotics in hospitals are necessary. Additionally, pharmacists, being the most accessible healthcare workers, can build awareness of rational antibiotic therapy among patients.</p
A chronicle of crises and emergencies: (dis)continuity of care for Syrian refugee children with neglected non-communicable diseases in Lebanon
Get PDFLebanon’s recent history has been marked by intersecting crises, including a severe economic collapse, the Beirut port explosion, and the COVID-19 pandemic. Amidst this “polycrisis,” the healthcare system has become increasingly reliant on international humanitarian assistance. This paper examines how these overlapping crises have affected the provision of care for children with thalassemia, a neglected non-communicable disease (NCD), within a Médecins Sans Frontières (MSF) paediatric unit operating in Lebanon between 2018 and 2023. Drawing on a single-case study design, the research explores the dynamics of power between state and non-state actors as well as within international humanitarian organizations and their approaches to healthcare delivery. The study employed a mixed-methods approach, including audio diaries, interviews, document analysis, and co-development groups involving 11 staff members and 18 caregivers of Syrian paediatric patients. Participants shared insights into operational challenges, decision-making processes, and the lived experiences of navigating Lebanon’s collapsing health system. Findings reveal three interconnected issues: (1) the polycrises created an unsustainable environment even for resource-rich international non-governmental organizations (iNGOs); (2) the withdrawal of humanitarian services exacerbated the suffering of structurally marginalized Syrian families reliant on no-cost thalassemia treatment; and (3) national staff experienced profound professional and personal challenges as navigated tensions between iNGO policies and patient needs, often leading to burnout and reduced well-being. The study underscores the need for a reorientation of humanitarian healthcare models in protracted crises. This includes greater equity in decision-making between international organisations and national actors, longer-term planning for chronic disease care, and deeper engagement with national staff and affected communities. Prioritising sustainability, health justice, and the lived realities of both providers and patients is essential. While rooted in the specific context of Lebanon’s highly privatised and pluralistic health system, these findings hold broader relevance for fragile settings facing similar structural and political constraints.</p
Epidemiological Study of Childhood Idiopathic Epilepsy from 1990 to 2021 at Global, Regional, and National Scales
Get PDFObjective: To address the long-term impact of childhood idiopathic epilepsy on health and families, and to provide epidemiological evidence for developing effective prevention and treatment strategies, this study aimed to explore the trends in incidence, deaths, and disability-adjusted life years (DALYs) of childhood idiopathic epilepsy globally and across regions from 1990 to 2021. Patients and Methods: This cross-sectional analysis utilized data from the 2021 Global Burden of Disease database, covering idiopathic epilepsy cases among children aged 0-14 years across 204 countries and regions. The study period was from September 15, 2024, to October 31, 2024. Key indicators included incidence, deaths (all-cause and specific), and DALYs, with trend analysis conducted using the exponential annual percentage change (EAPC). All analyses were stratified by region, country, gender, and sociodemographic index (SDI). Results: In 2021, there were 1,227,191 new cases of childhood idiopathic epilepsy globally (95% uncertainty interval [UI], 786,363-1,734,488). From 1990 to 2021, the total number of cases increased by 26.3% (95% UI, 6.8%-51.2%), with the incidence rising from 55.85 per 100,000 population to 60.998, and an EAPC of 0.2% (95% CI, 0.17-0.23). Deaths decreased by 29.5%, from 25,768 to 18,171, with the death rate dropping from 1.482 per 100,000 to 0.903 and an EAPC of −1.39% (95% CI, −1.48 to −1.3). DALYs decreased by 14.90%, reaching 3,564,497 in 2021 (95% UI, 2,700,944-4,753,410), with an EAPC of −0.94% (95% CI, −1.0 to −0.89). Low SDI regions bore the highest burden, with the highest death rate (1.459 per 100,000 in 2021). Regionally, tropical Latin America saw the fastest growth in incidence (EAPC 0.29), whereas Tajikistan had the highest death rate (2.766 per 100,000), and Taiwan Province of China had the highest DALY rate (99.718 per 100,000). Conclusion: Childhood idiopathic epilepsy remains a significant global health challenge, with an increasing incidence. Despite a decline in global deaths and DALYs, the disease burden in low SDI regions remains substantial. Understanding the epidemiological characteristics of childhood idiopathic epilepsy is critical for developing effective prevention and management strategies. The findings highlight the importance of targeted interventions in resource-limited settings to bridge the gap in treatment outcomes for childhood epilepsy globally.</p
Beyond breakpoint - reconceptualising AMR as a symptom of planetary stress
Get PDFPlanetary boundaries range from climate change to biosphere integrity. They define the safe space for humanity. Ecosystem impacts on microbes are missing from a recent assessment showing six of nine boundaries are breached. Microbes represent enormous phylogenetic diversity and underpin multiple planetary systems. Here, we suggest that reconceiving AMR as a sign of ecosystem stress may enable us to steward our wider microbial commons, protecting planetary systems from being breached
Coping Strategies Following Fetal Loss Among Women Who Gave Birth in Selected Health Facilities in Eastern Ethiopia:A Phenomenological Study
Get PDFPregnancy is typically a joyous experience, but in low-resource settings, many pregnancies end in fetal loss, which has profound emotional and psychological effects. This is a phenomenological qualitative study used to investigate coping mechanisms using the Living with Grief after Pregnancy Loss model among purposively selected women who experienced fetal loss in two major hospitals in Harar Town, eastern Ethiopia. Results: Fourteen women (mean age 25.14 years) participated. Four main themes emerged: self/personal resilience, social support networks, religious and spiritual practices, and cultural belief systems. Connectedness was fostered through emotional support, active life participation, and strong family and spiritual support. Disconnectedness included denial, blaming oneself or a partner, isolation, and avoidance of social support. Withdrawal from religious practices and cultural conflicts, such as not adhering to gender roles, hindered coping. Conclusion: Coping with fetal loss is shaped by spiritual, personal, social, and cultural factors. Support from family, religion, and community helps women navigate grief, while blame and isolation impede recovery. These findings highlight the importance of social capital and suggest that a holistic approach that incorporates emotional, spiritual, and cultural support is critical for helping women cope with fetal loss.</p
World health Organization's guidance for tracking non-communicable diseases towards sustainable development goals 3.4:an initiative for facility-based monitoring
Get PDFBackground: Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization. Methods: This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants. Findings: The final output consisted of 81 validated indicators—22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings. Interpretation: This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness. Funding: This study was funded internally by WHO.</p