21367 research outputs found
Sort by
Economic returns on investing in early childhood development in Vietnam: a cost-benefit analysis
Get PDFBackgroundEconomic evidence on the long-term benefits of investing in early childhood development is limited. This study aimed to estimate the potential long-term economic benefits of an early childhood development intervention ‘Learning Clubs’ in Vietnam.MethodsWe conducted a cost-benefit analysis to estimate the costs and benefits of the intervention compared to the standard of care from a limited societal perspective. The intervention cost and child cognitive development outcome were derived from the published ‘Learning Clubs’ trial-based cost-effectiveness analysis. Benefits were monetised based on the gains in wages associated with improved cognitive development over a lifetime at the population level, using a life-table model. The benefit-cost ratio was estimated as the benefits in wages divided by the intervention cost with a 3% discount rate, assuming nationwide scale up to a hypothetical national birth cohort. Sensitivity, scenario, and threshold analyses were conducted to examine the uncertainty around the model.ResultsThe benefit-cost ratio was 5.52, indicating that the expected benefit for each US5.52. The intervention would generate economic benefits of US2.28 billion per national annual birth cohort. Probabilistic sensitivity analyses estimated the benefit-cost ratio to be 5.90 (95%CI 2.66 to 11.12). The findings were relatively robust as the benefit-cost ratios remained above 1 in all sensitivity and scenario analyses.ConclusionsOur findings support greater investments in early childhood development. The Excel-based model is available for further use and adaption to other settings.</p
Factors associated with mortality among patients aged 12 years and above requiring hospitalization for severe respiratory illness (SRI): Findings from the COVID-19 vaccine effectiveness evaluation in Kenya and Mali, 2022-2023.
Get PDFMortality attributed to respiratory illnesses is well characterized in children <5 years. However, there is paucity of data among older populations. Here, we leveraged data from the COVID-19 Vaccine Effectiveness Evaluation to establish the factors associated with mortality among patients with severe respiratory illness (SRI) in Kenya and Mali. We enrolled patients (≥ 12 years) requiring hospitalization for SRI, defined as acute onset (≤ 14 days) of at least two of the following: cough, fever (reported/measured temperature of ≥38 °C), chills, rigors, myalgia, headache, sore throat, fatigue, congestion or runny nose, loss of taste or smell, or pneumonia diagnosis, from referral hospitals in Kenya and Mali. We collected demographic, clinical characteristics of the patients, and nasopharyngeal and oropharyngeal specimens for SARS-CoV-2 testing using RT-PCR. A mixed-effects logistic regression model was fitted to identify factors associated with 30-day mortality among patients with SRI. Between July 2022 and October 2023 9947 SRI patients were enrolled, of whom 9743 were included in this analysis and 1620 (16.6 %) died (Kenya: 1533/7822 [20.0 %]; Mali: 87/1921 [4.5 %]). Compared to patients aged 12-24 years, those aged >64 years were more likely to die (adjusted Odds Ratio [aOR] = 2.36; 95 % Confidence Interval [95 % CI] 1.72-3.24). Patients who were in coma (aOR = 3.45; 95 %CI 2.27-5.24) or Intensive Care Unit (aOR = 2.98; 95 %CI 2.06-4.31), or had HIV infection (aOR = 2.47; 95 %CI 2.11-2.90), liver disease (aOR = 2.42; 95 %CI 1.57-3.74), cancer (aOR = 2.09; 95 %CI 1.46-2.99) or SARS-CoV-2 infected (aOR = 1.24; 95 %CI 1.02-1.52) were at increased risk of death. Additionally, diarrhea, malaise/fatigue, difficulty in breathing, confusion, mechanical ventilation, vasopressor support, malnutrition and admission to High Dependency Unit had significant associations. Mortality was heightened among SRI patients who were older, required critical care, had chronic conditions and infected with SARS-CoV-2 suggesting need for early identification of these conditions to improve possible treatment outcomes. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.]</p
Seizure prediction in pregnant women with epilepsy: An umbrella review of clinical practice guidelines and systematic reviews
Get PDFObjectiveTo identify risk factors for seizure in pregnant women, and in the general population with epilepsy.Study designUmbrella review of clinical practice guidelines and systematic reviews on risk factors or prediction models for seizure occurrence in pregnant women with epilepsy, adults with epilepsy, or all individuals with epilepsy. Guidelines or systematic reviews exclusively for children were excluded. We searched MEDLINE, Emcare, Embase, CINAHL, TRIP PRO, Epistemonikos, World Health Organisation, Guideline International Network, DANS, and grey literature (2000-2023) without language restrictions. Risk factors or predictors listed in the final guidelines or systematic reviews were collated and thematically analysed.ResultsFrom 3406 citations, we included 13 articles (ten guidelines, three systematic reviews) reporting 26 risk factors in pregnant women and the general adult population with epilepsy: eight factors in guidelines for pregnant women only; five in both pregnant women and general adult populations (four in both guidelines and systematic reviews, one in guidelines only); and 13 factors in the general adult population (four in both guidelines and systematic reviews, eight in guidelines, and one in a systematic review). Risk factors were categorised into five broad themes: seizure type; seizure control; anti-seizure medication; neurological; and epilepsy and medical history. Three risk factors for seizure ocurrence were cited in more than two guidelines or systematic reviews: seizure freedom (reduced risk), immediate initiation of anti-seizure medication after first seizure (reduced risk), and abnormal electroencephalogram (increased risk). Three risk factors were linked to a more than two-fold chance of seizures in pregnant women with epilepsy: tonic-clonic seizures in the last three months (RR 7.20, 95% CI 6.63-11.93), a history of non-tonic-clonic seizures (RR 2.11, 95% CI 1.88—2.62), and seizures in the pre-pregnancy year compared to no seizures (RR 3.51, 95% CI 3.13-3.94).ConclusionMultiple risk factors have been recommended for use in practice across different guidelines and reviews to identify those at increased risk of seizures in the adult population with epilepsy, and specifically in pregnant women with epilepsy. Further research is needed on the implementation of tools for predicting seizures to improve maternal and neonatal outcomes.</p
Genetic diversity of Toscana virus glycoproteins affects the kinetics of virus entry and the infectivity of newly produced virions
Get PDFToscana virus (TOSV) is a pathogenic and transmissible Phlebovirus of the Bunyavirales order. To date, two principal genetic lineages (A and B) have been identified and the impact of TOSV genetic diversity on its biology is still unknown. We used a reverse genetic approach based on two TOSV strains belonging to lineage A or B (i.e., TOSV-A and TOSV-B) and displaying different in vitro replicative fitness. Our results demonstrate that the sequences of Gn and Gc glycoproteins are responsible for the differences in replicative fitness between the two TOSV strains. Moreover, our data show that TOSV-A and TOSV-B display different entry kinetics and that newly-produced virions have different infectivity. This comparative approach demonstrates that the genetic diversity of TOSV can significantly impact viral properties and highlights the need for better molecular characterisation of the genomes of circulating TOSV strains, with a particular focus on the viral Gn and Gc glycoproteins.</p
Comparing apples with apples: A proposed taxonomy for “Community Health Workers” and other front-line health workers for international comparisons
Get PDFThis paper proposes a taxonomy for Community Health Workers (CHWs) and others engaged in front-line community health activities, encompassing formally-employed workers extending government primary health care (PHC) service delivery as well as a range of other actors with roles at the nexus of government PHC and communities. The taxonomy is grounded in current definitions from the World Health Organization and the International Labor Organization, and proposes some refinements for future iterations of guidance from these agencies. The designation, “Community Health Worker” is currently used to cover a broad range of roles. Furthermore, there are programs engaging workers or community members in roles closely adjacent to those generally recognized as CHWs that use other designations, not commonly included under the rubric of “CHW”. This potentially confusing range of roles and nomenclature leads at times to over-generalizations, applying insights and principles relevant for one type of worker or community member that are not necessarily relevant for another. It also leads to a failure to consider occupational groups not commonly thought of as CHWs—but engaged in PHC service delivery at the most peripheral level—in community-based-PHC planning and management arrangements. Building on ILO and WHO classifications and standards, a further clarification of terms and a taxonomy is proposed, with the intention of contributing to clearer communication and shared understanding and, ultimately, sounder community health policy, program planning, and implementation; and more substantial progress towards Universal Health Coverage.</p
You are just like them: The paradoxical position of Nairobi's community health promoters, a photovoice study
Get PDFKenya's community health promoters (CHPs) are essential in expanding healthcare access for vulnerable and marginalised populations, particularly in informal settlements. Embedded within these communities, CHPs facilitate culturally sensitive care, improve service access, and contribute to the efficiency of the local health system. Despite global literature on community health workforces, the specific roles CHPs play in informal settlements remain neglected and underexplored. Understanding their realities is vital for creating supportive health policies that address urban transitions and enable CHPs to fulfil their roles.This study uses photovoice with six CHPs in Nairobi's Viwandani settlement to document their experiences of marginalisation. Through co-analysis, we mapped the results using White's wellbeing dimensions, creating a framework for CHPs' lived realities in urban informality. Material challenges impacting CHP and community wellbeing include limited housing, water, sanitation, and employment. Social dimensions reveal complex dynamics between CHPs, community members, and government stakeholders, affecting CHPs' impact and community perceptions. Human dimensions reflect CHPs' aspirations, self-perception, and personal struggles, while subjective experiences intersect across all domains.We highlight practically and theoretically that CHPs occupy a paradoxical role as healthcare providers within an environment and health system that fails to meet their needs and those of their communities. Our framework provides a unique contribution to knowledge that can support health systems decision-makers in thinking differently about the role of CHPs and the support needed for transforming urban health systems. CHPs' vulnerabilities should be recognised and addressed as they are crucial to creating a just and sustainable urban health system.</p
Technology-assisted cognitive-behavioral therapy for perinatal depression delivered by lived-experience peers: a cluster-randomized noninferiority trial.
Get PDFPerinatal depression affects one in four women in low- and middle-income countries. The World Health Organization’s Thinking Healthy Programme (WHO-THP) is an established ‘task-shared’ cognitive-behavioral therapy intervention for perinatal depression. However, efforts to scale up are hampered by overburdened health systems struggling to maintain quality and fidelity. Here, to overcome these challenges, we coproduced with end users a technology-assisted digital version of the THP delivered by lived-experience peers (technology-assisted peer-delivered THP (THP-TAP)). We aimed to evaluate the effectiveness of THP-TAP compared to the established WHO-THP. A single-blind cluster-randomized controlled noninferiority trial was conducted in rural Rawalpindi, Pakistan, with 70 village clusters randomly distributed to the two interventions. From June 2022 to May 2023, we recruited 980 women with perinatal depression registered with primary healthcare centers. The primary outcome was remission from the depressive episode at 3 months postnatal. On assessment of 846/980 (86.3%) participants at 3 months postnatal, the difference in the remission rate was 8.91% with the lower boundary of the one-sided 97.5% confidence interval being 4.25%, larger than the prespecified −10% noninferiority margin (Pnoninferiority < 0.0001). In settings where health systems are weak and overburdened, THP-TAP offers an effective and potentially scalable alternative to the delivery of psychosocial interventions.</p
Arboviruses in UK Armed Forces: a review of historical cases and identification of future threats
Get PDFIntroduction: Arboviruses are a diverse group of arthropod-borne pathogens and are emerging global public health threats with no approved therapeutics. Arboviruses are spreading rapidly, posing a health threat to UK Armed Forces (UKAF) service personnel (SP) through deployment to endemic regions. There are limited data on the burden of arboviral infections in UKAF SP. Methods: A retrospective service evaluation of UKAF electronic healthcare records (eHRs) and statutory notifications to the Defence Public Health Unit was conducted. Cases with possible/confirmed dengue, chikungunya or Zika virus infections between 2005 and 2023 were included. eHRs were interrogated and trends analysed. Results: Of 107 suspected infections between 2005 and 2023, 49 (45.8%) were laboratory-confirmed. Dengue fever was the most common (45/49) followed by chikungunya (3/49) and Zika (1/49) virus infections. The average yearly incidence of reported dengue infection increased from 0.51 cases per 100 000 UKAF SP per year in 2009–2011 to 3.85 cases per 100 000 SP per year in 2021–2023. 19/45 (42.2%) cases occurred during operational deployments and 24/45 (53.3%) during non-military activity. Dengue infection was most frequently acquired in Southeast Asia. Using WHO clinical severity criteria, 33/45 (73.3%) had dengue with warning signs and 5 (11.1%) had severe dengue. 23/45 (51.1%) dengue cases were hospitalised (median length of stay 5 days, IQR 3, range 1–9). No dengue fatalities or medical discharges occurred. Occupational impact was significant, with a median of 11 days stood down (IQR 10, range 0–45); 3/19 (15.8%) cases on operations required aeromedical evacuation (AEROMED). One deployed case of chikungunya required AEROMED and a 35-day downgrade. Conclusions: Reports of arboviral infections, particularly dengue, are increasing in UKAF personnel, presenting an emerging health threat. This has implications for UKAF provision of deployed diagnostics and dengue vaccination policy. The rapid spread of arboviruses outside their traditional geographical areas, including into Europe, necessitates further surveillance and requires diagnostic and therapeutic research.</p
Relative contribution of pharmacokinetics and immune signatures to clinical outcomes in patients with HIV-associated cryptococcal meningitis
Get PDFBackgroundHost immune responses to HIV-associated cryptococcal meningitis are critical in disease outcome. Their interaction with antifungal drug exposure is poorly understood. This study explored associations between immune biomarkers, antifungal drug exposure, and clinical outcomes in HIV-associated cryptococcal meningitis.MethodsWe analyzed serial plasma and cerebrospinal fluid immune biomarkers from 64 participants recruited from the AMBITION-cm trial. We estimated individual-level exposure to amphotericin B, flucytosine, and fluconazole. Associations between immune biomarkers, pharmacokinetic parameters, and clinical outcomes were evaluated.ResultsAn inflammatory cerebrospinal fluid response, characterized by coordination between tumor necrosis factor-α, granulocyte colony-stimulating factor, and interleukin-7 signaling, was linked to low fungal burden, low intracranial pressure, and survival. However, the value of specific immune biomarkers did not predict EFA or mortality. Exposure to amphotericin B was significantly associated with EFA.ConclusionsFavorable clinical outcomes from HIV-associated cryptococcal meningitis are associated with coordinated inflammatory and cytotoxic responses in the central nervous system. Antifungal drug exposure was the dominant predictor of EFA.</p
Off-grid field-deployable molecular diagnostic platform for malaria surveillance
Get PDFBackgroundMalaria, a major global health concern, continues to cause substantial morbidity and mortality, particularly in tropical regions. Traditional malaria diagnostic methods such as microscopy and quantitative polymerase chain reaction (qPCR) are effective but face challenges in field settings because of their requirement for laboratories with specialized equipment and trained personnel. This study presents the development and validation of a portable, cost-effective, field-deployable real-time qPCR platform for detecting Plasmodium species.MethodsField-compatible DNA isolation was performed using DNAzol, and TaqMan probes targeting 18S ribosomal RNA (rRNA) were employed to detect five Plasmodium species—P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi—using the bCUBE qPCR platform. In vitro-cultured P. falciparum and experimentally infected Anopheles gambiae were used to quantify P. falciparum infections, with infection prevalence compared to microscopy. The bCUBE qPCR system was also evaluated under field conditions to detect P. falciparum infections in field-collected An. gambiae mosquitoes.ResultsThe bCUBE qPCR demonstrated a strong linear correlation (R2 = 0.993) with a standard laboratory qPCR machine for detecting P. falciparum infections. It successfully detected as few as 0.5 parasites/µl of blood, one oocyst in mosquito guts, and 5–10 sporozoites in salivary glands. It was also capable of discriminating between P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. Field evaluations in Cameroon confirmed its accuracy in identifying P. falciparum in mosquito samples, with same-day results. The capability of the bCUBE qPCR system to detect infections in both individual and pooled mosquito surveillance further highlights its potential for in-field large-scale malaria monitoring surveillance.ConclusionsThe bCUBE qPCR system offers a portable, sensitive, and scalable solution for malaria diagnostics, enabling real-time surveillance in resource-limited settings. Its ability to provide rapid, on-site results reduces the need for centralized laboratory testing, facilitating timely decision-making in malaria control programs.</p