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Mechanisms driving the escalation of insecticide resistance in Anopheles funestus and its impact on malaria parasite transmission and vector control in Uganda
No full textBetter methods, better data: landscaping the priorities for improving methodologies in vector control
Get PDFThis article addresses the evolving challenges in evaluating insecticide-based tools for vector control. In response to the emergence of insecticide resistance in major malaria vectors, novel chemistries and products are coming to market, and there is a need to review the available testing methodologies. Commonly used methods for evaluating insecticides, such as the World Health Organization (WHO) cone bioassay, are inadequate for the diverse range of tools now available. Innovation to Impact (I2I) has studied the variability in laboratory methods, with the aim of identifying key factors that contribute to variation and providing recommendations to tighten up protocols. The I2I Methods Landscape is a living document which presents a review of existing methods for evaluating vector control tools, with the scope currently extending to insecticide-treated nets (ITNs) and indoor residual sprays (IRS). The review reveals a lack of validation for many commonly used vector control methods, highlighting the need for improved protocols to enhance reliability and robustness of the data that is generated to make decisions in product development, evaluation, and implementation. A critical aspect highlighted by this work is the need for tailored methods to measure endpoints relevant to the diverse modes of action of novel insecticides. I2I envisage that the Methods Landscape will serve as a decision-making tool for researchers and product manufacturers in selecting appropriate methods, and a means to prioritise research and development. We call for collective efforts in the pro-active development, validation, and consistent implementation of suitable methods in vector control to produce the data needed to make robust decisions.</p
Do self-help groups improve sexual and reproductive health and HIV outcomes among female sex workers in sub-Saharan Africa? A scoping review protocol
Get PDFIntroductionSelf-help groups (SHGs) have been effective in improving the health and wellbeing of women yet there is a dearth of evidence on how they can improve female sex workers’ (FSWs) HIV and sexual and reproductive health (SRH) outcomes, particularly in sub-Saharan Africa (SSA). The proposed scoping review seeks to address this gap by identifying and analysing literature on SHGs for FSWs in SSA.Materials and methodsThis scoping review will employ the methodology developed by Arksey and O’Malley (2005), expanded on by Levac and colleagues (2010) and Colquhoun and colleagues (2014), and further outlined by Peters and colleagues (2020): (1) identifying the research question(s); (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; and (5) collating, summarising, and reporting the results.ResultsWe will report our findings in accordance with the guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement.DiscussionThe review will generate the most up-to-date evidence and identify gaps in literature in addition to informing future research on how SHGs can help address SRH and HIV outcomes among FSWs in SSA. Additionally, the scoping review can potentially inform a subsequent systematic review.</p
A Y chromosome-linked genome editor for efficient population suppression in the malaria vector Anopheles gambiae
Get PDFGenetic control – the deliberate introduction of genetic traits to control a pest or vector population – offers a powerful tool to augment conventional mosquito control tools that have been successful in reducing malaria burden but that are compromised by a range of operational challenges. Self-sustaining genetic control strategies have shown great potential in laboratory settings, but hesitancy due to their invasive and persistent nature may delay their implementation. Here, instead, we describe a self-limiting strategy, designed to have geographically and temporally restricted effect, based on a Y chromosome-linked genome editor (YLE). The YLE comprises a CRISPR-Cas9 construct that is always inherited by males yet generates an autosomal dominant mutation that is transmitted to over 90% of the offspring and results in female-specific sterility. To our knowledge, our system represents a pioneering approach in the engineering of the Y chromosome to generate a genetic control strain for mosquitoes. Mathematical modelling shows that this YLE technology is up to seven times more efficient for population suppression than optimal versions of other self-limiting strategies, such as the widely used Sterile Insect Technique or the Release of Insects carrying a Dominant Lethal gene.</p
Insights of SEDRIC, the Surveillance and Epidemiology of Drug-Resistant Infections Consortium
Get PDFThe increasing threat from infection with drug-resistant pathogens is among the most serious public health challenges of our time. Formed by Wellcome in 2018, the Surveillance and Epidemiology of Drug-Resistant Infections Consortium (SEDRIC) is an international think tank whose aim is to inform policy and change the way countries track, share, and analyse data relating to drug-resistant infections, by defining knowledge gaps and identifying barriers to the delivery of global surveillance. SEDRIC delivers its aims through discussions and analyses by world-leading scientists that result in recommendations and advocacy to Wellcome and others. As a result, SEDRIC has made key contributions in furthering global and national actions. Here, we look back at the work of the consortium between 2018-2024, highlighting notable successes. We provide specific examples where technical analyses and recommendations have helped to inform policy and funding priorities that will have real-world impact on the surveillance and epidemiology of infections with drug-resistant pathogens.</p
A preliminary microscopic and molecular epidemiological survey of endoparasites within wild-caught and UK captive-bred reptiles: Assessing a potential parasitic disease public health risk?
Get PDFIn the UK, exotic reptiles are increasingly popular as pets, and housed in zoological collections, whilst venomous snakes of medical importance have long been the focus of herpetological studies. As all reptiles can harbour protist and helminth parasites, some of these may carry tangible zoonotic risk. This study utilised traditional and molecular diagnostic techniques, including sedimentation-flotation, real-time polymerase chain reaction (rtPCR), and necropsy, to investigate endoparasite infections in captive-bred (CB) and wild-caught (WC) reptiles. Representative animals originated from pet shops, zoological and private collections as well as those housed in research herpetariums. Parasitic infections were detected in 21.1% (n = 109) of samples from 58 reptile species across 12 families. The most prevalent infections included nematodes (17.4%), cestodes (0.9%) and protists (3.7%). The nematodes, particularly strongylid (9.3%) and ascarid (5.6%) species, being the most common. Of particular interest, zoonotic genera, Ophidascaris and Giardia were identified. When possible, necropsy revealed latent infections, including prepatent stages of the hookworm Kalicephalus sp. and pentastomid larvae in Echis ocellatus snakes. These accounted for 55.6% of all parasitic infections. Real-time-PCR methods detected additional co-infection overlooked by microscopy, whilst necropsy provided additional insights. These findings highlight the need in the UK for better parasitic screening protocols to enhance captive reptile welfare, mitigate zoonotic risks and safeguard public health.</p
Are facility service delivery models meeting the sexual and reproductive health needs of adolescents in Sub-Saharan Africa? A qualitative evidence synthesis
Get PDFBackground. Adolescents in Sub-Saharan Africa (SSA) face signifcant health and social challenges related to sexual and reproductive health (SRH), including unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STI). Barriers to information and services are compounded by lack of access to appropriate information, fear of being judged, health provider attitudes and contextual factors such as culture, religion, poverty, and illiteracy. Facility-based service delivery models for adolescents ofer a structured environment and provide an opportunity to deliver such information and services. The review critically examined how well these models meet the SRH needs of adolescents in SSA.Methods. A systematic search was conducted using five databases: Web of Science, MEDLINE, Scopus, PubMed, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to maintain transparency and completeness. Covidence software was used for screening and data extraction, and NVIVO 12 PRO was used to manage the analysis. A narrative synthesis using Thomas and Harden’s thematic analysis was used to identify themes.Results. The search yielded 14,415 articles, and 20 papers met the inclusion criteria and were included in this review. From the fndings, adolescents expressed the need for comprehensive SRH information, adolescent-friendly facili�ties, parental and male involvement, and respectful healthcare providers. Three facility-based adolescent-friendly SRH delivery models are used in SSA: Stand-alone clinics, Youth-friendly corners, and Integrated/mainstreamed models. Adolescent-friendly interventions, friendly staf, and accessibility were reported as facilitators to services meeting the needs of adolescents and promoting positive experiences. However, several barriers were identifed: negative attitudes of health workers, fnancial constraints, transportation challenges, waiting time, intimidating environments, and lack of confdentiality pose a challenge to the efectiveness of the model.Conclusion. Facility-based SRH service delivery models can improve access to information and services when com�plemented with community-based interventions, adolescent-friendly providers, and assurance of service accessibility. However, signifcant gaps, such as healthcare providers’ negative attitudes and behaviours, concerns about privacy</p
Assessing COVID-19 Pandemic-Era Vaccine Uptake and Adherence to Prevention Measures: A Comparative Analysis Among Men and Women Using Lot Quality Assurance Sampling in Central Uganda.
Get PDFAimThis study examined citizens' knowledge and compliance with COVID-19 standard operating procedures (SOPs), vaccine acceptance and hesitancy, and factors that could influence these behaviors.MethodsThe study that utilised the Lot Quality Assurance Sampling (LQAS) approach was conducted in eight districts of Central Uganda; Kiboga, Kyankwanzi, Mubende, Kasanda, Mityana, Luwero, Nakaseke, and Nakasongola districts. Each district was divided into five supervision areas (SAs). Data were collected from 19 respondents per SA, focusing on women aged 15-49 years and men aged 15 years and above. A satisfactory performance for study indicators was determined by the LQAS decision rules.ResultsThere was high awareness of COVID-19, with 98.2% of women and 99.3% of men having heard of the pandemic. However, knowledge of at least four COVID-19 preventive measures was low, reported by only 45.4% of women and 48.6% of men. Adherence to social distancing measures in the previous 24 hours was modest, with 67.2% of men and 66.5% of women complying. There was a pronounced lack of hand hygiene, with only 24.8% of women and 19.0% of men frequently washing their hands or using hand sanitizer. COVID-19 vaccine uptake was relatively high for the first dose, with 83.5% of women and 83.0% of men receiving at least one dose. However, full vaccination coverage was low, at 37.5% for women and 41.5% for men. A hesitancy to get vaccinated was driven by fear of side effects, misinformation, doubts about vaccine effectiveness, long distances and queues, and beliefs that vaccines cause infertility.ConclusionWhile awareness of COVID-19 was high, knowledge of preventative measures was lacking. The low vaccination rates highlight barriers to uptake. A tailored, trust-based messaging approach through community leaders was recommended to address these gaps. Inter-district and inter-SA disparities indicated the need for localized interventions.</p
Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa
Get PDFLarval source management (LSM) has a long history of advocacy and successes but is rarely adopted where funds are limited. The World Health Organization (WHO) guidelines on malaria prevention recommend the use of LSM as a supplementary intervention to the core vector control methods (insecticide-treated nets and indoor residual spraying), arguing that its feasibility in many settings can be limited by larval habitats being numerous, transient, and difficult to find or treat. Another key argument is that there is insufficient high-quality evidence for its effectiveness to support wide-scale implementation. However, the stagnation of progress towards malaria elimination demands that we consider additional options to the current emphasis on insecticidal commodities targeting adult mosquitoes inside homes. This letter is the result of a global, crossdisciplinary collaboration comprising: (a) detailed online expert discussions, (b) a narrative review of countries that have eliminated local malaria transmission, and (c) a mathematical modeling exercise using two different approaches. Together, these efforts culminated in seven key recommendations for elevating larval source management as a strategy for controlling malaria and other mosquito-borne diseases in Africa (Box 1). LSM encompasses the use of larvicide (a commodity) as well as various environmental sanitation measures. Together, these efforts lead to the long-term reduction of mosquito populations, which benefits the entire community by controlling both disease vector and nuisance mosquitoes. In this paper, we argue that the heavy reliance on large-scale cluster-randomized controlled trials (CRTs) to generate evidence on epidemiological endpoints restricts the recommendation of approaches to only those interventions that can be measured by functional units and deliver relatively uniform impact and, therefore, are more likely to receive financial support for conducting these trials. The explicit impacts of LSM may be better captured by using alternative evaluation approaches, especially high-quality operational data and a recognition of locally distinct outcomes and tailored strategies. LSM contributions are also evidenced by the widespread use of LSM strategies in nearly all countries that have successfully achieved malaria elimination. Two modelling approaches demonstrate that a multifaceted strategy, which incorporates LSM as a central intervention alongside other vector control methods, can effectively mitigate key biological threats such as insecticide resistance and outdoor biting, leading to substantial reductions in malaria cases in representative African settings. This argument is extended to show that the available evidence is sufficient to establish the link between LSM approaches and reduced disease transmission of mosquito-borne illnesses. What is needed now is a significant boost in the financial resources and public health administration structures necessary to train, employ and deploy local-level workforces tasked with suppressing mosquito populations in scientifically driven and ecologically sensitive ways. In conclusion, having WHO guidelines that recognize LSM as a key intervention to be delivered in multiple contextualized forms would open the door to increased flexibility for funding and aid countries in implementing the strategies that they deem appropriate. Financially supporting the scale-up of LSM with high-quality operations monitoring for vector control in combination with other core tools can facilitate better health. The global health community should reconsider how evidence and funding are used to support LSM initiatives.</p
Efficacy of communication interventions for promoting blood donation in low‐ and middle‐income countries: A systematic review
Get PDFBackground and ObjectivesIn low- and middle-income countries (LMICs), information on the efficacy of communication interventions promoting blood donation is very scarce. The present review aimed to identify specific communication interventions and their efficacy for increasing blood donation in LMICs.Materials and MethodsThe databases searched were PubMed, Scopus, PsycINFO, Web of Science, CINAHL, ProQuest, AJOL and CAB Abstracts. Grey literature sources included the websites of African Society of Blood Transfusion, International Society of Blood Transfusion and World Health Organization. The outcomes of interest were donation attempt or actual blood donations.ResultsA total of 16 studies including nine randomized controlled trials (RCTs) were included in the review. The communication interventions included social media and mass media, such as radio and television, as platforms for promoting blood donation, and newspaper articles or advertisements as an incentive for donor recruitment. Mobile text messages were used either alone or in combination with phone calls, and other interventions such as meetings and brochures. Only three of the 16 studies specifically targeted behavioural science theories, and none of the 16 studies used any implementation science framework. For some communication interventions, there was evidence of statistically significant increases in donations, but the quality of the studies was weak.ConclusionThe efficacy of communication interventions for promoting blood donations in LMICs remains limited due to few rigorous studies. More rigorous, theory-based studies on the use of communication interventions to increase blood donation in LMICs, especially in sub-Saharan Africa where no prior RCT were identified, are needed.</p