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Antimicrobial resistance, equity and justice in low- and middle-income countries: an intersectional critical interpretive synthesis
Get PDFGlobal inequities in the burden of antimicrobial resistance (AMR), between and within populations, are heavily influenced by the social and structural determinants of health. Yet, AMR action has had limited attention to equity, and social approaches to AMR haven’t routinely gone beyond an exploration of knowledge and awareness around ABU. This represents a missed opportunity to design equitable interventions and policy across One Health. We report the results of a critical interpretive synthesis of the social and structural drivers of AMR in Low- and Middle-Income Countries and present a conceptual framework of these drivers, linking to the Sustainable Development Goals (SDGs). We emphasise the limitations of a biomedical dominance in AMR research, highlighting the value of wider bodies of evidence for understanding the drivers of AMR to support equity and justice. We argue AMR interventions need action across the SDGs to target the root causes and address significant gaps in evidence
Predicting current habitat suitability for intermediate snail hosts of urogenital and intestinal schistosomiasis in the Lower Shire Valley floodplain of southern Malawi
Get PDFThis paper presents the first species distribution models (SDMs) for intermediate snail hosts for urogenital and intestinal schistosomiasis in Chikwawa and Nsanje Districts, which together form the Lower Shire Valley (LSV) in Malawi. The SDMs developed for this study are ensemble machine learning approaches based on Random Forest (RF), Support Vector Machines (SVM), and multilayer perceptron (MLP) and are specific to the Bulinus africanus group and Biomphalaria pfeifferi. The former transmits urogenital schistosomiasis (Schistosoma haematobium), while the latter transmits intestinal schistosomiasis (Schistosoma mansoni), both of which affect nearly 240 million people globally. This study addresses the following questions: 1. Where are the most suitable habitats for intermediate host snails in the LSV? 2. Which environmental factors are strongly associated with the geographical distribution of such snails in the LSV? Consistent with expectations, the SDMs reveal the following: 1) currently, Bu. africanus group not only has a wide distribution across central Chikwawa and eastern Nsanje but is also concentrated in floodplains, and the LSV has few habitats that can support Bi. pfeifferi, 2) vegetation cover is the most important predictor of Bu. africanus group distribution, whereas precipitation variables are most important for Bi. pfeifferi in the LSV. Understanding the spatial and temporal distributions of these snails is important for controlling and eliminating schistosomiasis
“Female Genital Schistosomiasis: Translational Challenges and Opportunities”: Outputs and actions from a consultative, collaborative and translational workshop
Get PDFFemale genital schistosomiasis (FGS) is a chronic disease manifestation of the waterborne parasitic infection, Schistosoma haematobium, that affects up to 56 million women and girls, predominantly in sub-Saharan Africa (SSA). Starting from early childhood, this stigmatising gynaecological condition is caused by the presence of Schistosoma eggs and associated toxins within the genital tract. S. haematobium typically causes debilitating urogenital symptoms, mostly a consequence of inflammation, that includes bleeding, discharge and lower abdominal pelvic pain. Chronic complications of FGS include adverse sexual and reproductive health and rights (SRHR) outcomes such as infertility, ectopic pregnancy and miscarriage. FGS is associated with prevalent human immunodeficiency virus (HIV) and may increase the susceptibility of women to high-risk human papillomavirus (HPV) infection. Across SSA and even in clinics outside endemic areas, the lack of awareness and available resources among both healthcare professionals and the public means FGS is underreported, misdiagnosed and inadequately treated. Several studies have highlighted research needs and priorities in FGS, including better training, accessible and accurate diagnostic tools, and treatment guidelines. On September 6th, 2024, LifeArc, the Global Schistosomiasis Alliance (GSA) and partners from the BILGENSA Research Network (Genital Bilharzia in Southern Africa) convened a consultative, collaborative and translational workshop: “Female Genital Schistosomiasis: Translational Challenges and Opportunities”. Its ambition was to identify practical solutions that could address these research needs and drive appropriate actions towards progress in tackling FGS. Here, we present the outcomes of that workshop – a series of discrete translational actions to better galvanise the community and research funders.</p
Data for the article 'Interventions to support parents, families and caregivers in caring for preterm or low birth weight infants at home: a systematic review and meta-analysis'
No full textSystematic review dataset
Correction to: ‘Unravelling nicotinic receptor and ligand features underlying neonicotinoid knockdown actions on the malaria vector mosquito Anopheles gambiae ’ (2024), by Ito et al.
Get PDFAlthough the biological data we presented in the original paper are correct, there is an error in the calculated log P values for certain compounds, now corrected in this Corrigendum. One conclusion in the original paper as published, which states that log P and Imax are negatively correlated with log k, is incorrect and we clarify that in this Corrigendum. The corrected calculations still indicate that the Agα1/Agα2/Agα8/Agβ1 nAChR is the most important factor determining the rate constant, as described in the original paper. This has been corrected in the text below.</p
VAR2CSA-specific IgG and IgM antibodies are markers of exposure and protection against adverse malaria pregnancy outcomes
Get PDFBackground: Placental malaria is caused by the binding of the Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) protein VAR2CSA, found on the surface of infected erythrocytes, to placental tissue. Complications include maternal anaemia, low birth weight, small for gestational age and preterm delivery. Acquisition of antibodies against VAR2CSA during pregnancy has been linked to immunity against infection. Methods: Pregnant Malawian women were enrolled at their first antenatal care visit at 16–28 weeks’ gestation into a trial of malaria prevention. Women with malaria infection at enrolment (n = 321) or any later point in pregnancy (n = 145) were selected. The IgG and IgM plasma levels against the VAR2CSA DBL1X-ID2a domain were measured at enrolment and delivery. Associations between the DBL1X-ID2a VAR2CSA-specific IgG and IgM antibody levels at enrolment or delivery and low birth weight, small for gestational age, maternal anaemia at delivery, and preterm delivery were assessed using logistic regression with confounder adjustment. Result: Women with malaria infection at enrolment had higher antibody levels to DBL1X-ID2a than uninfected women, and these declined from enrolment to delivery. There were no significant associations between the IgG antibody level measured at enrolment and the birth outcomes of interest, but the IgG antibody level at delivery in women uninfected at enrolment was associated with a lower risk of low birth weight, adjusted odds ratio (aOR) 0.43 (95% CI 0.19–0.97) p = 0.04. Additionally, in women infected at enrolment, one log higher IgM antibodies to DBL1X-ID2a VAR2CSA at enrolment were associated with a significant 23% decrease in maternal anaemia at delivery, aOR 0.77 (95% CI 0.60–0.99), p = 0.04. Conclusion: VAR2CSA-specific IgG and IgM antibodies are markers of malaria infection and protection against placental malaria outcomes.</p
Current approaches in livestock geotagging:Assessing available technologies and applications to public health research in Kenya and Malawi
Get PDFLivestock geotrackers are increasingly used for public health research, particularly within the field of One Health, to draw inference on pathogen exposure and human risk from livestock movement data. There are many dozens, if not hundreds, of devices available to researchers, including devices purpose built for livestock such as collars, ear tags, rumen boluses (placed in the forestomach of a ruminant), or other formats; those intended for wildlife but suitable for livestock; and devices intended for other geotracking applications which can be retrofitted for livestock. To assist other researchers in navigating the wealth of available options, we present here our experiences with six devices—four intended for livestock, one intended for wildlife, and one intended for humans— applied to cattle, camels, sheep, goats, and donkeys in rural locations in Eastern and Southern Africa. We summarize the technical specifications and features of these devices, our deployment strategies, and our experiences in terms of battery life, durability, data quality and retrieval, and acceptability by livestock owners. We found that both FindMy and CatLog2 performed well and were cost-effective at under $250 per unit. While FindMy is more costly than CatLog2, this device transmits signal, allowing users to track device locations from an app or browser. Our results support other One Health researchers weighing the hundreds of options for livestock geotracking available to them, considering their project’s context, objectives, and available resources.</p
A machine learning approach for automated injuries classification on postmortem images
Get PDFThe application of Artificial Intelligence (AI) in forensic science offers new opportunities for the automated detection of injuries in postmortem analysis. This study focuses on the semantic segmentation of two significant types of injuries—bruises and abrasions. A dataset of postmortem injury images was collected, followed by the development of appropriate data preprocessing and annotation techniques to train and evaluate AI models. Three deep learning architectures—U-Net, FPN, and LinkNe—were implemented, using EfficientNetB3 and ResNet50 as backbone networks. An optimisation strategy was employed to enhance detection performance by incorporating a custom loss function alongside a combination of image transformation and class balancing techniques. Experimental results demonstrated high sensitivity (92.7%) and specificity (98.9%) for the best-performing model. These findings highlight the potential of AI-driven methods for automated and objective analysis of postmortem images in injury detection, laying the foundation for further research
An investigation of female genital schistosomiasis and associated genital infections in southern Malawi
Get PDFUrogenital schistosomiasis caused by zoonotic or hybrid schistosome infection(s) is an emerging public health concern in Malawi and we describe a 1-year clinical sub-study with three inspection time-points for female genital schistosomiasis upon selecting 86 women with proven urogenital schistosomiasis. This sub-study was set within a broader 2-year longitudinal 'Hybridization in UroGenital Schistosomiasis (HUGS)' investigation. A detailed cervicovaginal examination with a portable colposcope was conducted, examining cervicovaginal lavage (CVL), cervical swabs, cervical biopsy and urine with traditional parasitological and molecular diagnostic methods. At baseline, overt FGS by colposcopy was 72.1%, 64.3% by CVL real-time PCR and 51.2% by both colposcopy and CVL-PCR, noting urine-microscopy could often be negative. Human papilloma virus was detected in 31.0%, with 8.3% also FGS positive by colposcopy and real-time PCR. Over the year, FGS prevalence by colposcopy increased by 32.7% during the study to 84.6%, homogenous yellow and grainy sandy patches being very common in the youngest 18-25 age group, where 51.9% were positive. FGS appears widespread locally and we discuss difficulties in its detection without invasive sampling. In addition to the presence of S. haematobium, S. mattheei was noted alongside key concurrent sexually transmitted infections. From our findings, we point out that improved prevention and management of FGS is required, foremost, better availability and regular accessibility to praziquantel treatment is needed. Furthermore, targeted health education, raised community awareness and dovetailing synergistic public health activities within Sexual and Reproductive Health services and local HIV/AIDS programmes could develop an appropriate holistic health intervention package.</p
Impact of dual active ingredients long-lasting insecticidal nets on the genetic structure of insecticide resistant populations of Anopheles gambiae in Southern Benin
No full textBackground: Insecticide resistance amongst vector populations is a major challenge, exacerbated by the continued use of the same active ingredients. The present study assessed the impact of long-lasting insecticidal nets (LLINs) bi-treated with chlorfenapyr-alphacypermethrin (PY-CFP LLIN) or pyriproxyfen-alphacypermethrin (PY-PPF LLIN) on the genetic structure of resistant populations of Anopheles gambiae in 60 clusters divided into three arms from three districts in southern Benin. Methods: The study was conducted between September 2019 and October 2021 in 123 villages grouped in 60 clusters. Mosquitoes were collected indoors and outdoors using human landing catches (HLCs) in 4 households in each cluster every 3 months. After morphological identification, a subsample of An. gambiae sensu lato (s.l.) was analysed by PCR to detect the molecular species and the presence of L1014F vgsc-kdr and G119S-ace-1 mutations. Results: Anopheles coluzzii (56.9%) and An. gambiae sensu stricto (s.s.) (42.8%), with a few hybrids (0.2%), were identified within 4242 samples of An. gambiae tested. The frequency of L1014F vgsc-kdr decreased in An. coluzzii collected both indoors and outdoors locations in the PY-CFP LLIN and PY-PPF LLIN arms post-intervention compared to baseline. In An. gambiae, the frequency of the L1014F allele decreased in year one but increased above baseline in year 2. In both species, the allelic frequency of G119S-ace-1 was < 10%. For L1014F vgsc-kdr, the fixation index was positive (FIS > 0) in both species. However, it was negative (FIS < 0) for the presence of G119S-ace-1. Weak genetic differentiation, especially in the PY-PPF LLIN and PY-CFP LLIN arms (FST ≤ 0.05), was observed in An. gambiae s.s. populations with L1014F vgsc-kdr, while it was generally higher for both species with G119S-ace-1. Conclusion: The frequency of the L1014F vgsc-kdr resistance allele was high, while that of the G119S-ace-1 allele was low throughout the study period. Consistent changes in allele frequencies were not observed in any of the treatment arms suggesting that the pyrethroid component of dual AI (active ingredients) nets continues to select for the resistant allele and there is little if any evidence that the non-pyrethroid insecticide selects for the wild-type kdr allele.</p