21367 research outputs found
Sort by
Healthcare in the Margins: A Qualitative Study of Healthcare Access and Utilization in Bangladesh’s Informal Urban Settlements
Get PDFThis study investigates healthcare access and health-seeking behavior in informal urban settlements of Bangladesh, focusing on the roles played by key stakeholders in the public, private, NGO, and informal sectors, toward positive health outcomes. Utilizing data gathered from service mapping (N = 5), validation sessions (N = 5) and case studies (N = 15) in five informal urban settlements. The study uncover many important barriers to healthcare access, with those linked to economic and infrastructural shortcomings emerging as particularly critical. Although healthcare is available, public hospitals are overcrowded and have long waiting lists. Poorer patients are often mistreated and fees at private health facilities are unaffordable for many residents. Culturally relevant alternatives, often referred to as informal healthcare providers play an important role in these communities. Local unlicensed pharmacies and Traditional Birth Attendants (TBAs) are particularly prominent. However, they often offer services that include risks such as over-prescribing and insufficient training. Factors including financial stress, low health literacy, and a fragmented healthcare system drive health inequities. This study underscores the importance of enhancing health literacy and education to enable marginalized groups to make effective health choices. The study provides fresh insights into the healthcare needs and associated inequities in these informal urban settlements. These findings reinforce the relevance of SDG 3 goals by emphasizing the need for inclusive, equitable, and community-oriented healthcare approaches to ensure healthy lives and promote well-being for all.</p
Regional variations in cardiovascular risk predictions: a comparative analysis of Framingham, SCORE2, and WHO models across 53 countries
Get PDFBackground Risk prediction models for cardiovascular diseases (CVDs) have been widely applied in clinical practice and in designing prevention policies globally, yet their accuracy across different regions with distinct epidemiological profiles remains uncertain. We examined the regional variation in risk distribution and agreement between these models. Methods We analysed 53 nationally representative health surveys in seven regions. Using the World Health Organization (WHO), SCORE2, and Framingham CVD risk prediction models, we estimated the respondents’ 10-year CVD risk and categorised them into low-, moderate-, or high-risk groups. Results We included 86 430 individuals aged 40–69 years without a history of CVD in our analysis. Globally, CVD risk estimates differed substantially across models (WHO: 7.75%; 95% confidence interval (CI) = 7.70–7.80; SCORE2: 3.72%; 95% CI = 3.69–3.75; Framingham: 12.42%; 95% CI = 12.34–12.50). We also noted regional disparities in identifying moderate- and high-risk subjects, particularly in South Asia (WHO: 12.57%; 95% CI = 11.63–13.51; SCORE2: 18.24%; 95% CI = 17.14–19.33; Framingham: 29.40%; 95% CI = 28.11–30.70), sub-Saharan Africa (WHO: 16.30%; 95% CI = 15.78–16.83; SCORE2: 22.69%; 95% CI = 22.09–23.28; Framingham: 33.85%; 95% CI = 33.18–34.52), East Asia & the Pacific (WHO: 21.06%; 95% CI = 20.57, 21.55; SCORE2: 31.03%; 95% CI = 30.47, 31.59; Framingham: 45.54%; 95% CI = 44.93–46.14), and Latin America & the Caribbean (WHO: 23.09%; 95% CI = 21.48–24.70; SCORE2: 41.56%; 95% CI = 39.68–43.44; Framingham: 55.83%; 95% CI = 53.94–57.72), with greater than two-fold differences across models. Agreement in classifying individuals into low-, moderate-, or high-risk groups remained relatively high across risk models (63.1%), but varied considerably across regions, from 73.91% in South Asia to 47.54% in Latin America & the Caribbean. Conclusions The CVD risk estimates produced by the WHO, SCORE2, and Framingham models varied significantly across regions, with poor consistency in identifying at-risk individuals in some regions. These discrepancies may lead to undertreatment and inefficient use of otherwise limited healthcare resources. Region-specific adaptations are needed to enhance risk targeting, promote equity, and improve the overall effectiveness of primary prevention.</p
Trends and patterns of insecticide susceptibility of Anopheles gambiae between 2015 and 2020: implications for malaria vector control interventions in Ghana
Get PDFBackground: The distribution and use of insecticide treated nets (ITNs) and indoor residual spraying (IRS) are the two main insecticide-based tools that have been scaled up in Ghana. Although insecticide resistance to different insecticides have been reported in parts of Ghana, there is little information on the status and extent of resistance in malaria vectors across different areas in the country. There was, therefore, a need to generate annual geographically specific insecticide resistance data to assist in the development of insecticide resistance management strategies in Ghana. This study presents five years data on monitoring of four classes of insecticides. Methods: Standard World Health Organization (WHO) insecticide susceptibility tube assays were carried out annually on adult female Anopheles gambiae reared from immature stages in 30 sentinel sites across Ghana each year from 2015 to 2020. Insecticide papers impregnated with seven insecticides in four classes were used for assays in the selected sites. PCR was performed to identify mosquito species and detect knock down resistance, kdr-west (L1014F) and acetylcholinesterase, ace-1 G119S gene mutations in forty randomly selected mosquitoes per site. Results: High resistance to pyrethroids and DDT was detected in all the sites with a decrease in susceptibility over the years. The susceptibility of carbamates and organophosphates reduced in all the sites over the 5 years. Anopheles gambiae sensu stricto (s.s.) and Anopheles coluzzii represented the two-main species of the complex living in sympatry mostly in the southern sentinel sites, with Anopheles arabiensis in smaller numbers in the northern Sahelian sites. The target site resistance frequency was significantly higher for the L1014F compared to the G119S with variations across the sites. Conclusion: Findings showed that resistance to deltamethrin, permethrin (pyrethroids), DDT (organochlorine) malathion and pirimiphos-methyl (organophosphates) and bendiocarb and propoxur (carbamates) was widespread in Ghana. There is high frequency of L1014F alleles (kdr-west) in all the sites with marginal increase for G119S ace-1 mutations. This highlights the need for continuous monitoring of the insecticide resistance of An. gambiae sensu lato in the country to ensure informed decision-making on resistance management strategies and choice of insecticides for malaria vector control in Ghana.</p
In vitro and in situ analysis of novel copper-based antimicrobial surface coatings designed to reduce the microbial bioburden of high-touch surfaces in a hospital environment
No full textBackground: The hospital environment plays a crucial role in healthcare-associated infections. Current cleaning protocols to address this are costly and labour intensive, with further complications related to compliance, efficiency and the environmental impact of cleaning agents. Findings: We developed a nano-structured coating, iC-nano™, which exhibits high antimicrobial activity. The 73 unique formulations assessed showed a range of activity in vitro. The best coatings displayed high activity within 15 min and were equally effective against all ESKAPE(e) pathogens except Enterococcus faecium, which required an increased contact time. Analysis within an active hospital environment identified 44% fewer colony-forming units (cfu) recovered from coated surfaces, though with some uncertainty in estimates of effect size (1.77 fold [95% credible interval {CrI}: 0.98, 3.13]). The highest counts were observed among toilet exits, whilst samples collected on a Wednesday had 45% less cfu than on Monday (0.55 fold [95% CrI: 0.32, 0.91]). Whilst the durability and antimicrobial activity of the coating remained stable, a key concern raised was the aesthetic of the product that gave the appearance of being soiled after sustained use, potentially leading to behaviour change. Conclusions: Through this study, we highlighted the promising potential of antimicrobial surfaces coatings. We suggest that future interventions, be they enhanced cleaning protocols or specialised coatings, should initially focus on locations such as toilet door handles, where the largest recoverable microbial bioburden was observed. Conversely, patient check-in screens saw minimal human interaction and are therefore considered a lower priority.</p
Advancing equity in collaborative research: reflections from the Cultural Evolution Society Transformation Fund
Get PDFAs the field of cultural evolution marks its fiftieth anniversary, it has an opportunity not only to evolve in theory and scope, but also in ethics of practice. This theme issue contributes to that shift by showcasing projects supported by the Cultural Evolution Society's Transformation Fund (CES-TF), which centred equity, diversity and inclusion (EDI). This opinion piece draws on our CES-TF projects, conducted across diverse cultural and geographical settings, to reflect on the challenges and possibilities of making cultural evolution-and human research more broadly-more just. We focus on three relational dimensions in which cultural evolution research can become more inclusive and equitable: fostering equitable cross-cultural research collaborations; building mutually beneficial researcher community collaborations; and cultivating supportive funding and institutional relationships. Our collective reflections, written by grant recipients and the CES-TF lead, emphasize that, while there is no universal model for ethical research, attending to positionality, power dynamics and diverse knowledge systems can foster responsible and impactful research. Striving to make the field more globally representative will enhance our capacity to critically reflect and improve, but real progress requires time, resources and structural reform, supported by institutions, funders and journals committed to embedding EDI at the core of research. This article is part of the theme issue 'Transforming cultural evolution research and its application to global futures'.</p
Community evaluation of VECTRON™ T500 (broflanilide) for indoor residual spraying for malaria vector control in Siaya county, Kenya
Get PDFBackground: Indoor residual spraying (IRS) remains a core malaria vector control intervention, but widespread insecticide resistance threatens its effectiveness. VECTRON™ T500, containing broflanilide, represents a novel IRS product with a new mode of action targeting GABA receptors. Methods: A two-arm non-inferiority study was conducted in Bar Olengo, Siaya County, Kenya, between June and November 2024. Twenty-five structures per arm were sprayed with either VECTRON™ T500 (100 mg a.i/m2) or Actellic™ 300CS (1 g a.i/m2), with five water-sprayed controls. Residual efficacy was assessed using world health organization (WHO) cone bioassays with pyrethroid-resistant Anopheles gambiae sensu stricto (s.s.) Bungoma strain and susceptible Kisumu strain monthly for six months. Wild vector susceptibility to insecticides, community acceptability, and adverse events were evaluated. Results: VECTRON™ T500 maintained significantly higher mortality than Actellic™ 300CS throughout six months on both wall types. Against resistant An. gambiae s.s. Bungoma strain, VECTRON™ T500 achieved 98.73 ± 3.51% mortality (95% CI 97.95–99.51%) compared to 80.22 ± 11.23% for Actellic™ 300CS (95% CI 77.72–82.72%; t₇₈ = − 10.15, p < 0.001, Cohen's d = 2.27). For susceptible Kisumu strain, VECTRON™ T500 maintained 100% mortality versus 89.60 ± 6.34% for Actellic™ 300CS (95% CI 88.19–91.01%; t₇₈ = 10.53, p < 0.001, Cohen's d = 2.38). Actellic™ 300CS efficacy declined below 80% after month 4, while VECTRON™ T500 remained > 95% effective throughout. Wild An. gambiae sensu lato (s.l.) and Anopheles funestus s.l. showed 100% susceptibility to broflanilide with no cross-resistance detected. No adverse events occurred in VECTRON™ T500 households versus 8% (12/150) in Actellic™ 300CS households. Community acceptance was 100% for VECTRON™ T500 versus 99.33% (149/150) for Actellic™ 300CS, though this difference was not statistically significant. Conclusions: VECTRON™ T500 demonstrated superior residual efficacy, excellent safety profile, and high community acceptance compared to Actellic™ 300CS. Its novel mode of action and absence of cross-resistance to pirimiphos-methyl and pyrethroids make it valuable for insecticide resistance management in malaria vector control programmes.</p
'He who knows it, feels it.' Stepping stones towards fulfilling a peer-advocate role among people with chronic stigmatising conditions in Liberia
Get PDFBACKGROUND: People affected by skin neglected tropical diseases (NTDs) are often stigmatised, experiencing discrimination in consequence of their condition. Peer advocates can help progress a person-centred agenda for people affected by NTDs, however, evidence gaps in the steps to becoming an advocate persist. METHODS: We wanted to understand the steps towards a peer advocacy role for skin NTDs. We used the participatory Stepping Stones method to identify steps on the journey to becoming an advocate with 48 participants, followed by three in-depth life histories with peer advocates for other stigmatising chronic conditions (e.g. disability, mental health, Ebola survivors). RESULTS: We found study participants frequently experience stigma and discrimination in consequence of their condition. The peer advocate role includes awareness raising and advocacy and providing mutual peer support. Among peer advocates, personal acceptance of their condition, vocational training and family support are important steps along the pathway to becoming a peer advocate. Outcomes of the role include personal determination and increased confidence for peer advocates, provision of help and support for others with similar conditions and broader change in understanding, attitudes and policy within the community and country. CONCLUSIONS: We find that when appropriately enabled, peer advocates can themselves be empowered and play a key role in person-centred care
Protective association of 13-valent pneumococcal conjugate vaccination against experimental carriage determined by 1-year post-vaccination re-challenge with Streptococcus pneumoniae serotype 6B in Blantyre, Malawi
Get PDFBackgroundIn Malawi, childhood pneumococcal conjugate vaccination has not achieved expected herd protection despite more than 10 years since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Vaccine efficacy and longevity of protection are crucial in achieving herd protection. We previously found that PCV13 offers immediate protection from experimental pneumococcal carriage in Malawian adults, but of uncertain duration. Using a pre-specified study protocol, we aimed to determine longevity of protection of PCV13 vaccination against experimental human pneumococcal carriage measured by one-year post-vaccination homotypic Streptococcus pneumoniae serotype 6B re-challenge in healthy Malawian adults.MethodsWe re-recruited all eligible participants available at one-year post-vaccination follow-up from a double-blind, parallel-arm, randomised controlled trial investigating the efficacy of PCV13 or placebo against experimental pneumococcal carriage of Streptococcus pneumoniae serotype 6B (SPN6B, strain BHN418) among healthy adults (aged 18-40 years) in Blantyre, Malawi, one year after vaccination. Participants were re-challenged intranasally with 80,000 colony-forming units (CFUs) of SPN6B per naris. The primary endpoint was experimental pneumococcal carriage, established by culture of nasalwash at 2, 7, and 14 days. Vaccine efficacy was estimated using a log-binomial model adjusting for prior experimental SPN6B carriage, prior natural carriage of any serotype, and prior inoculation dose.FindingsParticipant recruitment started on 10 May 2022 and the final visit was completed on 22 August 2023. 137 participants completed the study protocol after being re-recruited (57 PCV13, 80 placebo). In an adjusted model, there was a 73% protective effect of PCV13 vaccination against experimental pneumococcus serotype 6B carriage following re-challenge (RR 0.27, 95% CI 0.08-0.98, p = 0.047). Prior experimental serotype 6B carriage reduced vaccine protective effect, and even reversed it (RR 2.20, 95% CI 0.85-5.67, p = 0.10). The effect of PCV13 vaccination was reduced within prior serotype 6B carriers (RR 8.95, 95% CI 2.27-35.33, p = 0.002) and prior natural pneumococcal carriers (RR 14.31, 95% CI (1.65, 124.20), p = 0.016). Lastly, in the placebo but not vaccine arm, experimental pneumococcal carriage rate was lower after nasal re-challenge compared to the primary challenge (12 [15.0%] of 80 vs 30 [28.3%] of 106; McNemar’s test p=0.031) indicating an immunising effect of the primary challenge.InterpretationThe study indicates that PCV13 vaccination has a role in preventing pneumococcalcarriage for at least one year, with strong interaction with natural carriage events. This suggests that the inability to achieve herd protection in Malawi is probably due to factors other than the efficacy or duration of protection of the PCV13 vaccine
Peter J Diggle’s contribution to the Discussion of ‘Some statistical aspects of the COVID-19 response’ by Wood et al.
No full textEvaluation of the effectiveness of a restricted diet therapy package combining standardised caloric intake with exercise in obese patients: A 12-month randomised controlled trial.
Get PDFObjectives to background and aims: Obesity is a major global health challenge associated with increased risks of diabetes and cardiovascular disease. Although calorie restriction and exercise are cornerstone strategies for weight management, long-term adherence remains difficult in real-world settings. This randomised controlled trial aimed to evaluate the effectiveness of a structured calorie-restricted dietary therapy package combined with exercise in achieving weight loss and improving metabolic and psychological outcomes among obese adults. Methods: In this 12-month, parallel-group randomised controlled trial, 99 obese adults were randomly assigned to an intervention group (standardised meal kit + exercise) or a control group (standard dietary advice + exercise). Weight, glucose, lipid profiles, and mental health outcomes were assessed at baseline, 3, 6, and 12 months. LASSO regression was used to identify predictors of successful weight loss, and linear mixed-effects models evaluated associations between percentage weight loss and changes in glycaemic, lipid, and psychosocial outcomes. Results: By month 12, all participants in the intervention group achieved ≥5 % weight loss, with 59.18 % achieving ≥10 %, compared to 38.00 % and 6.00 % in the control group, respectively. Group assignment was the strongest predictor of weight loss success, followed by HDL levels and family history of obesity. Each 1 % reduction in body weight was significantly associated with lower FPG, 2hPG, TC, TG, and LDL-C, as well as improved SDS, SAS, and SF-36 scores. These associations remained significant after adjusting for confounders. However, interaction analyses showed no significant between-group differences in the effect of weight loss on outcomes. Conclusion: A standardised dietary therapy package combining calorie restriction and exercise is a feasible and effective strategy to achieve clinically meaningful weight loss and improve metabolic and psychological health in obese adults. Although both groups experienced improvements, the structured intervention enhanced adherence and overall effectiveness.</p