International Health最新文献

Background: The evaluation unit comprising Kaoma, Luampa, and Nkeyema districts, Western Province, Zambia, has persistent active trachoma. In 2023, we sought to compare the evaluation unit-level prevalence of the active trachoma sign, trachomatous inflammation-follicular (TF), to that of conjunctival Chlamydia trachomatis (Ct) infection and anti-Chlamydia trachomatis (Ct) seropositivity.

Methods: We conducted a cluster-sampled cross-sectional survey. In selected households, we examined all consenting residents ≥1 y of age for trachoma. We collected dried blood spots (DBSs) by finger-prick from children ages 1-9-y and conjunctival swabs from the left eyes of children ages 1-5-y. DBSs were tested for antibodies to the C. trachomatis antigen Pgp3 by lateral flow assay. We tested conjunctival swabs for C. trachomatis DNA by GeneXpert polymerase chain reaction (PCR).

Results: The TF prevalence in children ages 1-9-y was 9.2%. In children ages 1-5-y, anti-Pgp3 seroprevalence was 1.7% and the seroconversion rate was 0.6 per 100 person-years. The prevalence of conjunctival C. trachomatis DNA in children ages 1-5-y was 0%.

Conclusions: Based on TF prevalence, this population qualified for additional antibiotic mass drug administration rounds, but PCR and serology-more specific indicators of current or recent C. trachomatis infection than TF-confirmed an absence of significant current community C. trachomatis transmission, allowing a transition to surveillance. Adding these indicators is helpful in persistent active trachoma.

This systematic review and meta-analysis aimed to identify risk factors and mortality rates in HIV and TB co-infected children in Ethiopia. An electronic literature search was conducted using multiple databases, including PubMed, Medline, Web of Science, African Journal Online, Google Scholar and university research repositories for gray literature. Weighted inverse variance random-effects meta-regression was employed to calculate pooled mortality rates, utilizing Stata/SE-17 for analysis. The meta-analysis included six eligible studies, encompassing a total of 2025 co-infected children. Among these, 238 deaths were reported over 1670.6 person-years. This made the crude mortality rate 11.74% (95% CI 11.49 to 16.12%) with an incidence of 1.5 deaths (95% CI 1.17 to 1.89) per 100 person-years. Factors including WHO stages III and IV (4.34, 95% CI 2.25 to 8.36), poor antiretroviral therapy (ART) adherence (3.11, 95% CI 2.04 to 4.15), missed isoniazid preventive therapy (IPT) (3.07, 95% CI 1.52 to 6.23) and low hemoglobin levels of ≤10 mg/dl (2.84, 95% CI 2.02 to 3.99) were predictors compared with their counterparts.This review reveals an unacceptably high pooled incidence of mortality among HIV and TB co-infected children in Ethiopia. Therefore, implementing systematic screenings for IPT, enhancing ART adherence counseling and addressing anemia through early treatment are critical for preventing premature deaths. Protocol registration in Prospero = CRD42024502038.

Background: This study assessed the use effectiveness of the symptothermal method (STM) to ameliorate the unmet need for family planning.

Methods: The study adopted a quasi-experimental design. A total of 260 women, comprising 136 STM users (interventional group) and 124 oral contraceptive pill (OCP) users (control group), were recruited. Intervention was conducted for 3 months with longitudinal monitoring for 12 months. Questionnaires, cycle charts and thermometers were used for data collection and data were analysed using SPSS version 23 (IBM, Armonk, NY, USA). To estimate the use effectiveness of STM vs OCPs, survival analysis of the Life table and Kaplan-Meier with log rank, was performed at 95% confidence interval (CI). To estimate the hazard ratio based on the effects of its covariates, a Cox proportional hazards model with 95% CI was applied. The Cox proportional hazards assumption was checked and four categorical covariates were adjusted for in the Cox model analysis.

Results: In the STM group, no pregnancy occurred. Use effectiveness of STM for 12 months was 100%. For OCPs, three pregnancies occurred. The use effectiveness was 97-99% with failure of 1-2%. The Cox proportional hazards model had a hazard ratio of 0.01 (p=0.058), indicating that the risk of unintended pregnancy was lowered by 99% in STM users compared with OCP users. A p-value >0.05 indicated no significant difference between the two groups.

Conclusions: Our study demonstrated that STM, when used correctly, is very effective in ameliorating the unmet need for family planning based on the World Health Organization's algorithm on STM effectiveness as an alternative to artificial contraceptive methods.

Background: Depression is prevalent among men who have sex with men (MSM) in South Africa and can impact their adherence to PrEP and ART. We developed the WeCare coaching intervention, adapted from the evidence-based Friendship Bench/Inuka problem-solving therapy program, to address their mental health challenges.

Methods: Twenty MSM with symptoms of mild to moderate depression (Patient Health Questionnaire-9 scores 5-14) and using PrEP or ART were recruited from two clinics in Johannesburg and Pretoria. Participants received adapted Inuka coaching (four individual and up to four group sessions). Mental health outcomes were assessed preintervention and postintervention using the SRQ-20. Postintervention in-depth interviews and focus group discussions were conducted with participants and lay health workers (LHWs). Qualitative data evaluated utility. Data were analysed using thematic analysis.

Results: Median SRQ-score improved from preintervention to post-intervention assessment (p<0.001). Participants found coaching acceptable, qualitatively highlighting the value of a safe space to discuss emotional well-being. Key themes included: (1) need for cultural and contextual adaptation of coaching content; (2) stigma-related stressors shaping mental health and perceived engagement with ART/PrEP; and (3) LHWs expressed enthusiasm for delivering support but requested strengthened ART/PrEP literacy training.

Conclusion: Findings supported acceptability and feasibility and informed further development of the WeCare intervention.

Previous studies have focused on the effects of ozone (O3) exposure and preterm birth (PTB), but the findings are contentious and the susceptible window for O3 exposure during pregnancy remains inconclusive. Here, we pooled the current evidence to explore the relationship between maternal O3 exposure and PTB and further identified the susceptible exposure windows. We pooled a meta-analysis of 17 eligible studies by searching Embase, PubMed and Web of Science through 9 September 2024. The odds ratio (OR) and the corresponding 95% confidence intervals (CIs) were extracted for analysis. The tests for heterogeneity, sensitivity and publication bias between studies were performed using Stata 15.0 (StataCorp, College Station, TX, USA). The combined results showed a positive association between O3 exposure and PTB (n=13; OR 1.065 [95% CI 1.056 to 1.073]), and middle pregnancy (gestational weeks 13-27) may be a susceptible window of O3 exposure with PTB (n=11; OR 1.033 [95% CI 1.029 to 1.036]). This meta-analysis suggested that O3 exposure during pregnancy may independently increase the risk of PTB and gestational weeks the 13-27 is a critical window for preventing this risk. Reducing outdoor activity or a wearing protective mask and multiple micronutrients supplementation during pregnancy may reduce the risk of O3 exposure in PTB.

Background: Zoonoses pose a significant health challenge globally, with livestock playing a major role in disease transmission. Understanding livestock farmers' knowledge, attitudes and practices (KAP) is crucial for prevention and control.

Methods: A cross-sectional survey was conducted among 150 livestock farmers in Ghana's Coastal Savannah agroecological zone. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression analysis assessed the association between farmers' KAP and socio-economic and farm characteristics.

Results: While 66.0% of farmers had satisfactory knowledge of specific zoonoses and 74.0% perceived preventive practices as protective, only 49.0% perceived the diseases as zoonotic and 39.3% practiced prevention satisfactorily. Farmers with fewer disease encounters (adjusted OR [aOR] 0.499 [95% CI 0.347 to 0.717]), males (aOR 3.238 [95% CI 1.213 to 8.648]) and intensive farmers (aOR 5.396 [95% CI 1.276 to 22.808]) have higher odds of having satisfactory knowledge. Conversely, males (aOR 0.261 [95% CI 0.077 to 0.885]) and farmers with more disease encounters (aOR 0.664 [95% CI 0.490 to 0.898]) have lower odds of having satisfactory perception.

Conclusions: This study highlights a knowledge-practice gap among livestock farmers regarding zoonoses, influenced by factors like gender, production systems and disease encounters. Targeted training is recommended for women, extensive systems and disease-prone farms.

Background: To provide the groundwork for a future declaration of elimination of trachoma as a public health problem in Brazil, we conducted house-to-house surveys following WHO methodological guidance.

Methods: An observational cross-sectional study was conducted in 10 non-indigenous and five indigenous evaluation units (EUs) from 2018 to 2023; data on six EUs are reported here for the first time. Two-stage cluster sampling was used: 30 clusters per EU, and 30 households per cluster. We estimated the prevalence of trachomatous inflammation-follicular (TF) in 1-9-y-olds and trachomatous trichiasis (TT) unknown to the health system in those aged ≥15 y. Data on sanitary conditions were collected in household interviews.

Results: In all EUs, TF prevalence was below the elimination threshold (5%). TT prevalence was lower than the 0.2% threshold in 14 EUs. In 'Noroeste Cearense' mesoregion, TT prevalence was 0.22% (95% CI 0.06 to 0.44%), but statistical analysis showed a 58% likelihood of TT elimination in this EU. In three indigenous EUs, >10% of households had no sanitary facilities and high percentages of open defecation.

Conclusions: It is highly likely that trachoma has been eliminated as a public health problem in all the EUs surveyed. The findings on sanitary conditions mandate public policies to overcome socioenvironmental inequalities.

Conflict in Sudan since April 2023 has disrupted health information systems, particularly in hard-to-reach areas like Darfur. In response to limited surveillance capacity and reports of suspected outbreaks (e.g. measles, cholera, hepatitis E), Sudan's Federal Ministry of Health, Health Cluster partners and the WHO piloted an emergency surveillance programme using the WHO-developed Early Warning, Alert, and Response System Mobile (EWARS Mobile) in Central and East Darfur states from September 2024 to January 2025. The approach enabled simplified, offline reporting of eight priority diseases and event-based surveillance through partner-supported health facilities. A total of 158 health facilities submitted 752 weekly reports, generating several verified alerts, including suspected measles and acute flaccid paralysis. Despite resource and connectivity challenges, the system provided timely, actionable data for early detection and prompt response, and worked as a beachhead for enhanced partner coordination. The pilot highlighted the value of fit-for-purpose surveillance tools in complex emergencies and demonstrated the feasibility and utility of EWARS Mobile in conflict-affected settings. Based on improved reporting timeliness and partner engagement, the system was approved for expansion to all Darfur states in February 2025.

Background: Despite a 95% immunisation rate in Fiji, disparities exist in the distribution of immunisation in children from different socioeconomic backgrounds. We used data from the 2021 Fiji Multiple Indicator Cluster Survey (MICS) to determine socioeconomic inequalities contributing to differences in immunisation coverage.

Methods: Data were extracted from the 'Household', 'Fertility/Birth history' and 'Children under 5' modules from the 2021 Fiji MICS to determine wealth quintiles and calculate vaccination rates for children aged 12-23 mo. Logistic regression was performed with factors of interest. Erreygers' corrected concentration index (ECI) was calculated and used to measure socioeconomic inequality.

Results: Out of 417 children; 85.6% (357/417) were fully immunised, 12.0% (50/417) partially immunised and 2.4% (10/417) had no immunisations. Factors associated with increased probability of being fully immunised included being in the highest wealth quintile after adjusting for the number of children in the household. Children from larger households were more likely to be partially immunised after adjusting for household wealth. The ECI for fully vaccinated children was positive, whereas the ECI was negative for partially vaccinated children. Logistic regression also indicated a pro-rich inequality in vaccination.

Conclusions: Our results help guides policy decisions on the delivery of immunisation services, enabling more equitable childhood immunisation in Fiji.