International Health最新文献

Cholera persists in Ghana due to sanitation challenges. This systematic review aims to synthesize data on the prevalence, antimicrobial resistance, risk factors and community knowledge of cholera in Ghana. Extensive literature searches were conducted in PubMed, Scopus, ScienceDirect, Web of Science and African Journal Online. After screening, we included 33 studies, assessing their quality using the Joanna Briggs Institute checklist. Random effects meta-analysis and subgroup analysis were conducted using RStudio. The pooled prevalence of cholera was 18.42%. Based on subgroups, the highest prevalence was reported in studies that combined rectal swabs and stool samples (57.58%), involved human populations (31.79%) and were conducted in the Greater Accra-Ashanti region (64.52%). Cotrimoxazole had the highest resistance rates (75-100%) and gentamicin the lowest (1-11%). Multidrug resistance ranged between 68% and 100%. There were reports of individual resistance genes to some antibiotics (strA, floR and dfrA1). Case fatality and mortality rates were 3.40% and 2.7%, respectively. Risk factors such as eating street-vended food and proximity to refuse dumps were also reported. Cholera persists in Ghana with high drug resistance rates and regional prevalence variations. Strengthening surveillance, improving sanitation and regulating antibiotics are critical to mitigating outbreaks and resistance spread.

Background: This study aimed to validate the 'Engage & Treat' (E&T) and 'Test & Treat' (T&T) strategies to treat individuals who seldom or never participate in lymphatic filariasis mass drug administration (LF MDA).

Methods: The study was conducted in a hotspot district of Ghana, with 20 years of MDA. Treatment registers documenting participation were used to identify non-participating individuals. Individuals willingly accepting treatment were given the drugs (E&T). Those who refused treatment were offered testing using the filaria test strip (FTS) and further engaged to receive treatment if positive (T&T). A portion of the E&T participants were also tested.

Results: Overall, 25 068 individuals who missed the last MDA were identified; 93.13% accepted the drugs; 9958 people were tested, revealing an overall prevalence of 7.26% (95% CI 6.76 to 7.79%). Positivity was higher in T&T (12.10%; 95% CI 10.43 to 13.92%) than in the E&T group (6.47%; 95% CI 5.96 to 7.01%). The odds of testing positive were higher (OR=1.99; 95% CI 1.66 to 2.39; p<0.0001) among the T&T population and missing three consecutive MDAs (OR=2.22; 95% CI 1.86 to 2.64; p<0.0001).

Conclusions: The study confirms the validity of the strategies in addressing the challenges with non-treatment during LF MDA. Their implementation in areas of persistent transmission can support elimination in these settings.

The South East Asian initiative for elimination of kala-azar from the Indian subcontinent that began in 2005 is coming to fruition, with India in the last mile of elimination. This aptly timed commentary based on the publication of Pandey et al. (2025) entitled 'Kala-azar elimination in India: reflections on success and sustainability' highlights the complementarity of political commitment that ensured socioeconomic development, along with evidence-based operational research, that needs to be sustained for zero transmission to become a reality.

Background: The phenomenon of street children, adolescents and young adults (SCAYA) is a growing global challenge. In Africa, >10 million children reside in the streets, driven by poverty, abuse and family instability. In Cameroon, this phenomenon is particularly evident in major cities. Being on the street exposes SCAYA to unsanitary living conditions, sexual exploitation, drugs and health challenges. Despite significant health challenges faced by SCAYA, there are few studies on their health status.

Methods: A cross-sectional study was conducted in Yaoundé, Cameroon, from March to July 2022. A total of 147 male street children, adolescents and young adults were enrolled through convenience sampling and voluntary consent. Data collection included semi-structured questionnaires, medical examinations and the collection of blood and stool samples for screening infectious diseases. Fisher's exact test and binomial logistic regression were used to assess associations between participant characteristics and health conditions, including malaria, helminth infections, human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

Results: Our results revealed a prevalence of malaria parasitaemia of 34.3% (47/137) among mostly asymptomatic participants. Helminth infections accounted 10.9% (16/147), HIV 3.6% (5/138) and HBV 8.7% (12/138). Other pathologies noted were scabies, ringworms, rhinobronchitis, oral infections, wounds and fractures. The logistic regression analysis did not show any statistically significant association between the presence of infectious diseases and the sociodemographic characteristics of SCAYA.

Conclusion: Our study is one of the first to shed light on the health status and prevalence of infectious diseases among SCAYA in Cameroon. The absence of significant associations with participant characteristics suggests multifactorial influences on the health of these individuals. Targeted healthcare and social interventions are essential to address SCAYA vulnerabilities and improve health outcomes.

Background: The prevalence of diabetes-related distress is high among diabetes mellitus patients, causing physical, psychological and economic burdens. China's general medical alliances and compact general alliances provide treatment for patients with type 2 diabetes mellitus (T2DM). This study aims to analyse the influence of medical alliances on diabetes-related distress and verified the mediating role of self-efficacy among T2DM patients.

Methods: From one general and one compact medical alliance, data on 2156 T2DM adults >45 y of age were investigated through a questionnaire survey conducted in China. Diabetes-related distress, medical alliance data, self-efficacy information and control variables were collected. Hierarchical linear regression mediation analysis was used to analyse the influence of compact medical alliances and general medical alliances on diabetes-related distress and to verify self-efficacy as a mediator between medical alliances and diabetes-related distress.

Results: Most patients (94.57%) with T2DM were suffering from diabetes-related distress, with an average score of diabetes-related distress (11.77±7.65). The respondents from compact medical alliances had lower diabetes-related distress (11.08±8.64) than from general medical alliances (12.38±6.61). Self-efficacy mediated the association between the type of medical alliance and diabetes-related distress (p<0.05). Higher income, lower health expenditure, lower education level, less sleep time, low physical exercise and low diabetes cognition were significant risk factors of diabetes-related distress (p<0.05).

Conclusions: Compact medical alliances reduced diabetic patients' diabetes-related distress significantly more than general medical alliances. Self-efficacy was a mediator between medical alliances and diabetes-related distress. Accelerating the transformation of the compact medical alliances can decrease diabetes-related distress and provide an integrated program of education, diabetes cognition and optimal sleep and exercise regimens to reduce diabetes-related distress.

Background: Respectful maternity care (RMC) is important for women living with human immunodeficiency virus (WLHIV) to promote their well-being and long-term healthcare engagement. This descriptive mixed-methods study explored the experiences of RMC during childbirth among WLHIV in Tanzania.

Methods: We conducted a mixed-methods study and recruited 103 WLHIV from six healthcare facilities within 48 h of giving birth. Participants completed a survey using audio computer-assisted self-interview survey technology. In-depth interviews were conducted with 12 pregnant WLHIV and 12 postpartum WLHIV.

Results: In the survey, self-reported RMC was overall high. The median score on the full RMC scale (possible range 0-100) was 74.4, with the highest scores in the subscale of dignity and respect (83.3), followed by supportive care (77.8) and communication and autonomy (62.9). Qualitative data suggested a general appreciation of the care received, but some participants reported that providers neglected them, avoided physical contact or did not seek their consent for procedures.

Conclusions: These data suggest an opportunity for additional provider training in clinical empathy and patient-centred practices to address the unique needs of WLHIV and enhance their overall maternity care satisfaction and health outcomes. There is also a need for investments in clinical infrastructure to support the delivery of RMC.

Background: Trachoma is a public health problem in Zambia. We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-y-olds and of trachomatous trichiasis (TT) in ≥15-y-olds after the implementation of trachoma elimination interventions to determine if the trachoma elimination thresholds had been achieved: <5% for TF in 1-9-y-olds and <0.2% TT for ≥15-y-olds.

Methods: Two rounds of impact prevalence surveys in two evaluation units (EUs) comprising four districts of Western Province were conducted; the first in 2018, the second in 2023. All individuals aged ≥1 year from 30 households of 24 clusters in each EU were examined for trachoma. Data were captured electronically.

Results: In 2018, TF prevalence in 1-9-y-olds was 13.9% in Kalabo/Sikongo and 17.9% in Shang'ombo/Sioma. Following further interventions, TF prevalence among 1-9-y-olds in 2023 was 7.7% and 12.5%, respectively. TT prevalences in ≥15-y-olds were 0.10% and 0.79% in 2018, and 0.4% and 0.2% in 2023, respectively.

Conclusions: These EUs did not attain trachoma elimination thresholds as a public health problem. They fulfilled the WHO definition for persistent trachoma. Therefore, they warrant further investigation, including collection of Chlamydia trachomatis infection data, to inform future programmatic decision-making. Further TT surgical services are also needed.

Background: To identify the predictive factors of maternal near miss in caesarean patients in the obstetrics and gynaecology service at Hospital III Daniel Alcides Carrión, Tacna, Peru.

Methods: A retrospective cohort study was conducted from 1 January 2022 to 31 December 2023. Preoperative, intraoperative and postoperative clinical and laboratory characteristics of caesarean patients hospitalized in the obstetrics and gynaecology service were analysed. Cox proportional hazards regression was used to identify predictors.

Results: We identified 264 caesarean patients, of which 49 experienced maternal near miss. The mean age was 32.81±5.13 y, the median number of prenatal visits was 7 (interquartile range [IQR] 6-9) and the median gestational age was 39 weeks (IQR 37.5-40). Identified predictive factors for maternal near miss were systolic blood pressure ≥140 mmHg before caesarean (adjusted hazard ratio [aHR] 2.20), duration of the caesarean (aHR 1.02) and number of prenatal visits (aHR 0.90).

Conclusions: The findings suggest that systolic hypertension before caesarean delivery, caesarean duration and number of prenatal visits are significant predictors of maternal near miss. These results underscore the importance of early prenatal care, monitoring blood pressure levels and optimizing surgical duration to improve maternal outcomes. Future research should focus on the implementation of targeted interventions based on these predictors to reduce maternal morbidity and improve health policies in low-resource settings.

Infertility is a significant reproductive health issue with high prevalence rates in Africa, where it is often stigmatized. This systematic review characterizes the experience of infertility stigma in Africa. A systematic search of relevant studies was conducted across PubMed, MEDLINE, CINAHL, PsycINFO, Global Health, Scopus and Web of Science, covering publications from their inception to March 2025. The search incorporated subject headings and keywords related to 'infertility' and 'stigma' in combination with terms specifying all African countries. A mixed methods approach was employed for data analysis, using the convergent thematic QUAL synthesis method. A total of 1987 records were identified, with 48 studies ultimately meeting the inclusion criteria. The analysis revealed four overarching themes in the experience of infertility stigma: mechanisms of stigma-factors that drive or perpetuate stigma surrounding infertility; stigma marking-the social markers and identifiers that distinguish individuals as stigmatized; manifestations of stigma-the varied forms through which stigma is expressed; and consequences-the psychological, behavioural, relational and health-related repercussions for individuals experiencing infertility stigma. Infertility stigma was widespread, with a prevalence as high as 64%. However, no interventions were developed and implemented to mitigate this issue. Infertility stigma in Africa is deeply embedded within cultural norms and social structures, significantly impacting the lives of those affected. This review emphasizes the critical need for culturally tailored interventions to alleviate stigma and enhance access to reproductive health services.

Background: Antimicrobial resistance (AMR) determinants on the ocular surface may contribute to poor treatment responses.

Methods: An exploratory comparative analysis of ocular surface AMR determinants, as determined by RNA-sequencing (RNA-seq), on patients presenting with corneal infections at the Proctor Medical Clinic at the University of California San Francisco in San Francisco, CA, USA, and the Queen Elizabeth Central Hospital at the Department of Ophthalmology of Kamuzu College of Health Sciences in Blantyre, Malawi, was conducted. All patients underwent swabbing of three sites on the ocular surface: cornea, ipsilateral conjunctiva, and contralateral conjunctiva.

Results: Mutations conferring macrolide resistance were present on the ocular surface in 58% (95% CI 44 to 71%) of the participants in Malawi and 32% (95% CI 20 to 46%) of the participants in San Francisco. Aminoglycosides resistance genes were also common on the ocular surface with 58% (95% CI 44 to 71%) prevalence in Malawi and 21% (95% CI 12 to 35%) in San Francisco. AMR was associated with poorer visual outcomes in a subset of patients.

Conclusions: As determined by RNA-seq, ocular surface AMR gene mutations are common in patients with infectious keratitis. Surveillance may be important for infectious keratitis treatment selection as well as providing guidance for antibiotic stewardship.