BMJ Global Health最新文献

Introduction: Tungiasis is a highly neglected tropical disease of the skin caused by an embedded female sand flea affecting the most resource-poor communities in sub-Saharan Africa, the Caribbean and South America. The global disease burden is unknown and systematic, fine-resolution spatial data on prevalence and environmental and ecological risk factors are rare.

Methods: We leveraged the Kilifi Health and Demographic Surveillance System of 90 257 households and asked whether they had a case of tungiasis in the household at interview during three survey rounds of routine surveys, undertaken between May 2021 and May 2022. Precise geospatial data to locate households were matched to macrolevel environmental, ecological and soil covariates, and multilevel logistic regression models were used to test for associations.

Results: A total of 1376 (1.5%) households reported a case in at least one survey during the year, while only 25 households did for all three surveys. The prevalence decreased over the three rounds from 1.1%, through 0.5-0.2%. The odds of having a tungiasis case in a household were higher in houses with earthen floors and walls, and in rural locations. The odds increased with increases in the number of children in a household and with population density (within 1 km radius), rainfall, Enhanced Vegetation Index, land surface temperature, aridity, altitude and organic carbon in the soil. However, the odds of having a tungiasis case in a household decreased with increasing aluminium content in the soil. These factors accounted for 23.9% of the variability in tungiasis distribution by household.

Conclusion: Tungiasis distribution was heterogenous and changed over time. Macro level environmental factors predicted the niche maps for tungiasis and could have applications in guiding local surveys and interventions.

Sharing data and biospecimens is both a scientific imperative and an ethical duty in research and public health, yet global asymmetries in capacity and power risk perpetuating inequality rather than alleviating it. To genuinely advance global health equity, data sharing efficiency should be measured not by the volume or speed of data transfer, but by the deliberate flow of benefits, capacity and decision-making authority to structurally disadvantaged regions. This requires a complementary shift. First, advanced partners must move from directing to enabling, focusing on building local technical, analytical and governance capacities to ensure solutions are rooted where they are needed most. Second, less-resourced actors must reframe data sharing not as a risky obligation, but as an opportunity for leadership-actively shaping research agendas and harnessing the power of open science. Consequently, sharing mandates must be explicitly tied to tangible interventions and demonstrated successes in improving health outcomes, supported by sovereign, federated data systems and reformed academic incentives that valorise capacity building and equitable collaboration as core research outputs. We, therefore, urge health researchers, funders, publishers and agencies to collectively transform sharing of data and biological materials into an equity-centred process that actively rectifies historical power imbalances. By shifting emphasis from the data themselves to the people, systems and processes that translate data into action, we can ensure sharing serves as a true bridge to equity-one that actively advances global health for all.

Introduction: Our Bulabula MaPei trial of azithromycin administered during labour in Fiji found no evidence of a reduction in the primary endpoint of infant skin and soft tissue infections (SSTIs) at 3 months of age. Here, we determine the efficacy of this intervention on several secondary outcomes.

Methods: This randomised controlled trial included healthy pregnant adults presenting to hospital in labour. Prior to delivery, participants were randomly assigned a single dose of 2 g of oral azithromycin or placebo that were identical in appearance to mask treatment allocation, in a 1:1 ratio stratified by ethnicity. Cumulative incidence of infections and antibiotic prescription was compared using an intention-to-treat analysis of complete cases. Adverse events described as proportions by group at specified time points.

Results: From June 2019 to January 2022, we enrolled 2110 pregnant people and their infants (n=2122; azithromycin n=1059; placebo n=1063). At 3 months, the cumulative incidence of infant infections was 13.6% in the azithromycin group compared with 17.3% in the placebo group (risk ratio (RR) 0.79; 95% CI 0.63 to 0.99; p=0.038). Infections among birthing parents, including SSTIs, were reduced with the greatest effect 1 week postdelivery (infections: RR 0.31; 95% CI 0.13 to 0.71; p=0.006, SSTIs: RR 0.25; 95% CI 0.08 to 0.75; p=0.013) but with a diminishing effect up to 6 months postdelivery. There was no effect on the prescription of antibiotics at any time point.

Conclusions: Intrapartum azithromycin prevents a variety of infections for birthing parents and infants up to 12 months post partum in Fiji. However, further research is required to identify target populations and better characterise potential impacts on antimicrobial resistance and the infant microbiome and resistome.

Trial registration number: NCT03925480.

Background: Data-sharing mandates from funders and journals have increased in recent years, but little is known about how shared data are used. Existing research has focused on access frameworks, with less attention to conditions that enable or hinder subsequent analyses and their impact on science and policy.

Methods: We conducted semi-structured interviews with 22 key informants with experience using clinical research data. Participants included researchers, policy makers and senior staff from funding and pharmaceutical organisations. Interviews explored motivations, ethical and practical challenges, and enabling conditions for reuse. Data were analysed thematically using a combination of deductive and inductive coding. Reporting follows the Consolidated criteria for Reporting Qualitative research framework.

Results: Secondary data analyses have, in a few documented cases, shaped clinical guidelines and policy in low- and middle-income countries (LMICs). Individual participant data meta-analyses informed WHO recommendations for maternal and child health interventions, and analyses of COVID-19 data guided decisions at national and subnational levels in several countries. However, such cases remain uncommon. Secondary data users reported that shared data were seldom ready for analysis owing to incomplete metadata and under-resourced data curation. In academia, secondary analyses were driven by the potential for publication rather than health impact. Mistrust, particularly where data contributors feared reputational harm or exploitation, resulted in underutilisation of valuable data as analysts relied on a limited set of well-known or easily accessible datasets. This risks selection bias and limits the evidence base, especially for under-represented groups.

Conclusions: Mandating data sharing alone is insufficient to deliver impact in LMICs. Policies must be coupled with resourcing for data curation, efforts to avail machine-actionable metadata and incentives for impact-driven analyses. Equally critical is trust, built through recognition of contributors and equitable, transparent benefit-sharing between analysts and data generators.

Background: Internationally, investment in hospital-based services for sexual violence is increasing. However, service providers, including in low-income countries such as Ethiopia, report discrepancies between the profile of survivors seeking help and those identified in population-based studies. Research on this remains limited.

Methods: An explanatory mixed-method study design was employed, analysing 5 years' of retrospective records of 2283 women and girls attending hospital-based violence response services in Ethiopia; alongside interviews with 20 survivors of sexual violence and 17 key informants. Quantitative data were analysed using Stata V.18 to produce descriptive statistics. Interview data were analysed thematically.

Results: Analysis of hospital violence response services' records showed that 43.9% of women and girls seeking services were under 15 years old. Over 93.5% sought services for sexual violence, and 71.0% reported their assailants were strangers. Qualitative interviews revealed that adult women survivors of sexual violence, especially survivors of intimate partner sexual violence, were unlikely to seek help at hospital-based services due to stigma, fear of retaliation, perceptions that services are primarily for gathering criminal evidence rather than providing comprehensive care, and that marital rape is not illegal.

Conclusions: Analysis of records from hospital-based violence response services revealed a cohort of young clients, largely reporting non-partner sexual violence-in contrast to what might be expected from national prevalence data. Addressing barriers to hospital-based services and ensuring these services provide care for all survivors is essential.

Introduction: Implementing shared decision-making (SDM) in maternity care remains challenging in low-income and middle-income countries (LMICs). Decision aids can support SDM, but evidence on their effectiveness in such settings is limited. We assessed the impact of a decision analysis tool (DAT) for pregnant women on mode of birth (MOB) within the QUALIty DECision-making project, a multisite, multicountry pragmatic trial to reduce unnecessary caesarean sections.

Methods: We conducted a cross-sectional survey among postpartum women considered at low risk for caesarean section in early pregnancy and who delivered in 32 hospitals across Argentina, Burkina Faso, Thailand and Viet Nam. Associations between DAT exposure and selected outcomes were analysed using multilevel, multivariate regression models adjusting for confounders and cluster effects.

Results: Of 2368 women included, 249 (11%) had used it outside antenatal care visits, 212 (9%) had heard of but not used it, and 1907 (80%) had never heard of the DAT. Compared with women who had never heard of the DAT, users were more likely to identify at least three risks/benefits of each MOB (adjusted OR (aOR) 1.9; 95% CI 1.3 to 2.8; p=0.001) and to communicate their preferred MOB to providers (aOR 2.3; 95% CI 1.5 to 3.6; p<0.001). DAT users were less likely to prefer caesarean section in late pregnancy (aOR 0.4; 95% CI 0.2 to 0.8; p=0.006) and reported higher birth experience and satisfaction scores (adjusted β=1.9; 95% CI 0.5 to 3.3; p=0.006).

Conclusions: The use of the DAT was associated with improved knowledge, communication of birth preferences, lower caesarean preference and greater satisfaction, without adverse outcomes. Findings suggest that decision aids can strengthen SDM and promote respectful, women-centred maternity care in LMICs.

Trial registration number: ISRCTN67214403.

Introduction: Female sex workers (FSWs) in sub-Saharan Africa are at high risk of HIV acquisition. Here we explore the values and preferences of Zimbabwean FSW for long-acting pre-exposure prophylaxis (PrEP).

Methods: We employed mixed methods; focus group discussions (FGD) (n=15), a respondent-driven sampling (RDS) survey (n=4444) from 22 sites across Zimbabwe and a nested discrete choice experiment (DCE) (n=435) conducted in 4/22 sites in 2021. Purposively selected FSWs aged 18 or over who reported being HIV negative were eligible for inclusion in FGDs. Analysis of self-reported HIV negative survey participants was RDS-II weighted. DCE analysis estimated relative preferences. Qualitative and quantitative data were triangulated.

Results: Median age of survey participants was 28 years with IQR of 23-34 years. There was strong concordance across methods by product, provider, service and individual characteristics. Most FSWs indicated that they preferred long-acting injectable (LAI) PrEP to either oral PrEP or dapivirine vaginal ring (DVR). Most were interested in using LAI PrEP (74.1%; n=1835/2392), a few the DVR (10.9%, n=230/2392), and 2.4% (59/2392) and 13.5% (268/2392) either or neither of the two options, respectively. There was little trust in public sector healthcare providers, with most FSWs opting to access PrEP through programmes designed for sex workers (and stating they would miss a prescription refill/repeat injection if the public sector was the only available option). Injectable PrEP addressed privacy and adherence concerns to some extent, although FSWs felt that 6-monthly would be preferable to less frequent injections. Issues of privacy (related to PrEP and being a FSW), confidentiality and respect emerged as key qualitative themes.

Conclusions: FSW had a strong preference for LAI PrEP, but ensuring product choice and user privacy was key. FSW in Eastern and Southern Africa should therefore be prioritised for PrEP choices, with ongoing monitoring and evaluation of services to make sure they are acceptable, effective and evolve as products and delivery options become available.

Background: Q fever is a zoonotic infection caused by the bacterium Coxiella burnetii. French Guiana, largely covered by the Amazon rainforest, is considered a hyper-endemic region. While ruminants are the primary reservoirs worldwide, the reservoir in French Guiana remains debated, likely relying on wild fauna. This study aimed to identify spatiotemporal clusters of human Q fever in the Cayenne area and investigate their relationships with environmental factors using remote sensing data.

Methods: A retrospective study was conducted on acute Q fever human cases from January 2007 to December 2017. Cases were aggregated into regular grids, and explanatory variables derived from remote sensing data or local sources. Clusters were identified using spatial autocorrelation and spatiotemporal scanning. A generalized Poisson additive model was applied for explanatory modelling.

Findings: A total of 513 cases of acute Q fever were aggregated within 1205 analysis units. Spatial and spatiotemporal analyses identified six clusters, all classified as hotspots. An epicentre was detected at the base of 'Mont Rémire' in the municipality of 'Rémire-Montjoly'. Several risk factors were associated with the occurrence of acute Q fever cases: proximity to forests (edf: 4.05), wild live mammals watching (edf: 1.00), slaughterhouse (edf: 6.11), density of potentially unfit housing (edf: 6.53) and spatial distribution (edf: 2.00).

Interpretation: This study identifies priority areas where public health actions and research efforts should be focused, including slaughterhouses, farms and the surrounding wildlife.

Diarrhoea remains a major problem among children in low- and middle-income countries, driven by multiple pathogens including rotavirus, Shigella and enterotoxigenic Escherichia coli (ETEC). Rotavirus vaccines have notably reduced diarrhoea deaths. However, the health consequences associated with Shigella and ETEC, along with rising antimicrobial resistance (AMR), have prompted the WHO to prioritise vaccine development against these two pathogens. Understanding their disease burden is crucial for guiding this effort and informing preparedness for vaccine adoption.We conducted a systematic review and meta-analysis of primary peer-reviewed literature to establish the prevalence, subtypes and AMR patterns of Shigella and ETEC-associated diarrhoea in Ethiopia, Kenya and Malawi, where the authors have established a multidisciplinary research programme addressing gastrointestinal infections. We searched in PubMed, among other databases, for English-language publications from 1 January 2000 to 28 July 2023. The meta-analysis used a random effects model to estimate pooled prevalence.43 studies were included. Malawi exhibited a higher estimated prevalence of Shigella (24% (95% CI 10% to 39%)) than Ethiopia and Kenya (both with an estimated prevalence of 6%), most likely explained by the application of sensitive, molecular detection methods in Malawi. The overall pooled prevalence of Shigella was 8% (95% CI 6% to 9%). Malawi again displayed higher ETEC prevalence (24% (95% CI 14% to 33%)) compared with Kenya (7% (95% CI 5% to 10%)), with no studies of ETEC identified from Ethiopia. The overall pooled prevalence of ETEC was 11% (95% CI 6% to 15%). Shigella flexneri was the major species of Shigella, and heat-stable ETEC was highly prevalent. Shigella species displayed resistance to several classes of antibiotics, including penicillins, tetracyclines, macrolides and sulphonamides, but susceptibility to fluoroquinolones and cephalosporins.These findings underscore the need for countries to generate updated disease burden estimates for Shigella and ETEC through epidemiologically robust studies that use sensitive diagnostic methods in preparation for vaccine introduction.