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Background. There is paucity of information on the role of cytomegalovirus (CMV) infection as a cause of stillbirths or childhood deaths in low- and middle-income countries (LMICs). We investigated attribution of CMV disease in the causal pathway to stillbirths and deaths in children <5 years of age in 7 LMICs participating in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. Methods. We analyzed stillbirths and decedents enrolled between December 2016 and July 2023. Deaths were investigated using postmortem minimally invasive tissue sampling with histopathology and molecular diagnostic investigations of tissues and body fluids, along with review of clinical records. Multidisciplinary expert panels reviewed findings and reported on the causal pathway to death. Results. CMV was detected in 19.5% (1140/5841) of all evaluated deaths, including 5.0% (111/2204), 6.2% (139/2229), 41.2% (107/260), 68.1% (323/474), and 68.2% (460/674) of stillbirths, neonates (deaths <28 days postnatal), early infants (28 to <90 days), late infants (90 to <365 days), and children (12 to <60 months), respectively. CMV disease was attributed in the causal pathway to death in 0.9% (20/2204) of stillbirths, 0.8% (17/2229) of neonates, 13.1% (34/260) of early infants, 9.7% (46/474) of late infants, and 3.3% (22/674) of children. Decedents with CMV disease, compared with those without CMV disease in the causal pathway, were more likely to have severe microcephaly (38.2% vs 21.1%; adjusted odds ratio [aOR], 2.2 [95% confidence interval {CI}, 1.3-3.6]) and to have human immunodeficiency virus (HIV) (36.9% vs 6.2%; aOR, 10.9 [95% CI, 6.5-18.5]). Conclusions. CMV disease is an important contributor to deaths during infancy and childhood and is often associated with severe microcephaly and HIV infection. Improving management of CMV in children with HIV and a vaccine to prevent CMV are needed interventions.
Introduction: Psychological impairment is a common but often overlooked challenge among people living with HIV/AIDS (PLWHA), negatively affecting treatment adherence, retention in care, and quality of life. Despite increasing access to antiretroviral therapy (ART), evidence on the psychological well-being and coping strategies of PLWHA in Sierra Leone remains limited. This study assessed the prevalence of anxiety and depression, identified associated sociodemographic factors, and evaluated coping strategies among PLWHA in the Western Area Urban District. Methods An analytical facility-based cross-sectional study was conducted between August and October 2024 among 422 adults receiving antiretroviral therapy (ART) at Connaught, Rokupa Government, and Lumley Government Hospitals in Western Area Urban, Sierra Leone. Participants were recruited using consecutive sampling. Data were collected using interviewer-administered questionnaires incorporating the Hospital Anxiety and Depression Scale (HADS) and the Brief-COPE Inventory. Descriptive statistics were used to summarize participant characteristics, psychological impairment, and coping strategies. Binary logistic regression analyses were performed to identify factors independently associated with anxiety and depression. Variables with p-values < 0.05 in the bivariate analysis and those considered epidemiologically important were entered into multivariable logistic regression models. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was considered at p < 0.05. Results Overall, 49.8% of participants experienced mild anxiety, and 21.8% had symptomatic anxiety, while 50.5% had mild depression and 39.6% had symptomatic depression. Female participants had significantly higher odds of anxiety (AOR = 2.08, 95% CI:1.21–3.59) and depression (AOR = 3.72, 95% CI:1.53–9.05). Participants aged 30–49 years were less likely to experience depression (AOR = 0.16, 95% CI:0.05–0.50). Humour, planning, religious coping, acceptance, and informational support were the most frequently adopted adaptive coping strategies, whereas denial, substance use, and behavioural disengagement remained common maladaptive responses. Conclusion Psychological impairment is highly prevalent among PLWHA in Western Area Urban, Sierra Leone. Integrating routine mental health screening, psychosocial counselling, stigma reduction initiatives, and interventions that promote adaptive coping into HIV care is essential to improve mental wellbeing, treatment adherence, and overall health outcomes.
Abstract Technology using artificial intelligence (AI) has emerged with the potential to transform healthcare systems of low- and middle-income countries. Nonetheless, there is a lack of implementation of context-aware medical education devices. Many barriers exist in the implementation of these devices, often revolving around lack of internet access and electricity. We introduce AISHA, an offline voice-activated device which leverages the conversational abilities of AI to provide healthcare knowledge in rural areas. In this article, we explore AISHA’s design, capabilities, and limitations. We demonstrate the need for devices like AISHA and discuss their potential to transform the way healthcare workers interface with information. This research may assist other ventures in building similar devices in the future. By describing the design of the AISHA device, we will evaluate the considerations of introducing AI-based healthcare solutions in underserved areas.
BACKGROUND:Urinary iodine concentrations (UIC) from spot urine specimens are typically not normally distributed. As such, survey managers use the median UIC, rather than the mean, as the measure of central tendency. Non-normal distributions prevent the comparison of sample means to a standard or subgroup-specific means using parametric tests. OBJECTIVES:We used Box-Cox transformations of UIC data to obtain normal distributions to accurately calculate measures of precision and statistical significance. We compared this with the conventional method using bootstrapping to calculate 95% confidence intervals (CIs) around the median. METHODS:We applied the Box-Cox transformation to UIC data from national surveys containing nonpregnant women in The Gambia, India, Kyrgyzstan, Lebanon, Senegal, Sierra Leone, and Uzbekistan. We calculated subgroup-specific means and CIs and used parametric statistics (i.e., t-tests and analysis of variance) to assess the statistical significance of subgroup differences while accounting for complex sampling. Means and CIs were then back-transformed into the original units (μg/L). The back-transformed mean of the transformed UIC values can be interpreted as an estimate of the population median, given the near symmetry of the transformed values. RESULTS:The crude UIC data from all countries were not normally distributed. Box-Cox λ values ranged from 0.128 to 0.454, and all transformed datasets had skewness values between -0.1 and +0.1, confirming approximate normality. The Box-Cox method allowed detection of statistically significant differences in the back-transformed mean UICs by region and household-salt iodization status in nearly all countries. CONCLUSIONS:The Box-Cox transformation enables the calculation of results that account for complex sampling, enables the estimation of the statistical significance of apparent subgroup differences, and offers a more accurate approach to analyzing skewed UIC data. Program planners can use this approach to prioritize population groups with insufficient iodine status and tailor nutrition programs to address inequities in iodine nutrition.
Background Primary health facilities are critical to delivering primary health care (PHC) to Malawi’s predominantly rural population, but operate with limited autonomy, no dedicated plans or budgets, and constrained decision space over resources. Although facilities receive in-kind support from District Councils and development partners, this model is often associated with delays in procurement, limited flexibility to address facility-specific priorities, and misalignment with facility-level priorities. To address these constraints, the Ministry of Health piloted the Direct Facility Financing (DFF) model in 2023/24 across 15 PHFs in Rumphi District, providing direct grants of USD 1,000–2,000 per facility to support routine operational costs and service-enabling investments. Health Facility Management Committees (HFMCs) were reconstituted and capacitated to participate in public financial management (PFM) and oversee fund use. The main objective of this study was to evaluate the implementation and performance of the DFF pilot, with a focus on its relevance, effectiveness, efficiency, and sustainability. Methodology: An exploratory qualitative study design guided by the Organisation for Economic Co-operation and Development’s Development Assistance Committee (OECD-DAC) evaluation framework was employed. Data were collected in May 2024 through key informant interviews with facility in-charges, district health officials, Ministry of Health staff, and implementing partners across all 15 pilot facilities. Thematic analysis was used for the analysis. Results The DFF pilot was perceived as highly relevant, addressing long-standing gaps between centralized financing systems and frontline operational needs. Facilities prioritized minor infrastructure repairs and WASH investments as essential enablers of service delivery. DFF was perceived to improve access, quality, and operational efficiency by enabling facilities to resolve routine bottlenecks, extend service hours, and improve service readiness. The integration of HFMCs into planning and budget oversight strengthened accountability, transparency, and community ownership. Conclusion DFF is a feasible and contextually relevant reform for strengthening PHC delivery in Malawi. Its principal value lies in repositioning financial decision-making authority closer to service delivery points and communities. While national scale-up of DFF is warranted, sustained effectiveness will depend on continued capacity strengthening, adaptive budgeting mechanisms to manage macroeconomic pressures, streamlined administrative systems, and robust performance monitoring within Malawi’s broader health financing and decentralisation agenda.
