Mycobacterium tuberculosis remains the leading cause of death from a single infectious pathogen globally despite decades of effective chemotherapy. In 2024, an estimated 10·7 million people developed tuberculosis, including approximately 620 000 people living with HIV (PLHIV), and tuberculosis caused an estimated 1·23 million deaths overall, including approximately 150 000 deaths among PLHIV. Men accounted for more than half of the cases, and children represented a substantial burden, reflecting ongoing transmission and diagnostic gaps. Approximately a quarter of the world's population has been infected with M tuberculosis, with immunological evidence of previous or current infection. This population includes groups at increased risk of progression to tuberculosis disease, particularly those with recent infection, HIV, undernutrition, young age, or other clinical and social vulnerabilities. Following 3 years of COVID-19-related setbacks, global tuberculosis incidence declined modestly (1%) from 2023 to 2024 but remains higher than in 2020 and far off-track to meet the 2025 WHO End TB Strategy milestones. Case detection improved to 8·3 million notifications (78% of estimated incident cases), supported by expanded molecular diagnostics; however, prevalence surveys continue to reveal substantial proportions of bacteriologically confirmed but asymptomatic tuberculosis, highlighting persistent transmission and missed diagnoses. 30 high-burden countries accounted for 87% of cases, led by India, Indonesia, the Philippines, China, Pakistan, Nigeria, the Democratic Republic of the Congo, and Bangladesh. M tuberculosis-HIV co-infection remains a major driver of mortality in sub-Saharan Africa. Drug-resistant tuberculosis threatens progress: of 390 000 estimated multidrug-resistant or rifampicin-resistant tuberculosis cases in 2024, only 42% initiated treatment, although treatment success improved to 71%. Tuberculosis-preventive treatment reached 5·3 million people, including 58% of PLHIV and 25% of eligible household contacts, well below global targets. Persistent undernutrition, poverty, HIV, diabetes, smoking, alcohol use, air pollution, migration, and conflict continue to shape tuberculosis epidemiology. With financing at only 27% of global targets, accelerated prevention, proactive case finding, social protection, and sustained political commitment are essential to eliminate tuberculosis.
Context Transformative agri-food system change requires innovation and scaling approaches that are socially inclusive. Agricultural Research for Development (AR4D) organizations therefore emphasize the integration of gender and social diversity into innovation design and scaling, but translating these commitments into practice remains challenging. Although scaling decision support tools (SDSTs) look promising, research on their practical effects is limited. Objective This study assesses GenderUp, a dialogue-based SDST designed to identify relevant social diversity, anticipate differentiated consequences, and adapt scaling strategies for equity by (i) eliciting the underlying mechanisms of change through which it is expected to influence scaling processes and (ii) examining how and under what conditions it contributes to socially inclusive scaling. Methods We adopted a realist evaluation approach using document analysis, observations of a GenderUp workshop, follow-up observations of project inception meetings one year and six months after the workshop, and interviews and focus group discussions with stakeholders across the value chain to examine and test GenderUp's elicited mechanisms of change in the context of upscaling high-quality cassava peel (HQCP) technology in Nigeria. Results and conclusions GenderUp triggered critical reflection, enabling teams to identify diversity dimensions, articulate intersectional at-risk profiles, and revise scaling-strategy elements. However, donor requirements and consortium structures shaped the translation of insights into actionable strategies, enabling participation but constraining implementation of re-designed scaling strategies by prioritizing quantitative targets. Limited local representation in the workshop meant that outcomes reflected national-level assumptions rather than local realities; and insufficient historical reflexivity left key barriers e.g., feed adulteration undetected. Significance The study provides empirical insight into how SDSTs can advance inclusive scaling in AR4D and highlights key enabling conditions and methodological improvements, such as: enhancing participant selection guidance, incorporating local cross-checking and information gathering, and engaging donors and consortium partners more explicitly. These can strengthen the contextual validity and institutional uptake of findings generated through tools like GenderUp.
Ghana’s cocoa frontier increasingly overlaps with mechanised artisanal and small-scale gold mining (ASGM), creating competition over land and labour. This article examines how declining cocoa production and intensifying ASGM reorganise a local labour regime and reshape rural livelihood pathways in Juaboso District, Western North Region. It draws on 40 semi-structured interviews with cocoa farmers, ASGM workers and institutional actors, alongside observations at four ASGM sites, conducted in 2024. The analysis combines the Sustainable Livelihoods Framework for the 21st Century (SLF-21) with a labour-regime lens. The findings show that cocoa decline and political arrangements governing access to land, machinery, finance and licences create uneven openings for mining. Landowners and operators can convert cocoa land and capture mining rents, while young, often migrant, workers enter hazardous and insecure work. At the same time, ASGM expansion reduces labour availability for cocoa production, increases labour costs for cocoa farmers and degrades land and water used by farming households. Mining income can meet urgent household needs and, in some cases, support farming, but these gains coexist with risks that are shifted onto workers, non-mining farmers and younger generations. These risks are unevenly distributed across generations, with younger people likely to bear a greater burden through depleted land and water resources, and the health and educational consequences of mining-centred livelihood pathways.
Tuberculosis treatment has undergone its most profound transformation since the launch of the standardised DOTS strategy in 1994. Since 2020, a series of pivotal randomised trials, including TB-PRACTECAL, ZeNix, Nix-TB, endTB, BEAT-TB, SHINE, and Study 31/A5349, have redefined the management of both drug-susceptible and drug-resistant tuberculosis. These studies have enabled shorter, fully oral regimens with improved efficacy and safety across adult and paediatric populations, including people with HIV, and have driven major updates to WHO treatment guidelines. Despite these advances, tuberculosis remains the leading cause of death from a single infectious agent worldwide, with substantial mortality occurring before treatment initiation due to delayed diagnosis and pretreatment loss to follow-up, and additional deaths during treatment related to advanced disease, drug resistance, comorbidities, and challenges with treatment tolerance and adherence. In 2024, an estimated 10·7 million people developed tuberculosis of whom approximately 390 000 developed multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis. Tuberculosis caused an estimated 1·23 million deaths globally, including approximately 150 000 deaths attributable to MDR tuberculosis or RR tuberculosis. Outcomes remain poorest among people with HIV, young children (who rarely access treatment and prevention), migrants, and displaced populations. The tuberculosis drug development pipeline in 2026 is more advanced than at any time since the introduction of rifampicin. Novel and repurposed compounds, including DprE1 inhibitors, next-generation oxazolidinones (including TBAJ-587 and TBAJ-876), cytochrome bc1 inhibitors, and long-acting formulations, are in late-stage evaluation. Host-directed therapies are also advancing as adjunctive strategies to reduce inflammation-mediated tissue damage and long-term morbidity, although they remain investigational. This Series paper synthesises advances in adult and paediatric tuberculosis therapeutics from Nov 15, 2020, to Jan 15, 2026, and highlights priorities to translate therapeutic innovation into equitable population-level effects.
This paper interrogates the growing use of the term “off-grid sanitation” in describing service provision in southern cities. While the “off-grid” imaginary originates in northern infrastructural contexts (particularly energy and electricity) it has become a widely used descriptor for sanitation systems that lack sewerage connections in southern cities. Drawing on interviews, group discussions and observations in Tamale, Ghana (a city that never had gridded or networked sanitation and where people do not aspire to one), we seek to re-situate their sanitation practices as infrastructural configurations guided by labour, spatiality and negotiation rather than an absence of a ‘grid’. Theoretically, we draw upon and add to the broader discourse on infrastructural labour, adding attention to the ideas of spatiality and negotiation in sustaining everyday management of sanitation in Tamale. In doing so, we show that sanitation in Tamale is not captured by a binary of connection or disconnection to a ‘grid’, rather that access falls unevenly across gender, age, mobility, and class, producing differentiated negotiations, that ‘off-grid’ framings obscure. This framing decentres northern imaginaries, instead it offers a more explicit, grounded analytic of the labour intensive, spatially contingent and daily negotiated sanitation realities, for a more situated understanding of sanitation infrastructural configurations in southern cities.
