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.
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.
The short- and medium-term effects of agricultural soil compaction are well documented, but its long-term impacts and the role of biopores in subsoil recovery remain poorly understood. This study evaluated legacy effects of subsoil compaction on soil hydrophysical properties and root density and assessed the contribution of earthworm biopores to soil recovery. The compaction experiment was established in 1995 on a silt loam Haplic Luvisol by applying six passes of a wheel loader with a maximum wheel load of 5 Mg. Soil measurements were conducted immediately after compaction (1995) and repeated in 2019 and 2023. Measurements in 1995 included soil penetration resistance (PR), bulk density (BD), air-filled porosity (ɛₐ), and relative gas diffusivity (Ds/D0). Winter wheat root density was assessed in 2019. In 2023, PR, BD, ɛₐ, Ds/D0, saturated hydraulic conductivity (Ks), earthworm abundance, and subsoil structural quality (Ssq) were measured. Intact soil cores (30–35 cm) collected in 2023 were grouped according to the presence or absence of visible earthworm biopores. Compaction effects persisted after 28 years. Compared with the control, compacted soil had higher BD (+7.4%), PR (+78% at 20–40 cm), Ssq (+133%), and lower ɛₐ (−31.7%) and Ds/D0 (−33.1%). Root density, Ks, and earthworm abundance were statistically identical between treatments. These hydrophysical differences persisted strongly in samples without biopores, but largely disappeared in biopore-containing samples. Comparison with 1995 data indicated partial recovery of aeration and gas transport, especially in biopore-rich samples. These results show that subsoil compaction can persist for decades, but recovery of pore connectivity is strongly mediated by earthworm biopores.
Estuaries influenced by artisanal and small-scale gold mining (ASGM) are highly susceptible to contamination by heavy metals and excessive sediment inputs. These disturbances can disrupt benthic communities, alter biogeochemical processes, and elevate human exposure risks through seafood consumption. This study assessed benthic macroinvertebrates and ecological and human health risks from Cu, Zn, Ni, and Hg in sediments, fish, and oysters (Crassostrea tulipa) from the Pra Estuary. Surface sediments, five fish species, and Crassostrea tulipa were sampled at six locations within the estuary. Metal concentrations were measured using atomic absorption spectroscopy (Cu, Zn, Ni, Fe) and direct mercury analysis (Hg). Sediment contamination was evaluated with enrichment factors and geo-accumulation indices. Ecological risks were assessed through benthic sampling, Sediment Quality Guidelines, and biota–sediment accumulation factors. Human health risks were estimated using target hazard quotients (THQs) and total THQs (TTHQs). Zn and Hg levels posed minimal ecological risks, while Cu and Ni showed moderate risks. No benthic macroinvertebrates were found, indicating severe habitat degradation linked to factors such as turbidity, sedimentation, and contaminants. Crassostrea tulipa accumulated higher metal levels than fish, with Hg nearly double sediment concentrations. Fish posed no significant health risks (TTHQs < 1), but Crassostrea tulipa exceeded safety thresholds (TTHQ = 2.36), raising food safety concerns. In conclusion, the Pra Estuary exhibits ecological stress, with moderate heavy-metal contamination and the absence of benthic macroinvertebrates indicating degraded ecosystem health. The findings underscore the need for sustainable mining practices to protect ecosystem integrity and public health.
Background: Agriculture degrades soils, affects the delivery of ecosystem services, and contributes to climate change. Methods: This research examined nitrogen and sulfur recycling in soils under cropland expansion in Ghana at (a) reconnaissance scale in northern Guinea savannah (NGS), southern Guinea savannah (SGS), forest-savannah transition (FST), and semi-deciduous forest (SDF) agro-ecological zones (AEZs), and (b) farm level in rain Forest and the FST AEZs based on "duration of cultivation". Fresh soils (20 cm depth) were incubated for 28 days at 28 degrees C, followed by the determination of mineralized nitrogen and sulfur at 14 and 28 days using standard methods. Results: Low nitrogen and sulfur contents led to predominant nitrogen and minor sulfur immobilizations, particularly in FST and savannah AEZs. Microbial biomass and pedogenic Fe controlled much of the nitrogen immobilization. At the farm level, dithionite Al and soil pH controlled nitrogen immobilization, particularly in relatively older farms, being pronounced in forest-related AEZs. Conclusions: Although the study is laboratory-based, it highlights the severe nature of soil degradation (SD) under cropland expansion in regions prone to poor nutrient budgets. Therefore, it calls for drastic measures to halt SD by adopting ecozone- and climate-driven sustainable soil management and agricultural systems.
