Abstract Background Mental health (MH) disorders remain a major global public health concern, disproportionately affecting adolescents and young people living with HIV (AYPLHIV). Limited access to MH services, stigma, and a shortage of trained professionals hinder effective care, particularly in low-resource settings. Mobile health (mHealth) applications have emerged as accessible and scalable tools for improving MH support and reducing disparities in service delivery. This systematic review assessed the effectiveness of mHealth applications in improving access to MH services and outcomes among AYPLHIV and comparable populations globally. Methods A systematic search was conducted across PubMed, PsycINFO, Web of Science, and the Cochrane Library for studies published between January 2020 and March 2025. Eligible studies evaluated mobile or app-based interventions designed to enhance MH access, engagement, or outcomes. Systematic reviews, meta-analyses, SMS-only interventions, and non-empirical studies were excluded. Two independent reviewers (CM and PS) screened articles, extracted data, and assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Data were synthesized narratively following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. Results Of 265 records identified, 16 empirical studies met the inclusion criteria. The studies covered Africa (Ethiopia, Kenya), Asia (Indonesia, Vietnam, Iran, Malaysia), Europe (Spain, Poland, United Kingdom), North America (USA), and Oceania (Australia), and employed randomized controlled trials, mixed-methods, pre–post, and cross-sectional designs. Across studies, mobile interventions consistently improved user engagement, accessibility, and MH outcomes, including significant reductions in depression, anxiety, and stress symptoms (p < 0.05). Peer-based models delivered via WhatsApp demonstrated high feasibility and acceptability among AYPLHIV, while cognitive behavioral therapy (CBT) and mindfulness-based apps such as IntelliCare and Headspace produced outcomes comparable to traditional care in several settings. Key facilitators included personalization, app usability, and human or AI-enabled feedback (e.g., chatbot support), while barriers included privacy concerns, connectivity constraints, and low digital literacy. Conclusions mHealth applications substantially improve access to and delivery of MH services for AYPLHIV and related groups. Integration of these tools into existing health systems, combined with culturally tailored design, ethical AI use, and sustainability strategies, can strengthen MH care globally. Future research should address long-term impact, cost-effectiveness, and equity in implementation.
Cholera remains a significant public health burden in many countries in sub-Saharan Africa, though the exact mechanisms of bacterial emergence and spread remain largely undefined. We generated genomic data from 763 Vibrio cholerae O1 isolates predominantly collected between 2019-2024 to create the largest dataset of V. cholerae genomes sequenced locally in Africa. This dataset enabled us to interrogate recent patterns of spread, including the rapid circulation of the AFR15 lineage associated with unusually large outbreaks in Southern Africa. We provide evidence for the movement of the AFR15 lineage into new African Union Member States and confirm previously observed differences in V. cholerae transmission dynamics in West versus East Africa, though cross-border transmission is prevalent on both sides of the continent. Despite observed differences, evolutionary processes are similar across lineages and we find no evidence for significant changes in antimicrobial resistance genotypes. Overall, our findings emphasize the importance of regionally coordinated cross-border surveillance and interventions, while also demonstrating the critical role of locally generated genomic data in understanding the spread of cholera in Africa.
BACKGROUND:Klebsiella pneumoniae is the leading cause of sepsis among neonates in low- and middle-income countries (LMICs) in Africa and Asia, contributing substantially to the overall burden of antimicrobial-resistant infections and mortality among neonates globally. Pathogen sequencing has been used to investigate case clusters and confirm nosocomial transmission in a small number of neonatal units. Here we utilise pathogen sequence data to estimate the fraction of K. pneumoniae neonatal sepsis attributable to nosocomial transmission in African and South Asian countries. METHODS AND FINDINGS:We estimated the proportion of invasive K. pneumoniae disease involved in nosocomial transmission clusters in a given neonatal unit, using single-linkage clustering based on pairwise temporal and genetic distances estimated from bacterial whole-genome sequences aggregated from 10 contributing studies. Analysing 1,523 K. pneumoniae isolates from 27 units in 13 countries in Africa and South Asia between 2013 and 2023, we inferred 156 nosocomial transmission clusters, ranging from 2 to 188 neonates each (83 of the clusters comprised ≥3 cases). Overall, we estimated that 1,035 neonatal infections (68.0%) were part of nosocomial transmission clusters. Excluding the first infection in each cluster as a potential index case, we estimate at least 879 (57.7%) infections were acquired via nosocomial transmission. Sensitivity analyses showed that results were robust to the choice of genetic distance estimation methods and thresholds used to define clusters, and cluster estimates were stable over temporal distance thresholds ranging from 2 to 8 weeks. Isolates were mostly extended-spectrum beta-lactamase (ESBL) producers (90.9%) and included 172 multi-locus sequence types (STs). Fourteen STs, including several globally recognised multidrug-resistant lineages, were associated with transmission clusters at multiple units, and these were collectively responsible for two-thirds of all infections. Carriage of carbapenemase genes (adjusted odds ratio, aOR = 2.08 [95% confidence interval, CI: 1.04, 4.14]; p = 0.04) and ESBL genes (aOR = 2.48 [95% CI: 1.26, 4.90]; p = 0.006) were significantly positively associated with transmission in a logistic regression model with site as a covariate. Limitations of this study include the lack of sufficient clinical data to allow high-resolution investigation of transmission dynamics and lack of facility-level data to investigate contributors to the observed differences in transmission burden across sites. CONCLUSIONS:Nosocomial transmission contributes to a substantial proportion of K. pneumoniae sepsis in neonatal care units in Africa and South Asia. Reducing transmission within these settings through improved infection prevention and control and other measures could substantially reduce the neonatal sepsis burden. A high burden of transmission clusters is associated with the same drug-resistant lineages that are recognised as high-risk clones associated with hospital outbreaks in high-income countries, indicating global connectivity of the antimicrobial-resistant pathogen population.
BackgroundThe rapid emergence of generative artificial intelligence (AI) tools such as ChatGPT is transforming teaching and learning practices in higher education. This study assessed the awareness, attitudes, and usage patterns of ChatGPT among university students in Zambia and examined factors associated with students’ attitudes toward the technology.MethodsA multi-institutional cross-sectional study was conducted among 1,829 university students in Zambia using a structured questionnaire adapted from instruments informed by the Technology Acceptance Model (TAM). Data were analysed using SPSS version 26.0, with statistical significance set at p < 0.05.ResultsAmong the 1,829 participants, 81.7% were aged 18–25 years, 52.5% were female, and 92.4% were unmarried. Overall, 96.8% of the students had heard of ChatGPT, and 85.6% reported having used it before this study. Among AI-usage constructs, 74.8% of respondents perceived high risks associated with AI use, 73.3% perceived ChatGPT as easy to use, 64.0% perceived it as useful, and 56.8% reported behavioural intention to use AI tools. In multivariable analysis, students aged ≥40 years were more likely to report positive attitudes toward ChatGPT compared with those aged 18–25 years (aOR = 5.91; 95% CI: 1.23–28.33; p = 0.026). Technology/social influence was also significantly associated with positive attitudes (aOR = 2.04; 95% CI: 1.55–2.68; p < 0.001). Conversely, perceived risks were associated with lower odds of positive attitudes (aOR = 0.57; 95% CI: 0.43–0.75; p < 0.001). Regarding ChatGPT use, perceived usefulness significantly predicted higher usage (aOR = 1.49; 95% CI: 1.17–1.89; p = 0.001), while perceived risks were associated with reduced usage (aOR = 0.61; 95% CI: 0.45–0.84; p = 0.003).ConclusionAwareness and use of ChatGPT are widespread among university students in Zambia, with more than four out of five students reporting prior use. Perceived usefulness and social influence were positively associated with adoption, whereas perceived risks were linked to lower attitudes and reduced use. These findings highlight the need for higher education institutions to develop clear policies and integrate AI literacy into curricula to promote responsible and effective use of generative AI technologies in academic environments.
BackgroundClimate change is increasingly recognised as a significant barrier to malaria elimination, particularly in low- and middle-income countries. This study explored frontline perspectives of healthcare workers and community-based volunteers on climate change and how malaria control programmes are responding to these changes in Zambia.MethodsA cross-sectional qualitative study was conducted in 20 districts representing higher- and lower-malaria burden settings in Zambia. Nine key informant interviews and fourteen focus group discussions were conducted with 64 healthcare workers and community-based volunteers. Data were analysed thematically using ATLAS.ti.ResultsParticipants reported that flooding, drought, deforestation, and shifting rainfall patterns were altering malaria transmission and increasing mosquito breeding sites. Climate-related disruptions, poor road access during floods and competing health priorities, including cholera outbreaks and COVID-19, were perceived to hinder malaria prevention and case management. Although participants recognised climate-related malaria risks, proposed responses remained largely focused on strengthening existing interventions such as indoor residual spraying and insecticide-treated nets, with limited reference to broader climate adaptation measures or national climate policies. Participants also identified barriers, including vector resistance, diagnostic challenges and supply chain disruptions.ConclusionsFrontline perspectives highlight substantial climate-related challenges to sustaining malaria control in Zambia. While healthcare workers and community-based volunteers recognised that climate variability influences malaria transmission, this awareness was not consistently accompanied by consideration of how malaria programmes may need to adapt. Strengthening climate-health competencies, improving policy dissemination, and integrating climate considerations into routine malaria planning and decision-making may help support climate-adaptive malaria control and sustain progress towards elimination.
