Tobacco consumption has long been implicated in several lethal diseases. However, the tobacco industry has continued to develop new products and marketing schemes to attract new generations of customers and sustain its market share and sales. This year’s World No-Tobacco Day theme zeroes in on the driving force behind the global tobacco epidemic – the tobacco industry and its relentless pursuit of new victims.
BACKGROUND:To compensate for the non-availability of intensive care specialists, Cachar Cancer Hospital and Research Centre (a tertiary hospital in a resource-constrained setting, northeast India) introduced a hybrid intensive care unit (ICU with a centralised monitoring model). METHODS:This was a cohort study involving secondary data for patients admitted with curative intent in the hybrid ICU (October 2021 to December 2022). We report on our early implementation experience in the form of patient management and outcome indicators. RESULTS:There were 909 admissions with curative intent, of which 73% were post-surgical. There were 238 admissions from October 2021 to March 2022, which increased to 671 from April to December 2022 (the period when effective implementation happened). The changes (unadjusted P value) in management and outcome indicators over these periods were ventilator use, 8%-12% (P = 0.128); death during admission, 7%-6% (P = 0.575); readmission within 3 months, 21%-25% (P = 0.309); and median length of stay, 1-2 days (P = 0.035). CONCLUSION:Despite an increase in admissions following the introduction of the hybrid ICU, it did not adversely impact management and outcome indicators. Post-ICU hospital care, patient caregiver education, and home care team engagement should be strengthened to decrease readmissions.
OBJECTIVES: To describe receipt of intermittent preventive treatment for malaria in pregnancy (IPTp) doses, assess compliance with the recommended minimum of three IPTp doses, and identify factors associated with non-compliance among antenatal care attendees. This was a non-concurrent cohort study using routinely collected hospital data in 2024 at the Princess Christian Maternity Hospital, a university-affiliated tertiary teaching hospital in Freetown, Sierra Leone. RESULTS: Among the 733 pregnant antenatal care attendees, 682 (93%) registered after the first trimester, and only 30 (4%) had ≥4 antenatal contacts. Of the 733, 406 (55%) received first dose and only 62 (8%) received three doses. The maximum number of doses received was six by a single woman. In adjusted analysis, women with less than four antenatal contacts had three times higher risk of non-compliance (adjusted relative risk: 2.7, 95% confidence interval: 1.6–4.5) compared with those with ≥4 contacts. Receipt of IPTp doses and compliance with the recommended minimum of three doses were low and were associated with fewer antenatal care contacts. CONCLUSION: Our findings underscore the need to understand the reasons for the gaps in treatment and to address them systematically. Strategies to increase the number of antenatal care contacts may improve compliance with the recommended minimum three doses.
SETTING: TB remains a major public health problem in Pakistan, a high-burden country with a high prevalence of multidrug-resistant TB (MDR-TB). Directly Observed Treatment (DOT) is widely used to improve treatment adherence; however, provincial-level evaluations remain limited, particularly in Sindh. OBJECTIVE: To assess the effectiveness, outcomes, and challenges of DOT in Sindh Province over a 12-year period. A retrospective observational study was conducted including all patients enrolled in the National DOT Programme in Sindh from 2010 to 2022. Demographic, clinical, and treatment data were evaluated. RESULTS: Pulmonary MDR-TB was highly prevalent among individuals aged 16–35 years. Extensively drug-resistant TB (XDR-TB) accounted for 6.32% of cases and pan drug-resistant TB (PDR-TB) for 0.32%. Before enrolling into DOT, most patients (48.35%) had treatment outcomes that were not evaluated or had failed treatment (38.45%) in their previous non-DOT therapy. DOT achieved cure rates of 68% for long-term regimens and 75% for short-term regimens, with timely sputum conversion. CONCLUSION: DOT was effective for managing MDR-TB; however, high MDR-TB prevalence, delayed diagnosis, treatment-related side effects, and patient loss to follow-up emphasise the need for strengthened early detection, adherence support, and monitoring strategies to improve treatment outcomes.
OBJECTIVES: To assess compliance with national malaria guidelines for confirmatory diagnosis and parenteral artesunate administration, and to evaluate hospital exit outcomes among children under five admitted with suspected severe malaria. DESIGN: A cohort study utilising routinely collected data in Ola During Children’s Hospital, a tertiary paediatric hospital in Freetown, Sierra Leone, from January to December 2024. RESULTS: Of 735 admitted children (55% male), 657 (89%) underwent rapid diagnostic tests, but none had microscopic confirmation. A total of 650 (88%) received all three recommended doses of parenteral artesunate at 0, 12, and 24 h. Among the remaining 85 children, 48 (56%) received one or two doses, and 37 received none. Two children died before completion of 24-h dosing schedule. Correct weight-based dosing and scheduling were administered in 420 children (parenteral artesunate compliance = 57% [420/733]). Among admissions, 642 (87%) were discharged and 73 (10%) had unfavourable hospital exit outcomes, including 59 deaths, 13 discharged against medical advice, and 1 absconded. Underweight status, multiple convulsions, and failure to receive correct artesunate dosing were associated with unfavourable hospital exit outcomes. CONCLUSION: Compliance with recommended parenteral artesunate dosing was suboptimal, potentially contributing to unfavourable hospital outcomes. Strengthened monitoring, mentorship, and enforcement of malaria management guidelines are urgently needed.
SETTING: Sierra Leone, using data from the District Health Information System 2 (DHIS2) database. OBJECTIVE: This study examined the spatial and spatio-temporal distribution of malaria incidence, and the relationship between malaria incidence and rainfall in surrounding areas in Sierra Leone from 2021 to 2024. METHOD: A cross-sectional geospatial study was conducted using malaria case data, mean rainfall data, population estimates, and chiefdom-level geographic coordinates. Spatial clustering was evaluated using Moran’s I, significant district-level clusters were identified through space–time Poisson models (α = 0.05; 999 permutations), and the relationship between malaria incidence and rainfall in surrounding areas was assessed using bivariate Moran’s I, implemented in Python. RESULTS: Between 2021 and 2024, 7.4 million malaria cases were reported. Chiefdom-level incidence ranged from 21.2 to >750 per 1,000 population. Significant spatial clustering was observed (Moran’s I > 0; P < 0.01). Persistent high–high clusters (P < 0.05) and low–low clusters (P < 0.05) were identified across the country. Space–time analysis identified both high-risk (relative risk [RR] = 1.2–1.9; P < 0.01) and low-risk districts (RR = 0.5–0.9; P < 0.01). There was no significant association between malaria incidence and rainfall in surrounding areas at the national level. CONCLUSION: Malaria transmission remains spatially and temporally heterogeneous, with persistent hotspots that require tailored subnational interventions to accelerate progress towards elimination.
Childhood pulmonary TB diagnosis remains a challenge due to difficulties in obtaining suitable specimens and the paucibacillary nature of the disease. Recent advances in sample collection and diagnostics could improve care for children, especially those with rifampicin-resistant TB (RR-TB). Although these have been recommended by the WHO, there have been limited reporting of the clinical impact of these novel approaches. We report the clinical impact of stool sampling in four children at Karonga District Hospital in Malawi. All four children were diagnosed with RR-TB, received all-oral regimens, and experienced successful treatment outcomes.
BACKGROUND:Strengthening research leadership in low- and middle-income countries (LMICs) is essential for addressing diseases of poverty. Since 1999, World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR) has supported this through the Clinical Research and Development Fellowship (CRDF), but evidence on its long-term impact remains limited. We therefore assessed the leadership trajectories of CRDF fellows trained between 1999 and 2021. METHODS:An online cross-sectional survey of CRDF alumni (1999-2021) used a structured questionnaire capturing career progression, productivity, leadership roles, collaborations, institutional contributions, and challenges. RESULTS:Of 116 fellows contacted, 88 responded (75.8%). More than half had secured competitive funding (55.7%), with a median grant value of USD 512,320 (interquartile range: 111,629-1,200,000; range: USD 700-70,000,000), including multiple national and international awards. Career advancement was notable: 43.2% served as principal investigators and nearly 80% supervised research staff. Many led developments of infrastructure and operating procedures (63.6%). Re-entry grants strengthened institutional capacity for respondents. Collaborations were sustained nationally (77.3%) and through South-South partnerships (71.6%). Almost all fellows (98.9%) continued applying TDR-acquired leadership skills. One third contributed to policy documents. Persistent barriers included difficulty accessing funding, limited institutional support, scarce national funding, and heavy workloads. CONCLUSION:CRDF alumni reported substantial engagement in research leadership, scientific productivity, and institutional capacity strengthening in LMICs.
BACKGROUND:Acute respiratory failure (ARF) is a life-threatening clinical syndrome that often reflects limitations in timely access to emergency and critical respiratory care. Among adolescents, severe respiratory illness remains an important but poorly characterised contributor to preventable mortality. OBJECTIVE:To describe long-term global trends and cause composition of adolescent ARF-related mortality, and assess changes associated with the coronavirus disease 2019 (COVID-19) pandemic. This was a descriptive analysis using a syndrome-based proxy derived from Global Burden of Disease 2023 cause-of-death estimates from 1990 to 2023. RESULTS:Between 1990 and 2019, global adolescent ARF proxy deaths declined modestly, followed by a sharp increase during the COVID-19 pandemic, peaking in 2021. Before 2020, lower respiratory infections accounted for over 85% of ARF proxy mortality, with a stable cause composition. During 2020-2021, COVID-19 emerged as a major contributor, accounting for nearly half of ARF proxy deaths at its peak. By 2023, total ARF proxy mortality and cause structure returned toward pre-pandemic patterns. CONCLUSION:Adolescent ARF-related mortality has declined modestly over three decades and shows a stable underlying structure re-emerging after the COVID-19 shock. These findings highlight persistent health-system vulnerabilities in delivering timely acute respiratory care for adolescents and support the need to strengthen emergency and critical care services alongside prevention.
BACKGROUND: In 2023, Sierra Leone started tuberculosis preventive therapy (TPT) implementation. The tuberculosis programme recommends four contacts per index case for tracing and screening. METHODS: This study was to assess the performance of early implementation of contact tracing, screening, and TPT uptake in five regional hospitals. RESULTS: Of 905 index cases recorded, 1,222 contacts were traced and screened by community health workers. Of these, 433 were enrolled into TPT, and 353 (82%) completed the TPT regimen. Eighty out of 353 (18%) on TPT were lost to follow-up. CONCLUSION: Deficiencies in documenting contacts and logistical constraints to trace, screen, and follow up for enrolment and completion of TPT need to be addressed for TPT scale-up.
Tamil Nadu Kasanoi Erappila Thittam (TN-KET) is India’s first state-wide differentiated TB care initiative to reduce TB deaths. Since April 2022, this involved triaging for severe illness at diagnosis and prioritisation of severely ill for inpatient care. In the third year (2024), TN-KET sustained its performance in comprehensive assessment of severely ill during inpatient care, possibly contributing to low deaths in 2024. The information on reasons for severe illness provided will guide strengthening of infrastructure during inpatient care. While therapeutic nutrition and diabetes care is work in progress, sustained efforts are required for managing severe alcohol addiction and chronic lung disease.
SETTING: Since 2017, India’s TB programme is implementing active case finding (ACF) in high-risk populations in all districts. Symptom screening followed by confirmatory testing was the ACF algorithm. OBJECTIVE: To determine differences in pre-treatment delays and severe illness at diagnosis between ACF- and passive case finding (PCF)-detected adults with drug-sensitive pulmonary TB in high-risk populations. DESIGN: Cross-sectional analytical study from 28 randomly sampled districts across India (2023). Post-triaging, severe illness was defined as presence of very severe undernutrition, respiratory insufficiency, or poor performance status. RESULTS: Of 790 enrolled, 426 were ACF-detected and 364 PCF-detected. ACF-detected adults were significantly older (mean 47.1 year vs 43.9 year), lived farther from diagnosis facilities (median 8 km vs 6 km), had lower formal education exposure (52% vs 37% with no formal education), lower household income (₹20,000 vs ₹24,000 annual per capita), and experienced fewer health care provider visits (median 1 vs 2). Pre-treatment delay from symptom onset to treatment initiation (median 46 days in both groups) and burden of severe illness (39% vs 34%, P = 0.180) were similar. CONCLUSION: Though ACF linked the vulnerable to care and reduced health care provider visits, this did not translate into early detection. High burden of severe illness at diagnosis is a concern.
SETTING:Anti-retroviral treatment (ART) centres from eight districts of Sierra Leone. OBJECTIVES:Among children and adolescents (0-19 years) registered for ART after January 2023 and currently on care, to assess i) viral load (VL) testing coverage and viral suppression, ii) turnaround time from sample collection to results, and iii) factors associated with not undergoing testing. DESIGN:A cohort study using programmatic data extracted from April to October 2025. RESULTS:Of 950 participants, 931 (98%) were eligible for VL testing (on ART for ≥6 months). Of the total participants, 286 (30%) underwent VL testing at least once (coverage), of which 247 (86%) had viral suppression. Median turnaround time was 36 days, ranging from 6 days in districts with centralised VL testing laboratory to 65 days in a district far from the central laboratory. Participants from ART centres situated in the Western Area Urban district (adjusted relative risk: 1.8, 95% confidence interval: 1.0-3.1) were at higher risk of not undergoing VL testing. CONCLUSION:Although high viral suppression was appreciable, less than one third of children and adolescents underwent VL testing with a long turnaround time, delaying virological failure detection and appropriate care. The national AIDS control programme should decentralise VL testing and strengthen sample transportation to ensure equitable access.
This issue of Public Health Action (PHA) includes the first of a series of articles that provide evidence-based answers to questions raised by health workers on addressing HIV, TB and malaria on the frontlines in Sierra Leone. The research was conducted as part of a SORT IT course, which is a partnership-based initiative led by TDR and implemented with various partners. SORT IT aims to make countries ‘data rich, information rich and action rich’ to improve health care delivery and outcomes. The course in Sierra Leone brought together 19 institutions to foster global engagement, partnerships and communities of practice, and highlighted the convening power of SORT IT towards galvanizing research capacity strengthening at the country level.
BACKGROUND: The majority of active TB cases in low-burden, high-income settings arise from reactivation of TB infection (TBI). The London Borough of Newham, UK, piloted a novel screening and treatment TBI programme for recent migrants. This was situated entirely within primary care. OBJECTIVE AND DESIGN: This study aims to highlight key enablers and barriers to delivering a TBI programme in primary care. Views of health care professionals and relevant stakeholders were sought through questionnaires and semi-structured interviews. RESULTS: Perspectives from 43 health care professionals are included. A perceived ‘good relationship’ between patients and health care professionals was the most commonly cited enablers across groups, followed by education and training of service providers. Physicians reported time constraints as a common barrier, whereas pharmacists were more likely to identify low levels of patient knowledge surrounding TBI as a barrier to engagement. Enablers identified by stakeholders included effective communication between stakeholders and training of service providers. Aggregate data collection and monitoring was considered a significant enabler, as was patient education by health care professionals and novel educational tools. CONCLUSION: Community-based TBI programmes can be successful. Key enablers include TBI-specific training with communities and amongst health care professionals, collaboration between health care professionals and stakeholders, and aggregate data monitoring.
BACKGROUND:Kenya, a high-TB-burden country, is among eight WHO-priority countries for public-private mix (PPM) initiatives to engage all health care providers in TB prevention and care. OBJECTIVE:To describe Kenya's experience implementing a Global Fund-supported PPM intervention and its contribution to TB case finding. DESIGN:A descriptive case study using programmatic data from a Global Fund-supported PPM project implemented in nine counties in Kenya. RESULTS:Of 2,027 mapped facilities, 1,405 signed Memoranda of Understanding and 1,269 reported TB services. Of 4.3 million people screened, 260,922 (6%) were identified as presumptive TB, of whom 108,723 (42%) were investigated. Overall, 14,026 individuals were diagnosed with TB (64% bacteriologically confirmed), and 99% initiated on treatment. Level II facilities contributed 45% of notifications (7 per facility), while Level V facilities (only 4) reported the highest average yield (130 per facility). All counties recorded increased TB notifications during implementation, followed by a decline in Quarter 3, 2024. CONCLUSION:Engaging private sector providers significantly enhanced TB case detection. Kenya's PPM experience highlights the engagement choices that need to be made among levels of the health care system for scaling and sustaining PPM models in resource-constrained settings.
SETTING: In 2013, the New York City Health Department analysed its TB contact tracing programme. Despite long-term declines, TB remained a persistent public health issue in New York City, necessitating continued investment in prevention strategies. OBJECTIVES: The aim was to evaluate the financial and public health impact of the TB contact tracing programme by conducting a return-on-investment (ROI) analysis. DESIGN: The study measured programme costs-including personnel, diagnostics, and follow-up care-against projected savings from averted TB cases. A sensitivity analysis was conducted to assess the impact of varying progression rates from TB infection (TBI) to active TB. RESULTS: The programme identified 3,250 contacts and prevented 64 potential TB cases through early detection and TBI treatment. This resulted in a 95.13% ROI, meaning that for every dollar invested, nearly another dollar was saved. The ROI increased under assumptions of higher TBI progression rates, reinforcing the programme's costeffectiveness. CONCLUSION: Contact tracing plays a critical role in TB control, especially in urban areas with higher incidence. The evaluation supports sustained investment in public health infrastructure and demonstrates that the model can be applied to other infectious disease programmes for targeted prevention and early intervention.
BACKGROUND: This study aimed to investigate the association between water intake and lung function impairment, focusing on the potential effect of dehydration on respiratory health in elderly adults. METHODS: A community-based, cross-sectional study was conducted in rural regions of Taiwan between March and December 2022. A total of 888 participants were enrolled. Data collection included lung function tests, physiological measurements, demographic characteristics, and medical histories. The effects of various variables on lung function were analysed across different age groups. RESULTS: Both restrictive and obstructive lung function impairment were significantly associated with older age, low water intake, and lower educational attainment. Restrictive lung function impairment was additionally correlated with the presence of cardiometabolic diseases, whereas obstructive lung function impairment was associated with male sex and smoking. Among participants aged over 65 years, low water consumption was associated with increased odds of restrictive and obstructive lung function impairment. CONCLUSION: Low water intake is associated with an increased risk of both restrictive and obstructive lung function impairment, particularly in elderly adults. Public health interventions promoting adequate hydration may help preserve pulmonary function in elderly population.
BACKGROUND: Adherence to antiretroviral therapy (ART) is crucial for the clinical management of people living with HIV (PLHIV), but food insecurity can compromise it. The threshold at which food insecurity significantly affects adherence remains poorly studied. METHODS: A cross-sectional study was conducted in health care facilities in Kinshasa among 506 PLHIV receiving outpatient ART. Socio-demographic, clinical, behavioural, and nutritional data were collected through structured interviews and medical record reviews. Chisquare tests and logistic regression analyses were performed using Stata version 17.0 software, with a statistical significance threshold set at P < 0.05. RESULTS: Proportion of ART nonadherence was 51.4%. Overall, 74.9% of participants were food insecure, including 56.5% with severe food insecurity. In multivariate analysis, severe food insecurity was strongly associated with nonadherence (adjusted odds ratio [aOR] = 5.98). Other predictors included alcohol use (aOR = 1.93), absence of viral load monitoring (aOR = 1.63), travel outside Kinshasa (aOR = 3.52), and being widowed or divorced (aOR = 2.18). ART refill intervals of 3-6 months were protective (aOR = 0.42). CONCLUSION: Severe food insecurity significantly undermines ART adherence. Integrating targeted nutritional support into HIV programmes, alongside biomedical care, may help improve treatment adherence and support progress towards achieving the UNAIDS 95-95-95 goals.
