Background: Multiple sclerosis (MS) constitutes one of the foremost neurological causes of disability among younger and middle‑aged populations.Objective: This study aimed to examine global and regional trends in MS incidence from 1990 to 2021, with projections to 2030, using joinpoint regression and back‑testing validation to ensure evidence‑based scenario selection.Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 study. Joinpoint regression was used to calculate annual percentage changes (APC) and average annual percentage changes (AAPC) for 1990–2021. A retrospective validation (back‑testing) was conducted using data from 1990 to 2015 as the training period to project rates for 2016–2021, comparing predictive accuracy using mean absolute percentage error (MAPE) and root mean square error (RMSE). The method with lower error metrics was selected as the primary projection scenario for 2030, with the alternative retained for sensitivity analysis.Findings: Globally, the age‑standardized incidence rate (ASIR) decreased slightly from 0.77 to 0.75 per 100,000 (1990–2021), while new cases increased by 49.9%. High socio‑demographic index (SDI) (1.66) and EURO (2.57) regions had the highest ASIR in 2021, while low SDI (0.29) and Western Pacific Region (WPRO) (0.15) had the lowest. The back‑testing identified APC as the preferred method in 10 of 12 regions (83.3%), with the lowest MAPE in AFRO (0.05%) and the highest discrepancy in South‑East Asia Region (SEARO) (APC: 0.36% vs AAPC: 5.45%). Global ASIR is projected to decrease slightly to 0.747 by 2030, while SEARO (+12.3%) and low‑middle SDI (+8.2%) regions show the largest increases. Sensitivity analysis confirmed robust projections globally, with trend reversals observed in SEARO and low SDI regions.Conclusion: Global MS incidence is projected to rise in most regions by 2030, particularly in transitioning economies and Southeast Asia. Strengthening diagnostic infrastructure and implementing context‑specific health policies are urgently needed.
Introduction: Traditional bone setters (TBS) treat orthopedic injuries using natural remedies and traditional medicine. These practices can result in complications, including malunion, non-union, or gangrenous extremities. Despite these complications, communities in low- and middle-income countries trust and rely on TBS for musculoskeletal injuries and pathologies. Understanding patients' motives for patronizing TBS is necessary to work with TBS to reduce complications. Objectives: The objectives of this study were to assess the reasons patients patronize TBS, identify demographic trends associated with TBS usage, and evaluate how patient perspectives inform an understanding of TBS patronage. Methods: Four electronic databases, MEDLINE and Embase (via Ovid), Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched prior to April 2025. Primary studies examining reasons and patient perspectives on visiting TBS were included. Studies not reporting patient perspectives regarding TBS use were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. A narrative synthesis was conducted, with pooled descriptive statistics where appropriate. Results: A total of 28 studies involving 8,147 participants were included. A total of 5 articles directly included patients' perspectives, while 24 articles reported themes among reasons for the patronage of TBS. The main reasons cited for patronizing TBS were the belief in TBS and affordability. Recommendations from family/friends and negative perspectives on allopathic medicine were both frequently cited. No consistent association between participant demographics and TBS patronage was identified. Conclusions/Discussion: The reasons for patronizing TBS are multifaceted, extending beyond pure affordability and accessibility. The analysis showed that the general preference for TBS over allopathic practitioners and the belief in TBS practices are strongly rooted in the individuals and communities that TBS serve. Despite differing recommendations, collaboration with TBS to improve access to care and reduce complication rates was identified as a future direction.
Background: In early 2021, Lebanon's second COVID-19 wave coincided with financial collapse, health-workforce emigration, and the aftermath of the August 2020 Beirut port explosion, leaving hospitals saturated and many households unable to afford routine medical advice. Objectives: To describe the design, utilization, disposition outcomes, supervisory escalation, and direct operational cost of a free phone-based telemedicine clinic rapidly deployed through an academic-nongovernmental organization (NGO) partnership, and to identify transferable lessons for other crisis-affected, resource-constrained settings. Methods: Beirut Arab University Healthcare Center and the Federation of Businessmen for Support and Development (IRADA), a national NGO, launched a free 24-hour, 7-day-a-week phone-based telemedicine clinic staffed by 40 medical interns and residents using a standardized COVID-19 management protocol under a two-tier supervision model, with on-call family physicians reachable throughout each shift. WhatsApp voice calls were offered to provide free access, and missed calls were returned by the on-call responder. We retrospectively analyzed the de-identified records of all consultations managed during 14 weeks (February 2 to May 11, 2021); disposition categories were derived from the free-text recommendations using a rule-based classifier. Findings: The service managed 2953 consultations from all Lebanese governorates. After clinical assessment and safety-netting, 90.1% of consultations were managed outside hospitals at the point of consultation, 7.8% were referred to the emergency department, and 2.0% to primary care. The on-call family physician was consulted in 6.6% of consultations, concentrated on the highest-acuity calls (16.5% of emergency department referrals). The overnight window carried 3.7% of consultations but a higher emergency department referral proportion (12.8%). Direct operational cost was USD11,032 (USD3.74 per consultation), excluding non-monetary university contributions. Conclusions: An academic-NGO partnership, a standardized triage protocol, and tiered supervision can mobilize a trainee workforce safely, at low cost, and within days during a public health emergency.
Background: Universal Health Coverage (UHC) aims to ensure that all individuals have access to essential health services without financial hardship. Pakistan, despite constitutional commitments and policy reforms, faces significant hurdles in progressing toward this global goal due to systemic, structural, and socioeconomic challenges. Methods: This narrative review synthesizes available literature, policy documents, and programmatic evidence to examine Pakistan's preparedness for UHC. The analysis is structured around four thematic levels: policy, institutional, population, and service delivery, identifying barriers and opportunities within each domain. Findings: At the policy level, political instability, inadequate financing (<1% of GDP), and lack of evidence-based decision-making undermine sustained progress. Although a comprehensive UHC benefit package has been developed, its implementation is constrained by insufficient budget allocations. Institutionally weak regulation, fragmented governance, inequitable distribution of human resources, and limited stakeholder coordination impede service delivery. At the population level, low health literacy, poor awareness of insurance entitlements, and socioeconomic disparities result in low utilization of available services. Service delivery challenges include questionable quality of care, weak hospital empanelment standards, absence of standardized treatment protocols, and poor communication between public and private sectors. Out-of-pocket expenditures remain catastrophically high, pushing vulnerable populations further into poverty. Conclusion: Pakistan's path to UHC by 2030 requires a fundamental paradigm shift. Priorities include increasing health financing to at least 3% of GDP, strengthening primary healthcare as the platform for equity, scaling up social health protection programs nationwide, investing in workforce development and digital health infrastructure, and launching contextualized public awareness campaigns to improve health insurance literacy. A multi-sectoral, governance-focused approach is essential to translate policy intent into tangible health outcomes for all citizens.
Background: Infectious disease screening is widely recommended for migrants in Europe, yet implementation remains inconsistent across countries and settings. While guidance has focused on which infections to screen for, less attention has been paid to how screening is delivered, accessed, and linked to care. This structured review with thematic synthesis aimed to synthesize evidence on implementation gaps, barriers, and facilitators, with particular attention to differences across the migratory cycle. Methods: A structured search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for publications from January 2000 to February 2026, addressing infectious disease screening or related migrant health assessments in European settings. Of 49 included publications, 13 empirical studies formed the primary analytical basis and were quality-appraised using the Mixed Methods Appraisal Tool (MMAT, 2018); the remaining 36 contextualizing publications were used to interpret findings. Eligibility screening was performed independently by two reviewers. Results: Six interconnected thematic domains shaped screening implementation: administrative and legal barriers; communication, language, and cultural mediation; trust, stigma, and perceived coercion; organizational capacity and fragmented care pathways; the role of NGOs and community actors; and contextual differences across the migratory cycle. Barriers varied across the screening-to-care cascade: communication barriers and mistrust primarily affected uptake; legal and organizational barriers constrained linkage to diagnosis and treatment; and legal instability and fragmented services undermined continuity of care. First-arrival settings were characterized by systematic screening and high service pressure; long-term settlement contexts relied more heavily on primary care capacity, trust, and legal entitlement. Conclusions: Implementation gaps are driven less by the absence of clinical guidance than by structural, organizational, and relational barriers limiting access, linkage, and continuity. Screening should be embedded within integrated, migrant-centered care pathways supported by cultural mediation, trusted community actors, and separation from immigration enforcement.
Background: Global health inequalities are conventionally assessed through the mortality gap, yet the joint contribution of mortality and disability to health-adjusted life expectancy (HALE) gap and their dynamic evolution remain poorly understood. We aim to decompose the HALE gap between higher-income and lower-income countries into mortality and disability drivers, separate long-term trends from transient fluctuations, and reveal heterogeneity within the low-income group. Methods: Using data from the Global Burden of Disease Study for 199 countries (122 higher-income and 77 lower-income) from 2010 to 2019, we decomposed the HALE gap by age and cause via Horiuchi's method. Empirical mode decomposition separated each contribution time series into a long-term trend and residual fluctuations, enabling classification into dynamic archetypes: mortality catch-up, mortality divergence, disability catch-up, or disability divergence. Principal component analysis and partitioning around medoids clustering explored heterogeneity among lower-income countries, and generalized additive models assessed variation along the Socio-demographic Index (SDI) gradient. Results: The HALE gap narrowed from 9.10 to 7.93 years, with mortality contributing 6.87 years and disability 1.06 years in 2019. Mortality catch-up was concentrated in childhood infections and maternal conditions, while mortality divergence occurred for non-communicable diseases in adults. Disability divergence was driven by mental, musculoskeletal, and sense organ disorders. Low-income countries clustered into a high-mortality group (mainly sub-Saharan Africa and South Asia) and a disability-emerging group (Asia, Latin America). Along the development gradient, disability progressively dominated the HALE gap. Conclusions: The converging HALE gap masks a diverging disability gap. Sustainable progress in global health requires explicitly targeting the growing burden of non-fatal conditions alongside persistent mortality inequalities. The dynamic framework introduced here offers a reusable monitoring tool for health inequality.
Introduction: In Cameroon, there are not enough formal care (FC) providers to treat the high volume of injured patients. Traditional bone setters (TBS) offer widely patronized alternatives for injury treatment; however, the integration of TBS into the healthcare system remains limited. Collaboration between TBS and FC providers could expand the reach and effectiveness of injury care. We explore perceptions of Cameroonian TBS and FC providers regarding injury care and willingness to collaborate. Methodology: We used snowball sampling to survey TBS and FC providers in two regions of Cameroon. Structured questionnaires were used to assess FC and TBS providers' beliefs regarding potential collaboration. Categorical variables were analyzed with the chi-squared test while Likert scale responses were analyzed with the Kruskal-Wallis test. Results: We surveyed 120 providers (n=58 TBS, n=62 FC). TBS providers were significantly older (TBS median age 51, IQR 39-60 years vs. FC 34, IQR 30-36 years; P<0.001), greater percentage male (TBS 72.4% vs. FC 51.6%, P=0.019), and had more years of practice experience (TBS median 20, IQR 11-28 years vs. FC 5, IQR 3-8 years; P<0.001). While the majority of TBS (93%) and FC providers (77%) indicated willingness to collaborate, they disagreed regarding specific roles. Though the TBS providers believed they could conduct post-operative follow-up care, FC providers disagreed (TBS median response "Agree" vs. FC "Disagree," P<0.001). FC providers also did not believe TBS could provide appropriate injury care triage (TBS "Agree" vs. FC "Neutral," P<0.001). TBS and FC providers agreed that TBS could rehabilitate injured patients, although TBS agreed more strongly (P<0.001). Conclusions: The study demonstrates the willingness of both FC and TBS providers in Cameroon to collaborate in injury care, particularly in rehabilitation services. However, the cohorts disagree regarding the specific roles of TBS providers in injury triage and post-operative follow-up care.
Background: Despite notable progress in inpatient neonatal care expansion in Tanzania, expanding from 14 facilities in 2018 to 362 by 2025, a critical survival gap persists during the post-discharge transition. National policies heavily prioritize pre-discharge mortality, leaving the high-risk, 60-day post-discharge window unaddressed. This study evaluates targeted policy, financing, and digital health interventions designed to mitigate post-discharge neonatal mortality. Methods: We analyzed integrated implementation pathways within the Tanzanian health sector, specifically examining the institutional feasibility, scaling capacity, and clinical outcomes of the NEST360 Implementation Tracker (NEST-IT) and the Essential Coaching for Every Mother Tanzania (ECEM-TZ) mobile health framework. Results: Implementation data demonstrate that NEST-IT is a highly viable data-surveillance tool, achieving a 93% feasibility rate for daily clinical use and providing real-time data to drive national quality improvement targets. Concurrently, the ECEM-TZ digital platform effectively circumvents nurse-midwife resource limitations by providing a 54-message educational framework that improves caregiver knowledge and triples postnatal check-up attendance. Conclusion: Eliminating post-discharge mortality requires expanding longitudinal care frameworks. To achieve Tanzania's national target of 15 neonatal deaths per 1000 live births, strategic imperatives must include institutionalizing zero-rated mHealth tools, formalizing community health worker follow-up protocols, and explicitly integrating specialized outpatient neonatal services into the standard benefit package of the 2026 universal health insurance rollout.
Background: Scientific advances in global health rely on interdisciplinary researchers collaborating across cultures and orders to tackle complex health challenges. Sustained investment in the next generation of researchers is essential to maintaining this critical global health science capacity. This original article examines factors associated with the Fogarty International Center's (FIC) research training programs that produce independent global health researchers. Objectives: To examine factors within the FIC's research training programs that are associated with the successful production of independent global health scientists and to evaluate the long-term impact of the programs on alumni careers. Methods: This analysis synthesizes evidence from two cross-sectional surveys of FIC program trainees spanning the years 2003-2021. The surveys collected data from 717 and 690 alumni (with a 58% and 56% response rate, respectively). The analysis incorporates training experiences, career trajectories, and factors that influence professional independence, productivity, and research commitment. Findings: The analysis shows the program has successfully supported and expanded the global health research workforce. Sixty-two percent (62%) of alumni have careers in academia and 59% are actively working in research. Respondents consistently noted the importance of mentoring, protected research time, and robust professional networks contributing to a successful fellowship experience. The program has effectively stimulated interest, enlisted new partners, and addressed workforce development needs in global health research among early-career professionals in public health and medicine. Conclusions: FIC's research training programs are a successful model for developing the global health research workforce. Sustained training that emphasizes strong mentorship, dedicated research time, and collaborative partnerships is critical for fostering professional development and maximizing the long-term impact on global health equity.
Primary health care (PHC) is central to Sierra Leone's efforts to achieve universal health coverage. Despite substantial expansion of the peripheral health unit network, improvements in geographic access have not consistently translated into better health outcomes. This viewpoint argues that Sierra Leone must shift its focus from physical access to effective coverage, defined as the proportion of people who receive care of sufficient quality to produce meaningful health gains. Key challenges include persistent out-of-pocket expenditure, shortages of salaried health workers, weak service readiness, fragmented vertical programmes, limited digital infrastructure, and variable implementation capacity. Addressing these constraints will require reforms in financing, workforce formalisation, quality improvement, programme integration, and accountability. Strengthening these areas will be essential for ensuring that PHC delivers equitable and measurable health gains for all Sierra Leoneans.
Background: Stunting is a pervasive issue in low‑ and middle‑income countries, reflecting biological processes that adversely affect childhood cognitive development and increase the risk of chronic disease in adulthood. Nutritional intake is an important causative factor in stunting. Understanding the nutritional intake patterns of children with stunting can help inform nutrition program development. Objective: To characterize breastfeeding and dietary patterns from a clinical cohort of children with stunting in Guatemala and identify factors associated with linear growth. Methods: We included children with at least one diet record and one length/height‑for‑age z‑score below -2 from ages 0-5 years. We excluded children enrolled in complex care for severe non‑nutritional illness and records from prior to 6 months of age. We described adherence to World Health Organization infant and young child feeding indicators upon program enrollment. We longitudinally characterized breastfeeding and complementary feeding patterns of the cohort using generalized additive mixed modeling. We identified and quantified associations between various nutritional factors and linear growth using linear mixed effects models. Results: The final analytical dataset included 19,476 patient encounters from 2,352 children. Most children did not meet World Health Organization standards for dietary adequacy upon enrollment in the program. Dietary intakes were predominantly carbohydrate‑based. The factors most strongly associated with linear growth were food insecurity (negatively associated), portion size, and continued breastfeeding from 12 to 23 months. Adherence to the infant and young child feeding indicators was positively associated with linear growth. The intake of most food groups was also positively associated with linear growth. Conclusions: These findings suggest that the nutritional focus of interventions should be on adequate dietary diversity, earlier introduction and higher frequency of the less frequently consumed food groups, age‑appropriate portion sizes, and breastfeeding through 2 years of age. Public policy measures to address food insecurity are also necessary.
Pakistan is confronting the climate crisis as an immediate and systemic threat to national health security rather than an environmental concern. Recurrent floods between 2022 and 2025 affected more than 26 million people, damaged health infrastructure, disrupted essential services, and placed the country at the top of the Germanwatch Climate Risk Index. These shocks have intensified pre-existing health system fragilities by driving surges in malaria, waterborne infections, malnutrition, antimicrobial resistance, and forced displacement, while constraining routine service delivery. Climate-related migration to peri-urban informal settlements has created new epidemiological vulnerabilities characterized by overcrowding, poor sanitation, and outbreaks such as extensively drug-resistant typhoid. Simultaneously, crop losses and food system disruption have worsened child undernutrition in districts already exceeding emergency thresholds, with women and children disproportionately affected because of structural barriers to maternal, neonatal, and immunization services. Climate variability is also increasing the risk of zoonotic spillover and undermining progress toward Universal Health Coverage. We argue that climate change functions as a threat multiplier for Pakistan's health security and must be systematically integrated into health policy and planning. Key priorities include climate-resilient health infrastructure, strengthened integrated surveillance using digital and geospatial tools, prevention-oriented primary care, and operationalization of a One Health framework. Effective intersectoral governance, provincial implementation, and sustained collaboration with international partners, including the World Health Organization, are essential for building a resilient health system capable of maintaining continuity of care during increasingly frequent climate shocks.
Background: Cardiac-surgery-associated acute kidney injury (CSA-AKI) is a frequent postoperative complication worldwide and is associated with increased mortality, prolonged intensive care unit stay, and substantial resource utilization. While reported incidence appears broadly similar across high-income countries (HICs) and low- and middle-income countries (LMICs), emerging evidence suggests marked disparities in severity at presentation and clinical outcomes. Objectives: To compare the epidemiology, severity, outcomes, and health-system determinants of CSA-AKI across HIC and LMIC settings, and to identify system-level contributors to excess mortality in resource-limited environments. Methods: We conducted a focused narrative review of contemporary observational studies reporting CSA-AKI incidence, severity, renal replacement therapy (RRT) utilization, and mortality following adult cardiac surgery. Literature was identified through targeted searches of PubMed/MEDLINE and hand-searching of reference lists. Priority was given to studies using standardized AKI definitions (RIFLE, AKIN, or KDIGO) and reporting clinically relevant perioperative outcomes. Findings: Across income settings, CSA-AKI incidence ranged from approximately 20% to 43%. However, LMIC cohorts consistently demonstrated more advanced AKI at diagnosis and substantially higher AKI-associated mortality, particularly among patients requiring RRT. In HICs, dialysis-requiring CSA-AKI was uncommon (~1%) but carried high mortality despite early detection and unrestricted access to renal support. In contrast, LMIC settings reported lower RRT utilization, delayed initiation, and mortality exceeding 40-55% in advanced AKI stages. Conclusions: CSA-AKI is a common global complication of cardiac surgery with disproportionately severe consequences in resource-limited settings. Excess mortality in LMICs appears largely driven by delayed detection and constrained rescue capacity rather than biological susceptibility alone. Strengthening perioperative surveillance and access to timely renal support may substantially reduce avoidable mortality.
Climate change is a contributing factor to the high burden of infectious and noncommunicable diseases in Africa, in particular a resource-poor setting already faced with worsening humanitarian and socio-economic crises, as well as a rising incidence and prevalence of noncommunicable and chronic diseases. Thus, examining studies on the triad, climate change-migration-health, would provide more direction on how climate change mitigation can be incorporated into health system planning in Africa. This paper seeks to review studies on the climate change-migration-health triad with a particular focus on those that address elderly health outcomes in relation to the triad and provide guidelines on how governments can enhance their health systems and mitigate climate change to enable the elderly and elderly migrants to cope and age healthily. The author conducted a review of research articles, reviews, and documents using online databases, including Google Scholar, Google, and Web of Science. The following keywords were combined with the Boolean operators AND and OR to conduct the search: ageing population, environmental changes, climate change, gerontology, and the elderly. Limiters were: language: papers published in English on the themes; and period: papers and documents from 1990 to 2025. Documents, papers, and articles were from both regional (African region) and international sources. The author's search lasted 3 weeks and yielded 44 articles, of which 18 were selected for thematic analysis. Thematic analysis of articles revealed that climate change impacts on the elderly are severe, with the elderly migrants presenting a greater vulnerability; impacts of climate change on African health systems are projected to be severe due to weak health systems. This paper underscores the need for African health systems to integrate data-driven climate change mitigation strategies into health systems and improve community engagement and international collaboration to tackle climate change and health system challenges.
Background: Widespread exposure to multiple pesticides might potentially represent a genotoxic risk to humans. However, the effects of these mixtures are largely unknown. Genotoxicity is a key characteristic of carcinogens, and its assessment represents an important component of the safety assessment of pesticides. Methods: In the present study, an in vitro micronucleus test on intestinal Caco-2 human cells was performed according to OECD TG 487. Ten pesticides were tested (dose range 0-100 mg L-1) either individually or as mixtures. Objectives: Assessing the genotoxicity of 10 commonly used pesticides and their mixtures. Findings: Significant dose-related increases in micronuclei were observed following exposure to lambda-cyhalothrin, tebuconazole, glyphosate, deltamethrin, fluopyram, and the synergist piperonyl butoxide. Significant increases in micronuclei were also observed at different doses for cypermethrin, acetamiprid, and cyprodinil; however, these increases were not dose dependent. Imazalil genotoxicity could not be analyzed due to the confounding effect of high cytotoxicity even at low doses. Results show that the co-formulant piperonyl butoxide was genotoxic to human cell lines at all tested doses. Moreover, glyphosate, acetamiprid, and fluopyram showed genotoxic effects at concentrations of 0.01-1.0 mg L-1. Although previously reported to be not genotoxic, cyprodinil and deltamethrin were observed to be genotoxic to Caco-2 cells. A combination of three prioritized pesticides (acetamiprid, glyphosate, tebuconazole) showed genotoxic effects even at the lowest dose. A combination of eight prioritized pesticides showed genotoxicity at the highest dose. No synergistic interactions in micronuclei formation were evident in either the mixture of three or eight prioritized pesticides. Conclusions: This study provides important information on the genotoxicity of different widely used pesticides and confirms the validity of a component-based approach in the genotoxicity assessment of pesticide mixtures. This study was performed as part of the EU SPRINT (Sustainable Plant Protection Transition: A Global Health Approach) project.
The Catholic Church has developed a rich body of social teaching addressing the dignity of work and the protection of workers' health since the late nineteenth century. This article examines the trajectory of Catholic Social Teaching (CST) from Pope Leo XIII's encyclical Rerum Novarum (1891) to Pope Leo XIV's recent magisterium, including the apostolic exhortation Dilexi Te (2025) and the encyclical Magnifica Humanitas (2026) on safeguarding the human person in the time of artificial intelligence, with a particular focus on the concept of decent work as articulated by the International Labour Organization (ILO) and its intersection with Occupational Medicine (OM). The analysis highlights that Catholic social thought has consistently advocated for working conditions that safeguard the physical, mental, and social well-being of workers, anticipating many principles later codified in international labor standards. It further contends that Magnifica Humanitas extends this tradition to the challenges posed by digital technology and artificial intelligence to the dignity of work. The article argues that the convergence between CST and modern occupational health frameworks provides a compelling ethical foundation for advancing decent work and Occupational Health Services (OHS) worldwide.
Background: Timely tuberculosis diagnosis is essential for reducing transmission, preventable morbidity, and inequitable losses across the care cascade. In Indonesia, primary health centres are central to screening and diagnostic coordination, but delays may still occur after individuals with presumptive tuberculosis enter formal care. Objective: To quantify post-registration diagnostic delay among people with presumptive tuberculosis in Indonesian primary care and identify demographic, clinical, and referral-pathway factors associated with delayed results, tuberculosis diagnosis, and treatment initiation. Methods: We conducted a facility-based, register-based observational study using national presumptive tuberculosis register data from a primary health centre in Tasikmalaya City, West Java, Indonesia, covering 1 January to 31 December 2025. Diagnostic delay was defined as the interval from presumptive tuberculosis registration to the first recorded diagnostic result. Negative binomial regression estimated adjusted incidence rate ratios for delay, and logistic regression estimated adjusted odds ratios for prolonged delay, final diagnosis, and treatment initiation. Findings: Among 503 presumptive tuberculosis episodes, 486 had complete delay data. Median diagnostic delay was 4 days (interquartile range, 1-11 days). Delays longer than 14 and 30 days occurred in 94 episodes (19.3%) and 37 episodes (7.6%), respectively. Longer delay was associated with age 65 years or older (adjusted incidence rate ratio, 1.46; 95% CI, 1.12-1.90), extrapulmonary disease (1.58; 95% CI, 1.21-2.07), and referral from another health facility (1.35; 95% CI, 1.01-1.82). Overall, 176 presumptive episodes (35.0%) resulted in a tuberculosis diagnosis; 158 diagnosed patients (89.8%) had documented treatment initiation. Conclusions: Although most diagnostic results were recorded rapidly after registration, delays were concentrated among older adults, people with extrapulmonary disease, and referred patients. Strengthening register-based tracking, referral feedback, and escalation pathways for extrapulmonary tuberculosis may improve equitable continuity across primary care tuberculosis services.
Background: Access to safe drinking water is a considerable problem in Malawi. Contaminated water plays a major role in diarrheal disease, particularly for people living with HIV and their families. Water, sanitation, and hygiene (WASH) interventions can reduce the risk of diarrhea among children by up to 50%. However, few published reports describe WASH integration in routine HIV care programming in Africa. Objective: To evaluate a WASH program integrated within the prevention of vertical transmission of HIV (PVTH) care in Lilongwe, Malawi. Methods: The University of North Carolina's Project Malawi, the Proctor & Gamble Company (P&G), and the Malawi Ministry of Health implemented a safe drinking water program from 2008 to 2023, integrated within the national PVTH program in Lilongwe, Malawi. We provided a point-of-use WASH package to pregnant and breastfeeding women (PBFW) with HIV and their families that included soap, sieves, closed-water containers, and P&G water purification packets. We examine program impact by describing trends in childhood diarrhea and retention in care at 33 program facilities and 29 non-program facilities from 2018 to 2022. Findings: Over the program's final 5 years, an estimated 2 million water purification packets were distributed annually. From 2018 to 2022 in program facilities, non-bloody diarrhea rates among children under 5 years remained constant, while bloody-diarrhea rates fell at both program and non-program facilities. A small association was found between facility participation in the program and retention in care among PBFW living with HIV (incidence rate ratio: 1.05, 95% CI: 0.99-1.12), but of borderline statistical significance. Conclusions: In an environment where access to clean water is not assured, we demonstrated the feasibility of delivering a WASH package in HIV care settings over 15 consecutive years. The collaboration between government, academic, and industry partners provides an example for how to integrate WASH within PVTH programming.
Objective: The MEchanick Transculturalization Research and Innovation ConSortium/Bernard Lown Scholars in Cardiovascular Health Program Consensus Conference on Dysglycemia-Based Chronic Disease (DBCD) Transculturalization in Chile convened on November 20, 2023, in Santiago, Chile. The conference generated affirmed and emergent concepts, key strategies, and specific implementation tactics to improve type 2 diabetes (T2D) care in Chile. Findings: Important affirmed concepts included: (1) implementing a comprehensive approach to T2D management beyond glycemic control; (2) addressing unique challenges for early detection and treatment of T2D; and (3) applying expanded roles of telemedicine. Important emergent concepts included: (1) adopting transculturalized chronic care models such as DBCD; (2) recognizing prediabetes as a critical DBCD target to prevent T2D and T2D complications, especially cardiovascular disease; and (3) implementation of the DBCD model for individual and population health. Key strategies included: (1) validation of culturally adapted T2D risk assessment tools; (2) integration of social determinants of health (SDOH) and ethnocultural factors into DBCD care strategies/tactics; and (3) promotion of equity in healthcare access for all people comprising diverse populations. Finally, specific implementation tactics included: (1) focusing on patient-centered public policies; (2) ensuring access to effective treatments; and (3) using culturally relevant resources for education and prevention. When coordinated, these strategies and tactics mitigate DBCD progression, thereby enhancing healthcare outcomes. Conclusions and recommendations: Expert consensus emphasizes the need for a comprehensive approach to T2D management in Chile, leveraging transculturalized lifestyle medicine, validated risk assessment tools, SDOH, and patient-centered public policies. This process should begin with incorporating eHealth technologies, validation studies, and then translation into clinical practice guidelines. As this templated methodology is applied to other regions of the world, the resulting compendium of concepts, strategies, and tactics can foment a more effective preventive health culture and optimize DBCD care across the ethnocultural spectrum.
