BACKGROUND:Tuberculosis (TB) remains a major global health burden, particularly in low- and middle-income countries. Persistent TB-related inflammation has been implicated in significant endocrine and metabolic dysregulation. While previous studies have documented alterations in sex hormones or lipid profiles independently, the potential interplay between these biological systems has not been systematically investigated in patients with active TB. Moreover, comprehensive evidence from sub-Saharan Africa, including Ethiopia, where the burden of TB is substantial, remains limited. Elucidating the hormone-lipid interrelationship may provide important insights into the pathophysiological mechanisms underlying TB-associated metabolic disturbances. Therefore, this study aimed to comprehensively evaluate alterations in sex hormones and lipid profiles and to examine their interrelationships among adult TB patients in Gondar town, Northwest Ethiopia. METHODS:A comparative cross-sectional study was conducted among 150 HIV-negative, TB-positive patients (both newly diagnosed and on anti-TB treatment) and 150 age-matched TB-negative adults recruited from five selected health institutions in Gondar Town. Sociodemographic, clinical and behavioural data were collected using structured interviews. Fasting serum samples were analysed for lipid profiles, sex hormones and cortisol using a Beckman Coulter Clinical Chemistry analyser. Group comparisons were performed using t-tests and the Mann-Whitney U test and correlations were assessed using Pearson and Spearman's rank coefficients. Statistical significance was set at p < 0.05. RESULTS:Male TB-positive patients had significantly lower testosterone (mean difference: -2.6, 95% CI: -3.1 to -2.1), while oestradiol (+15.1, 95% CI: 9.5-20.7), LH (+5.8, 95% CI: 3.2-8.3) and FSH (+6.6, 95% CI: 4.1-9.0) levels were significantly higher compared with tuberculosis-negative individuals (p < 0.001). Female TB-positive patients showed markedly reduced testosterone and progesterone levels (p < 0.001, r = 0.7 and 0.4, respectively). Among females, testosterone levels were lower in underweight than normal-weight individuals (p = 0.006; overall p = 0.008), with no other hormone variations by BMI in either sex. Regarding lipid profiles, TB-positive patients exhibited significantly lower total cholesterol (mean difference: -40.5 mg/dL, 95% CI: -50.1 to -30.9, p < 0.001), while LDL (-15.7 mg/dL, 95% CI: -25.6 to 5.8), HDL (2.5 mg/dL, 95% CI: -3.5 to 8.4) and triglycerides (-0.5 mg/dL, 95% CI: -3.1 to 2.2) showed no significant differences. Among male participants, cholesterol was positively correlated with testosterone (r = 0.658, p < 0.001) and negatively correlated with oestradiol (r = -0.314, p = 0.002), FSH (r = -0.31, p < 0.001), LH (r = -0.223, p = 0.004) and cortisol (r = -0.424, p < 0.001). Among female participants, cholesterol was positively correlated with testosterone (r = 0.299, p < 0.001). CONCLUSIONS:TB was associated with substantial disruptions in sex hormone balance and lipid metabolism. Male and female TB patients showed distinct alterations in gonadal hormones, alongside BMI-related variations in testosterone among females. Reduced total cholesterol was consistently observed in TB-positive patients, including both newly diagnosed and treated cases. In addition, TB patients on treatment had significantly lower triglyceride levels compared with both newly diagnosed TB patients and TB-negative controls, while underweight individuals exhibited lower triglyceride levels compared with overweight individuals. These findings suggest an association between tuberculosis, endocrine disruption and altered lipid metabolism, with potential implications for disease severity, nutritional status and recovery. However, given the cross-sectional design of this study, causal relationships cannot be established. Integrating hormonal and lipid assessments into TB care may improve patient monitoring and support clinical management.
OBJECTIVES:Robust estimates of perinatal mortality are essential for improving perinatal survival in low- and middle-income countries. Mobile phone surveys may offer a scalable alternative to in-person surveys for such estimates. This study assessed the feasibility and validity of mobile phone-based Proxy Full Pregnancy History (mPFPH) interviews in rural Bangladesh, comparing proxy-reported and self-reported full pregnancy histories collected via mobile phones. METHODS:Between June and November 2022, women who had experienced at least one adverse pregnancy outcome (index women) and their nominated closest confidants participated in mobile phone interviews. Self-reports served as the reference standard. We examined selection biases associated with mobile phone access and evaluated concordance between self- and proxy-reports for perinatal outcomes. RESULTS:A total of 1838 index women and 1328 confidants were enrolled. Non-response rates ranged from 2.1% to 26.5%, with non-respondents more likely to be younger, multiparous, and from smaller households. Average interview durations ranged from 7.5 to 25 min. Compared with self-reports, proxy reports by index women and closest confidants underreported neonatal deaths by 9.9% (95% CI: 7.0%-12.8%) and 23.1% (95%-CI: 15.0%-31.2%), perinatal deaths by 13.6% (95%-CI: 11.2%-16.0%) and 21.3% (95%-CI: 15.1%-27.6%), early neonatal deaths by 11.6% (95%-CI: 8.2%-14.9%) and 20.5% (95%-CI: 11.6%-29.5%), stillbirths by 14.6% (95%-CI: 11.2%-18.0%) and 22.4% (95%-CI: 13.5%-31.2%), and other pregnancy losses by 30.8% (95%-CI: 27.1%-34.4%) and 46.9% (95%-CI: 41.4%-52.5%). The proxy-to-self rate ratios for index women were 0.91 (95%-CI: 0.79-1.04) for neonatal mortality, 0.89 (95% CI: 0.80-0.98) for perinatal mortality, 0.89 (95%-CI: 0.76-1.04) for early neonatal mortality, 0.88 (95% CI: 0.76-1.01) for stillbirths, and 0.74 (95% CI: 0.65-0.83) for other pregnancy losses. CONCLUSION:The mPFPH method demonstrated feasibility through high response and completion rates, efficient call durations, and strong two-way validation. However, proxy reports underestimated perinatal mortality relative to self-reports. Further validation across diverse settings is needed before large-scale implementation.
BACKGROUND:Snakebite envenoming is a neglected public health issue influenced by both environmental and socioeconomic variables. In Pará, the Brazilian state with the highest number of cases, knowledge gaps remain regarding the relationship between these factors and the temporal and geospatial distribution of accidents. This study investigates the influence of the El Niño-Southern Oscillation (ENSO), rainfall, river levels and socioeconomic indicators on snakebite incidence over nearly two decades (2007-2023). METHODS:Data were obtained from official public health, environmental and socioeconomic databases. A Generalized Additive Model (GAM) was used to assess social variables, cross-correlation analyses evaluated associations with rainfall and river levels and wavelet analysis was applied to explore temporal patterns linked to ENSO variability. RESULTS:A total of 87,267 cases were recorded during the study period, with the highest incidence in northeastern Pará, particularly in the municipality of Santarém. Snakebite occurrence showed positive correlations with poor sanitation, rural population density and illiteracy rates. Temporal associations were also observed with river levels, rainfall and ENSO variability. CONCLUSIONS:The most affected municipalities should be prioritised for preventive education and improved antivenom distribution. The association with poverty indicators underscores the need for structural improvements in health and social assistance systems. Climatic influences highlight the role of environmental variability in shaping snakebite incidence in the Amazon and raise concerns about potential impacts of ongoing climate change on snakebite risk.
OBJECTIVES:We evaluate the utility of mobile phone surveys (MPS) for estimating child mortality in Burkina Faso, where armed conflict and forced displacements hamper traditional face-to-face data collection on an important share of the territory. METHODS:We estimated under-five mortality from truncated birth histories collected in an MPS from September 2021 to October 2022. The sample consisted of telephone numbers collected in a prior face-to-face survey and an additional set of numbers generated through random digit dialling (RDD). We compared regionally disaggregated mortality estimates from the MPS with those from the 2021 Demographic and Health Survey (DHS), which could not cover parts of the national territory due to insecurity. RESULTS:Of 52,650 attempted phone numbers, 11,387 women of reproductive age were interviewed. Of these, 8077 were reached through RDD (36% lived in conflict-affected areas at the time of data collection) and 3310 via previously collected numbers (42% lived in conflict-affected areas). In regions not directly affected by conflict, under-five mortality rates have remained relatively stable over time: from 45 deaths per 1000 live births in 2018-2019 (95% CI: 36-54) to 58 in 2020-2022 (95% CI: 46-69). This finding mirrors the trend observed in the DHS data. In regions affected by armed conflict, however, the MPS data indicate a substantial increase in under-five mortality: From 47 deaths per 1000 live births in 2018-2019 (95% CI: 38-57) to 82 in 2020-2022 (95% CI: 67-98). This mortality reversal in conflict-affected areas is not apparent in the DHS, most likely due to the exclusion of the most insecure survey clusters from its sampling frame. CONCLUSION:MPS offers a viable alternative or complement to traditional face-to-face surveys for estimating child mortality in populations where insecurity limits face-to-face survey data collection.
OBJECTIVES:Bangladesh, a lower-middle-income (LMIC) South Asian country, relies on survey data for measuring adult mortality. Mobile phone surveys are an appealing alternative to in-person surveys because they are cheaper and can be deployed when enumerator mobility is hindered. In this contribution, we examined the quality of 'Parental Survival History' data collected over the phone by comparing it with data from a Health and Demographic Surveillance System. METHODS:We conducted a mobile phone survey from July to December 2021 among residents of the Matlab HDSS. Mobile phone survey data about the respondent's father and mother were individually matched to the HDSS database. Data were compared to the HDSS reference in terms of the vital status of the respondent's parents, their age, the time since death and adult mortality rates. RESULTS:A total of 2231 respondents reported information on their parents. Among these, 90.7% of fathers' names and 95.2% of mothers' names were matched between the mobile phone survey and the HDSS, and the matched dataset was used for subsequent analyses. Concordance in the vital status reports of the parent was very high (both sensitivity and specificity were above 99%). Further, we found that 50% of the parents' ages (current age for those who are alive and age at death for parents who died) were within 5 years below and 3 years above those recorded in the HDSS. Around 4% of parental deaths were erroneously located within or outside an 8-year reference period. The parents' mortality rate was 52.0 (95% CI: 49.3, 54.8) per 1000 person-years in the mobile phone survey and 52.3 (95% CI: 49.6, 55.0) in the HDSS. CONCLUSIONS:In this population, parental survival history data were reported with high accuracy in a mobile phone survey, highlighting their potential for measuring adult mortality in resource-constrained settings.
BACKGROUND:Leprosy is a chronic infectious disease affecting the skin and peripheral nerves, potentially causing deformities and disabilities. Transmission occurs mainly via aerosols and nasal secretions, with persistent endemicity in countries such as Brazil, India and Indonesia. Systematic monitoring of contacts is a key strategy for early detection and disease control. OBJECTIVE:To investigate risk factors associated with time to disease onset among leprosy contacts and describe the temporal dynamics of disease development in a historical cohort. METHODS:A retrospective cohort of 600 contacts of newly diagnosed leprosy cases (2002-2022) was followed for up to 5 years. Variables included age, Mitsuda test, anti-PGL-I IgM serology, qPCR in peripheral blood, BCG scar and type of contact. Disease-free survival was estimated with Kaplan-Meier curves and differences between groups were tested using the log-rank test. Variables with p < 0.20 were included in a multivariate Cox proportional hazards model, with stepwise removal until only variables with p < 0.05 remained. RESULTS:During follow-up, 123 contacts (20.5%) developed leprosy, with a higher incidence in the first 24 months: 33.3% of cases occurred in the first year and 25.2% in the second year, followed by a relative stabilisation of new cases in subsequent years. Median survival time was 52 months. In multivariate analysis, positive qPCR (HR = 3.67; 95% CI = 2.42-5.55) and positive anti-PGL-I IgM (HR = 5.48; 95% CI = 3.79-7.92) were independently associated with earlier disease onset. Other factors, including age, Mitsuda test, BCG scar and type of contact, were not significant after adjustment. CONCLUSIONS:Contacts with positive biomarkers face a higher risk of developing leprosy within 5 years. Understanding the temporal dynamics of disease onset supports targeted surveillance and timely intervention strategies, contributing to more effective leprosy control in endemic settings.
OBJECTIVES:Crimean-Congo hemorrhagic fever virus (CCHFV) is a zoonotic tick-borne virus causing severe and potentially fatal disease in humans, with case fatality rates of up to 30%. In contrast, domestic ruminants and camelids remain asymptomatic. Since the first reported case in Mauritania in 1983, CCHFV antibodies have been repeatedly detected in humans and animals. This study aimed to assess the local circulation of CCHFV in camels and cattle in southern Mauritania and in Nouakchott. METHODS:A total of 317 blood samples (174 cattle, 143 camels) were collected from southern regions bordering Mali and Senegal (n = 170) and from Nouakchott (slaughterhouse and animal market; n = 147). Sera were analyzed at the ONARDEP laboratory using the ID Screen CCHF Double Antigen Multi-species ELISA. The effects of age, species, sex and sampling year on seropositivity were evaluated using a generalized linear mixed-effects model (GLMM). RESULTS:Overall seroprevalence was 70% (222/317). Camels showed a higher seroprevalence (> 81%; 117/143) than cattle (> 60%; 105/174). Increasing age was significantly associated with higher seropositivity. Age and species had significant effects on CCHFV antibody status. Descriptive age-specific seroprevalence increased with age in both cattle and camels, whereas sex and sampling year showed no significant effect. CONCLUSIONS:Crimean-Congo haemorrhagic fever remains an endemic zoonosis and a significant public health threat in Mauritania and neighbouring countries. Our findings confirm high CCHFV seroprevalences in cattle and camels in the study area. However, important knowledge gaps remain regarding virus circulation and transmission dynamics. Strengthening diagnostic capacity, conducting integrated epidemiological studies across livestock, ticks and humans, and enhancing awareness and regional surveillance are essential for a better understanding and control of CCHFV spread.
OBJECTIVES:To describe the aetiology and antibiotic susceptibility patterns of common bacterial infections in hospitalised patients in Jakarta, Indonesia. METHODS:We conducted a hospital-wide point prevalence survey in six hospitals in 2019, capturing data from routinely ordered bacterial cultures taken before the start of antibiotic treatment. We report relevant bacteria-antibiotic combinations for Escherichia coli and the ESKAPE group of pathogens. RESULTS:A total of 562 patients (52% women, median age 46 years) were diagnosed with 587 infections, comprising 414 community-acquired and 173 hospital-acquired infections, with pneumonia most frequent (258, 44%). From 615 samples collected, 279 (45%) bacterial isolates were identified, of which 213 (76%) gram-negative, including Klebsiella pneumoniae (68, 24%), Escherichia coli (37, 13%) and Pseudomonas aeruginosa (35, 13%) among others, and 66 (24%) gram-positive, including Enterococcus faecalis (17, 6%) and Staphylococcus aureus (11, 4%) among others. Proportions of bacteria resistant to third-generation cephalosporins (3GC) were 75% (47/63) for Klebsiella pneumoniae , and 69% (22/32) for E. coli , and to carbapenems 64% (7/11) for Acinetobacter spp., 60% (3/5) for Enterobacter spp., 43% (3/7) for E. coli, 30% (7/23) for P. aeruginosa and 29% (9/31) for K. pneumoniae . Four of 11 S. aureus isolates were methicillin-resistant. A blood culture was done in only 52% (16/31) of sepsis patients, and the results of positive blood cultures were reported after a median of 4 days. CONCLUSIONS:This survey identified that a high proportion of common gram-negative bacteria exhibited reduced susceptibility to first-choice antibiotics and considerable underuse of bacterial cultures. These findings warrant enhanced infection prevention and control and antimicrobial stewardship.
OBJECTIVES:This study estimates the prevalence of wasting and examines associated factors among children aged 6-23 months in Ghana from a machine-learning perspective, with a particular focus on predicting new cases to inform preventive efforts. METHODS:This study is a secondary analysis of the 2022 Ghana Demographic and Health Survey, which includes 1506 children. Wasting status was assessed using the weight-for-height z-score. A broad set of 150 child-, maternal-, household- and environmental-level variables was considered. Factors associated with wasting were first identified using survey-weighted logistic regression, whereas Multiple Correspondence Analysis was applied to explore structural relationships among predictors. Subsequently, an ensemble machine learning model was fitted to evaluate the combined predictive capacity of these factors in classifying wasting status, also comparing algorithm performance. RESULTS:Wasting prevalence in Ghana was 9.4%, with marked regional heterogeneity. Lower odds of wasting were associated with higher maternal body weight, maternal formal employment, female sex of child and consumption of animal-source foods, whereas recent diarrhoeal episodes were associated with higher odds. The exploratory analyses further showed that these factors clustered into coherent vulnerability profiles, distinguishing more clearly between wasting and non-wasting patterns. The ensemble model outperformed individual algorithms, achieving an AUC of 0.79, with high sensitivity (0.85) and moderate specificity (0.62), indicating moderate-to-good internal predictive performance. CONCLUSIONS:These findings suggest that wasting is associated with interacting biological vulnerabilities and ecological constraints during a critical developmental window. Integrating nutritional quality, infection control and maternal socioeconomic conditions is essential for addressing acute malnutrition in early childhood and for advancing a holistic understanding of child growth within human populations, guiding data-driven public policies.
INTRODUCTION:Scrub typhus is a re-emerging, neglected tropical disease in India, often presenting with nonspecific symptoms. While classical features are well-documented, atypical and severe manifestations are underreported and frequently misdiagnosed. OBJECTIVES:Our objective was to describe uncommon clinical manifestations of scrub typhus in hospitalized patients at two tertiary care hospitals in Northern India. METHODS:This prospective cross-sectional study included 22 adult patients (no controls) with serologically confirmed scrub typhus (IgM ELISA positive) presenting between January 2024 and June 2025. Only cases with atypical manifestations were included. Demographic, clinical, laboratory, and imaging data were analysed descriptively. RESULTS:The study of 22 hospitalized scrub typhus cases with atypical presentations revealed the presence of multi-organ involvement with marked hepatic and renal impairment. In severe cases, mean values of urea (97.7 vs. 10.2 mg/dL, p = 0.001), creatinine (2.14 vs. 0.84 mg/dL, p = 0.004), ALT (218.7 vs. 11.5 IU/L, p = 0.011), AST (208.5 vs. 37.2 IU/L, p = 0.008), and ALP (427.6 vs. 95.6 IU/L, p = 0.001) were markedly elevated. ROC analysis of urea (AUC = 0.902), creatinine (AUC = 0.888), and ALP (AUC = 0.875) confirmed them as strong predictors of severe disease. CONCLUSION:The correlation heatmap and boxplots highlighted strong associations between ALT and AST (r = 0.98) as well as urea and creatinine (r = 0.83), along with distinguishing outliers indicating associated hepatic injury, renal impairment, and thrombocytopenia.
OBJECTIVES:Toxocariasis is a zoonotic helminthic infection caused by Toxocara canis and Toxocara cati, parasites commonly found in dogs and cats. It is endemic in many low- and middle-income countries, but cases are increasingly reported in non-endemic areas due to global mobility. The aim of this study is to describe the epidemiological and clinical characteristics of patients diagnosed with imported toxocariasis. METHODS:This is a retrospective of all imported toxocariasis cases diagnosed at the Vall d'Hebron-Drassanes International Health Unit in Barcelona, Spain (2014-2024). Diagnosis of toxocariasis was defined by a positive serological test accompanied by clinical and/or labouratorial alterations compatible with the diagnosis. We collected demographic, epidemiological, clinical and therapeutic information from electronic medical records. RESULTS:Eighty-seven cases of toxocariasis were included. Mean age of patients was 37.2 (SD 18.3) years and 47 (54.0%) were male. Most patients (82, 94.3%) were migrants, and five (5.8%) patients were travellers. Only 20 (23.0%) patients reported having symptoms, with gastrointestinal disturbances being the most common (11, 12.6%). Eosinophilia was present in 64 (74.4%) patients and elevated IgE (58, 84.0%) was common. Co-infections were observed in 26 (29.9%) patients. Of patients that received treatment, most were given albendazole (79, 96.3%). The majority who attended a follow-up appointment showed normalisation in laboratory results despite some remaining seropositive for Toxocara canis. CONCLUSIONS:These findings underscore the need to consider testing for toxocariasis when treating patients with eosinophilia who have visited endemic areas and highlight the value of a One Health approach in understanding, preventing and managing zoonotic diseases.
BACKGROUND:HIV co-infection affects host responses and pharmacokinetics (PK) of tuberculosis (TB) treatment. This study assessed the PK of first-line anti-TB drugs and clinical outcomes in patients with and without HIV co-infection. METHODS:In this prospective observational study, 61 adults with sputum-positive pulmonary TB, either confirmed by microscopy or GeneXpert, were enrolled, including 24 with HIV co-infection and 37 without. All HIV-positive participants were antiretroviral-naïve at enrolment. Standard anti-TB therapy was given, and PK assessments were conducted on Day 1 and Week 6. Efavirenz-based antiretroviral therapy (ART) began at a median of Day 21. Clinical outcomes, sputum conversion, and adverse events were monitored. RESULTS:At baseline, patients with HIV co-infection had reduced clearance of isoniazid and ethambutol, reflected by slower elimination rates. These differences resolved by Week 6 and were not significantly impacted by ART initiation. Logistic regression showed that HIV-positive status (OR = 14.25, 95% CI: 1.22-166.37, p = 0.03), and higher baseline sputum bacillary load (OR = 3.92, 95% CI: 1.5-10.5, p = 0.006) were independently associated with delayed sputum conversion beyond 8 weeks. Baseline CRP showed an inverse association after adjustment, but this did not reach statistical significance (OR = 0.98, 95% CI: 0.96-1.00, p = 0.06). CONCLUSION:HIV co-infection was associated with altered early PK of isoniazid and ethambutol although these differences were less apparent by Week 6. HIV-positive status and higher baseline sputum bacillary load were associated with delayed sputum conversion. Although some pharmacokinetic differences were statistically significant, their clinical relevance remains uncertain, and the current data do not support dose adjustment. These findings suggest early pharmacokinetic variability in TB-HIV co-infected patients and support further investigation in adequately powered exposure-response studies. TRIAL REGISTRATION:ClinicalTrials.gov: NCT02457208.
OBJECTIVE:To analyse the epidemiological characteristics, spatial distribution and predictors of TB-related mortality in Risaralda from 2020 to 2024. METHODS:A retrospective observational study was conducted using secondary data from the National Public Health Surveillance System (SIVIGILA). Descriptive statistics, spatial analysis (choropleth maps) and binary logistic regression were used to identify sociodemographic and clinical factors associated with TB case fatality. Model performance was evaluated using ROC curves, sensitivity, specificity and 5-fold cross-validation. RESULTS:A total of 2081 confirmed TB cases were analysed, with a case fatality rate of 13.2%. Mortality was higher among individuals ≥ 65 years (OR: 3.87), hospitalized patients (OR: 7.33), HIV-positive individuals (OR: 3.49), those with undernutrition (OR: 1.89), males (OR: 1.45) and Indigenous persons (OR: 1.67). The logistic model showed good discrimination (AUC: 0.82), with sensitivity of 79.2% and specificity of 73.8%. Cross-validation confirmed model stability (AUC: 0.81). Spatial analysis revealed high mortality in rural municipalities with low case burden, suggesting health inequities. CONCLUSION:TB mortality in Risaralda is influenced by age, comorbidities and social determinants, with pronounced territorial disparities. These findings support the integration of spatial and predictive tools in TB surveillance to strengthen targeted interventions and reduce mortality in high-risk populations.
BACKGROUND:Acute febrile illnesses in sub-Saharan Africa are often attributed to malaria, yet many patients test negative for malaria parasites. The aetiology of nonmalarial fevers remains understudied. Here, we examine likely causes of febrile illnesses and their association with poor clinical outcomes in Angola. METHODS:In September-October 2023 and May-June 2024 we enrolled 849 febrile patients with ages between 2 months and 94 years in two tertiary hospitals of Lubango city that serve 7 million people in southern Angola. We used clinical assessments and locally available laboratory diagnostics to assign likely causes of fever and applied logistic regression analysis to identify factors independently associated with an increased risk of hospital admission and death. RESULTS:Overall, 67.6% of the patients tested negative for malaria by microscopy, with upper (13.0%) and lower (19.5%) respiratory infections and gastrointestinal infections (16.7%) being leading causes of nonmalarial fever. The frequencies of gastrointestinal, upper respiratory, and genitourinary infections varied markedly with age, and malaria predominated at the beginning of the dry season. Malaria and lower respiratory infections were associated with increased risk of hospitalization (odds ratio [OR] = 3.20 and 5.17, p < 0.0001), while malaria and central nervous system infections were linked to significantly higher mortality (OR = 1.90 and 6.30, p < 0.0001). Empirical antibiotic use was widespread, even without clinical or laboratory evidence of bacterial infection. CONCLUSION:Most fevers in southern Angola are of nonmalarial origin, underscoring the need for better diagnostic strategies to guide specific treatment and reduce unnecessary antibiotic use.
Objective Non-adherence to tuberculosis preventive treatment (TPT) among people living with HIV (PLHIV) is a critical issue in Ethiopia and other Sub-Saharan African countries, where both TB and HIV burdens are high. To reduce TPT non-adherence among PLHIV, it is crucial to identify those at risk and implement targeted interventions. Therefore, the main objective is to identify subgroups based on co-occurring risk factors for non-adherence and examine their association with TPT adherence.Methods A cross-sectional study was conducted at selected health centres and hospitals in West Arsi, Ethiopia. Data from 390 PLHIV were collected through structured questionnaires administered via face-to-face interviews. Latent class analysis (LCA) was used to identify distinct subgroups, defined by risk factors for non-adherence, among PLHIV. Maximum Likelihood adjustment method was used to predict adherence outcome based on the identified latent classes.Results The overall prevalence rate of adherence in PLHIV was 60%. Two distinct latent classes emerged (prevalence rate noted): a "Lower risk of non-adherence" class (63%), and a "Higher risk of non-adherence" class (37%). PLHIV in the "Higher risk of non-adherence" class endorsed higher probabilities of each of the considered risk factors, particularly regarding perceiving the relationship with the healthcare provider and distance to the health facility as barriers, and were nearly twice as likely to be non-adherent compared to those in the "Lower risk of non-adherence" class.Conclusions The findings emphasize the importance of considering co-occurring risk factors for non-adherence and tailoring interventions accordingly. This study suggests specific practical implications: for example, screening tools assessing non-adherence risk, health providers training programs and strengthening of community-based primary care.
Background Early diagnosis of typhoid is important for reducing mortality. In the absence of a blood culture, the quantitative tube Widal test is the standard serological test used for the diagnosis of Salmonella typhi, but rapid test kits are largely used in Northern Ghana. Variations in the performance of rapid test kits have been noted in other studies. We compared the diagnostic performance of two rapid test kits to the quantitative Widal method.Methods This was a cross-sectional study conducted from April to May 2024 in the Northern Region of Ghana. Quantitative tube Widal and rapid diagnostic tests using two different rapid test kits were performed using plasma collected from suspected Salmonella typhi patients.Results Of the 154 participants, most were females, 84 (54.5%). The quantitative tube Widal method detected 14 (9.1%) and 5 (3.2%) positive results for Salmonella typhi O and H antibodies, respectively, whereas the rapid diagnostic test kit type-1(IgM/IgG) detected 101 (65.6%)/47 (30.5%) positive results, and the type-2(IgM/IgG) detected 117 (75.9%)/39 (25.3%) positive results. The diagnostic performance of RDT Type 1 (IgM/IgG) was: sensitivity (85.7%/80.0%), specificity (36.4%/71.1%), PPV (11.9%/8.5%), and NPV (96.2%/99.1%). On the other hand, the performance of RDT Type 2 (IgM/IgG) was: sensitivity (85.7%/40.0%), specificity (25.0%/75.2%), PPV (10.3%/5.1%) and NPV (94.6%/97.4%).Conclusion We found both rapid diagnostic test kit types to have a sensitivity of 85.7% with a specificity below 38% for IgM. Both test kit types also had low positive predictive values below 12% with negative predictive values above 94% for both IgM and IgG, and therefore detected more false positives than true positives.
BACKGROUND:Addressing the escalating threats of antimicrobial resistance (AMR) through developing and implementing context-specific strategy remains a worldwide priority response. However, its adoption and implementation have often been fragmented in low-resource settings and are currently under-researched. This study evaluates the multi-stakeholder perspectives, practices and operational challenges encountered across Ethiopian national lead implementers of the AMR strategic plan in combating AMR. METHOD:This cross-sectional, descriptive study recruited seven AMR stakeholders, recognised as lead implementers of the national AMR strategic plan across human, animal and environmental health sectors in Ethiopia. Data were gathered via face-to-face, semi-structured interviews and document review. Then the collected data were transcribed verbatim and thematically analysed. RESULTS:The findings reveal the adoption and commencement of implementing the Ethiopian national AMR strategic plan at varying levels across One Health sectors in Ethiopia. While all key informants had positive perspectives towards implementation and were familiar with the strategic objectives, the practices were inconsistent. Among the five strategic objectives, sub-indicators associated with raising awareness, strengthening infection and prevention control practices and optimising antimicrobial use were better implemented with moderate to full engagement of lead implementers (≥ 75%). Meanwhile, no stakeholder initiated new vaccines and drug substances development and environmental risk assessment for antimicrobials yet. The cross-cutting barriers such as weak and fragmented inter-sectoral collaboration, inconsistent follow-up and scarcity of human and financial resources remained hampering effective implementation. CONCLUSION:Findings demonstrated that despite the existence of an AMR tackling strategy and initiatives, implementation and enforcement remain below the level required by the urgency of the AMR situation. It underscores the importance of bridging implementation gaps by prioritising AMR, strengthening equivalent engagement and collaborations, and capacity building.
BACKGROUND:Leprosy causes nerve damage which may be clinical or subclinical. Leprosy-associated peripheral neuropathy (LPN) has an unpredictable course despite treatment with multi drug therapy, and results in significant disabilities and stigma. There are no reliable biomarkers to quantify nerve damage in leprosy or predict impending clinical neuropathy. METHODS:We conducted a cross-sectional observational study over 1 year. Leprosy patients with peripheral neuropathy (LPN, n = 30), leprosy patients without detectable peripheral neuropathy (L, n = 20) and healthy controls (HC, n = 20) were included. Patients with other known causes of peripheral neuropathy were excluded. The primary outcome was to estimate serum neurofilament light chain (NfL) levels using the Single Molecular Assay (SiMoA) HD-X analyzer. NfL concentrations were compared across the three groups and correlated with disease spectrum, bacterial load and severity of nerve function impairment (NFI). RESULTS:The median NfL level in the LPN group was 12.1 pg/mL (range: -1.68 to 224), in the L group was 17.25 pg/mL (range: 4.43-53.8) and in HCs was 4.85 pg/mL (range: 0.252-23.7). Leprosy patients had significantly higher NfL levels than healthy controls (p = 0.008), with a cut-off value of 7.48 pg/mL using ROC analysis (sensitivity 76%; specificity 25%). NfL levels between the LPN and L groups were comparable (p = 0.56). No significant correlation was found between NfL levels and severity of clinical neuropathy, although a non-significant positive trend with the bacterial index was noted. CONCLUSIONS:Serum NfL levels were significantly higher in leprosy patients compared to healthy controls, suggesting prominent axonal damage. NfL may serve as a minimally invasive biomarker of nerve damage in leprosy, but further longitudinal studies are needed to validate its predictive and therapeutic utility in LPN. TRIAL REGISTRATION:CTRI/2024/04/081960.
OBJECTIVES:Early warning systems (EWSs) are essential for alert, detection, and response to potential public health emergencies. Brazil's 2024 dengue epidemic, the largest ever recorded, offers a critical case for assessing correspondence between timely epidemic risk detection and health governance responsiveness. METHODS:We collected data on dengue cases, deaths, and public health emergency declarations (PHEDs) at federal, state, and municipal levels. We evaluated the timeliness of 2024 emergency declarations by retrospectively mapping observed risk levels across all states and capitals, utilizing the 2023 federal endemic channel guidelines and the updated 2025 risk-level criteria. Using logistic regressions, we investigated whether epidemic severity was associated with the enactment of a PHED, accounting for primary health coverage and political dynamics that influence local government declarations. RESULTS:The 2024 epidemic escalated rapidly. Brazil remained at an alert level for 19 consecutive weeks and at an epidemic level for 11, with epidemic risk thresholds reached unusually early. Eleven states and seven capitals issued PHEDs after epidemic thresholds were reached, and an additional five capitals were covered by overlapping state declarations. Despite prolonged epidemic conditions across 18 states and 20 capitals, only 11 states and 7 capitals issued emergency declarations. High-burden jurisdictions such as Bahia and Belém did not declare emergencies. Logistic regression models show that only the duration at elevated risk levels significantly predicted emergency declarations, while political factors and primary health care coverage did not. That declarations followed prolonged epidemic exposure rather than early detection underscores the need for institutional mechanisms that translate surveillance signals into timely governance responses. CONCLUSIONS:The EWS framework was insufficiently responsive to the rapid dynamics of the 2024 dengue epidemic. Strengthening responsive governance requires adaptive surveillance tools and institutional mechanisms that link early detection to timely, coordinated responses, while accounting for decentralized decision-making and uneven subnational capacities.
BACKGROUND:Tuberculous pleural effusion (TPE), the second most common form of extra-pulmonary tuberculosis (TB), remains difficult to diagnose due to low-yield, invasive and often unavailable diagnostics in resource-limited settings. This study aimed to evaluate the diagnostic accuracy of sonographic characteristics alone to predict TB aetiology of pleural effusions using point-of-care ultrasound (POCUS). METHODS:This cross-sectional study included 45 participants in Zambia who underwent ultrasound scanning and diagnostic thoracentesis. Key sonographic characteristics of pleural effusions-presence of septations, presence of plankton sign and unilateral location-were evaluated for their association with TB, using pleural fluid adenosine deaminase (ADA) ≥ 40 IU/L, combined with Xpert MTB/RIF and lipoarabinomannan, as the gold standard. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for each characteristic alone and in combination and multivariate logistic regression was used to determine statistical significance. Interrater reliability between clinician and expert image interpretation was calculated using a kappa statistic. RESULTS:Significant associations were found between TB positivity and unilateral location (either side) (p = 0.037), right-sided location (p = 0.043) and any two POCUS signs (p = 0.044). Diagnostic performance varied across the three POCUS signs, with the presence of any two POCUS signs demonstrating the highest sensitivity (90.9%) but moderate specificity (41.7%) and the presence of all 3 POCUS signs showing strong specificity (83.3%) but poor sensitivity (45.5%). Agreement also varied, with the lowest kappa score observed for the plankton sign and the highest for unilateral location. CONCLUSIONS:Multiple sonographic characteristics, including unilateral location (either side), unilateral right-sided location and any two positive signs were significantly associated with TB aetiology. Limitations included small sample size, potential selection bias, imperfect gold standard options, and inability to fully assess potential confounders. With additional study, these findings may be used to inform development of a non-invasive tool to predict TB aetiology of pleural effusions-and expedite initiation of anti-TB therapy-in high TB settings globally.
