Low- and middle-income countries (LMICs) face a growing burden of cardiovascular disease (CVD) that is not fully explained by traditional risk factors like hypertension. Anemia is highly prevalent in LMICs and may be an important non-traditional CVD risk factor. We evaluated the association between anemia and preclinical CVD, including left ventricular hypertrophy (LVH) and other echocardiographic measures, in two diverse LMIC settings. This was a cross-sectional analysis of data from two separate cohorts of adults in Mwanza, Tanzania (n = 999; data collected 2022–2023) and Port-au-Prince, Haiti (n = 3,005; data collected 2019–2021). Participants underwent clinical examinations, laboratory testing, and echocardiography. Models assessing the relationship between anemia and echocardiographic outcomes were adjusted for age, sex, HIV status, blood pressure, and body mass index. Anemia prevalence was 23
Impact assessment surveys (IAS) are central to monitoring and evaluating the effectiveness of mass drug administration (MDA) programs targeting soil-transmitted helminths (STH). Current survey designs often follow guidelines that lack flexibility and spatial representativeness. There is a need for more efficient and context-adaptable methodologies that can guide programmatic decision-making using available data. We developed a three-step geostatistical framework for optimal IAS design that integrates baseline prevalence data, environmental covariates, and treatment history. A geostatistical model is used to estimate baseline prevalence. A Markov model, coupled with a local spatial thinning algorithm, is then applied to forecast post-MDA prevalence surfaces. These projections guide the simulation and evaluation of candidate survey designs across different sampling intensities and spatial configurations. Design performance was assessed based on classification accuracy and survey cost. The methodology was applied to datasets from Kenya, Sierra Leone, and Zimbabwe. Compared to conventional survey designs, our model-based approach achieved similar classification accuracy with 60–90
The promotion of brain health has generally been undertaken at the level of individuals, for instance, in the quest for precision treatments for persons with, or at high risk of, neurological disorders. But the growing global burden of neurological conditions and the increasing understanding of the brain’s central role in all facets of human life have spurred interest in public health approaches to the brain that emphasise population-level strategies benefitting everyone as part of a “brain health for all” vision of society. This article defines the emerging concept of public brain health as intersectoral action to establish brain health priorities, empower communities, and reduce health inequities, with the ultimate goal of improving brain health at the population level across the lifetime. We propose a framework to promote and safeguard population brain health with the following key elements: co-defining priorities with communities, balancing prevention strategies, and reducing global gaps in brain health through ambitious policy-making. Public brain health calls for collective responsibility to maximise brain health equity across the life course.
Pakistan’s contrasting experiences with polio and leprosy show that technical interventions alone cannot achieve disease elimination. Sustained community trust, long-term partnerships with local civil-society organizations, integration with broader health needs, and institutional continuity should complement vaccination, surveillance, and outbreak response in the final stages of polio eradication.
Abstract Background The World Health Organization recommends human papillomavirus (HPV) testing and same-day treatment for cervical screening among women in the general population in low- and middle-income countries (LMIC). Among women living with HIV, additional triage is recommended due to lower specificity and predictive value of HPV testing alone in this population. We evaluated the performance of HPV DNA testing alone and in combination with alternative triage strategies for the early detection and treatment of cervical pre-cancer among women living with HIV in Papua New Guinea (PNG). Methods We did a prospective clinical cohort study among women living with HIV aged 30-59 years attending an HIV treatment and care service. Eligible women self-collected a vaginal specimen for point-of-care HPV DNA testing on the GeneXpert platform. All women testing HPV-positive, and a random sample of HPV-negative women, had enhanced visualisation of the cervix with digital colposcopy (EVA) and provided a clinician-collected cervical specimen for off-site liquid-based cytology. The primary outcome was the clinical performance (sensitivity, specificity, positive and negative predictive value [PPV, NPV]) of HPV testing alone and in combination with alternative triage strategies (EVA, HPV type restriction, modified assay cut-off values) for detection of high-grade squamous intraepithelial lesion (HSIL) or worse. Results Between May 3, 2024 and December 12, 2024, we recruited 404 women, of whom 168 (41.6%) tested positive for one or more of 14 oncogenic HPV types. Estimated sensitivity and NPV for HSIL or worse using manufacturer-defined cycle threshold cutoffs was >99%, specificity 63.3% (95%CI: 58.3%-68.3%), and PPV 18.6% (12.6%-24.6%). Restricting screen-positive to one or more of the 8 HPV types of greatest oncogenic potential had comparable sensitivity and NPV (>99%), with specificity 70.2% (65.5%-74.9%) and PPV 22.6% (15.6%-29.6%). HPV 8-type restriction with more stringent assay cut-offs (cycle threshold <33.99) had sensitivity 86.5% (75.3%-97.7%), specificity 80.1% (75.9%-84.3%), PPV 30.7% (21.7%-39.7%), and NPV 98.4% (96.9%-99.9%). EVA provided no additional benefits to HPV testing alone. Conclusions Applying HPV 8-type restriction with or without modified manufacturer assay cut-off values to the WHO pre-qualified Xpert HPV test improved clinical performance for detection of HSIL or worse among women living with HIV in PNG.
