Technological advancements show great potential in transforming and advancing global surgery. Compared to general medicine, technology in neurosurgery has seen an explosive growth in recent years in ways that directly address accessibility. New, rapidly developing innovations pave the way for the expansion of neurosurgical care worldwide, particularly in areas with historically limited access to such facilities, personnel, clinical expertise, or financial means. Here, we present promising innovations like telemedicine, online collaborative platforms (OCPs), immersive technology (IT), and clinical artificial intelligence (AI) and their implementation in mitigating barriers to neurosurgical care. We argue how these tools enhance communications between providers and patients, streamline intraoperative workflows, and democratise access to neurosurgical education and training by reducing resource demands such as time, travel, and human labour. It is necessary, though, to identify how these technologies can be most successful in the context of global neurosurgery. In addition to reviewing these various technological avenues, we explore the nuances associated with the implementation and reported outcomes for each tool-highlighting challenges and opportunities for further innovation.
Abstract Background Tungiasis is a neglected tropical zoonotic skin disease which is endemic to Sub-Saharan Africa and Latin America, caused by sand fleas of the genus Tunga , which burrow into the skin of affected humans and animals, most commonly when the feet come in contact with infested soil. Sand flea infection leads to inflammation, severe itching, and pain, with the potential for secondary bacterial or viral infections, gangrene, and disfigurement. Tungiasis disproportionately affects poor rural communities, and individuals living in unhygienic settlements. To date, the existing burden of tungiasis has never been estimated, despite being included in the World Health Organisation Neglected Tropical Diseases roadmap since 2021. Methods We applied a prevalence-based Disability Adjusted Life Year (DALY) approach focusing on Years Lived with Disability (YLD) to model the burden of human tungiasis in endemic countries. Prevalence range estimates were derived using a Bayesian hierarchical Beta-Binomial model, with probability distributions applied to represent uncertainty in estimates based on highly heterogeneous local reports, capture local and regional variation, and reflect fluctuations in symptom severity among affected individuals. A discrete time point model was implemented over a 52-week period to estimate annual DALYs lost per country included in the analysis. Monte Carlo simulation with 1000 iterations was used to generate mean DALY estimates. Results Globally, we estimate that up to 379,645 (95% UI 361,792–398,309) DALYs are lost annually, with the bulk of the burden in Sub-Saharan Africa. When comorbidities are included, this increases to 575,298 (95% UI 548,948–602,597). When adjusted for population size, we estimate that 24.2 DALYs (36.4 with comorbidities included) are lost annually per 100,000 people. In terms of DALYs lost, the disease burden is disproportionately concentrated in Sub-Saharan Africa, and Brazil. Conclusions Our estimates suggest tungiasis exerts a substantial burden of disease in endemic countries, comparable in absolute terms to that of soil-transmitted helminths and echinococcosis, and greater than that of toxocariasis, fascioliasis. Furthermore, we observe marked regional concentration of disease burden within Sub-Saharan Africa, with the disease burden in this region driven by large at-risk rural, and urban slum-dwelling, populations living within the ecological zone of transmission.
Gestational diabetes mellitus (GDM) is the most common medical condition occurring during pregnancy. Screening for GDM during antenatal care (ANC) provides an opportunity to prevent its progress and complications. Women’s experiences should help shape how GDM screening guidelines are implemented, which will further influence uptake and adherence to screening services. We aimed to explore women’s experiences of receiving ANC at two hospitals in Tanzania where we introduced GDM screening services. We employed an exploratory case study design in two district hospitals of Tanzania. We purposively recruited 22 women in 2024 who received ANC, which included GDM screening services. We conducted in-depth interviews using semi-structured interview guides, tape-recorded the interviews, transcribed verbatim, and analyzed the data using qualitative content analysis. Texts were condensed to meaningful units, abstracted to codes which were linked to the social-ecological model, developed sub-categories and categories. Participants described the suboptimal quality of health education and care provided during and after the GDM screening test. They expressed how the experience of receiving GDM screening services influenced their personal and community adaptations to a healthy lifestyle. Women suggested having GDM education in routine ANC health education sessions and to improve the timing and format of delivery of health education provided during ANC. Women expressed the need to simplify the logistics in doing the blood glucose tests, reduce user fees, and improve quality of care provided following the GDM screening test. GDM screening services should be offered as part of routine ANC services. Receiving GDM care within routine ANC improved women’s perception of quality health care provided. Counselling and health education on GDM need to be strengthened to improve the quality of GDM care provided. Hospital health management teams should systematically engage the community and improve hospital logistics in offering quality GDM services during ANC.
In 2019, the global EAT-Lancet Planetary Health Diet (PHD) introduced specific recommendations to promote sustainable, health-focused dietary changes in response to the increasing prevalence of diet-related diseases and escalating environmental challenges. We assessed the alignment of Swiss dietary habits with these recommendations. We analysed data from 2057 adults (18–75 years) from the 2014–2015 national nutrition survey menuCH. We matched different food categories with the PHD classification and calculated mean intakes (g and kcal) per food category, standardised to 2500 kcal, expressed as a percentage of the PHD recommendations (PHD = 100
Antenatal care (ANC) is a critical intervention for improving maternal and newborn health outcomes, particularly in low- and middle-income countries (LMICs). This study modelled the potential impact and cost-effectiveness of a theoretical community-based and risk-stratified model of ANC in LMICs. A decision-analytical model was developed to estimate health outcomes (maternal anemia, maternal deaths, newborn deaths, preterm births, stillbirths, low birth weight cases, and small for gestational age births) for 24 LMICs with demographic and health surveys conducted between 2018–2024. Three ANC scenarios were considered for the 2025–2034 period; status-quo (no changes in ANC-delivered intervention coverage); no ANC (a counterfactual where ANC-delivered intervention coverage was set equivalent to women reporting no ANC contacts); and a new ANC scenario (a community-based ANC delivery with risk stratification, assuming a 20
Loneliness is increasingly recognised as a major public health challenge with significant implications for mental, physical and social wellbeing. While there were previous large scale studies including loneliness measures, few datasets capture loneliness across the full adult life course, integrate neighbourhood-level social capital and provide geospatial mapping at national scale. The Measuring Loneliness in England (INTERACT) Study was designed to address these gaps by characterising the distribution, intensity and sociodemographic patterning of loneliness within a large volunteer-based sample across diverse population groups in England. The aim of this paper is to describe the development, implementation and early findings of the INTERACT study. A total of 135,725 adults completed the online survey between March and July 2023. The instrument included validated measures of loneliness: the University of California Los Angeles (UCLA) 3 item loneliness scale and Office for National Statistics Direct Measure (DMOL), social capital indicators and demographic variables. Descriptive statistics were stratified by key subgroups. A geospatial analysis at Lower Super Output Area level was used to visualise clustering of loneliness across England. 135,725 participants across the full adult life course (16+) were included. The cohort was predominantly female (61.6
Low- and middle-income countries face a growing dual burden of communicable and non-communicable diseases, while services remain vertically organised. In Nigeria, tuberculosis (TB) services are established at primary care level, whereas access to cardiovascular disease (CVD) and chronic respiratory disease (CRD) care remains limited in rural settings. Artificial intelligence (AI) enabled chest X-ray can integrate TB screening with identification of other cardiopulmonary abnormalities at community level. We describe the screening outcomes and referral cascade of a community-based, AI-enabled integrated programme. We conducted a non-randomised descriptive study using routinely collected programme data from five Local Government Areas in Ebonyi and Nasarawa States, January 2023 to December 2024. Community outreach used portable digital chest X-ray with AI software to screen individuals aged six years and above. People with presumptive TB underwent Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) testing on the GeneXpert platform, while non-TB radiographic abnormalities were referred for further evaluation. Descriptive analyses summarised screening yield, diagnostic outcomes, and linkage to care. In total, 9,585 individuals were screened through 93 outreach activities, and 3,166 (33
Clinical practice guidelines (CPGs) were developed to standardize and optimize cancer care delivery in low- and middle-income countries (LMICs). The aim of this scoping review is to identify implementation science (IS) frameworks and strategies to promote CPG adoption and adherence in LMICs. We identified studies that describe, develop, reference, or utilize IS frameworks or strategies to deliver or evaluate adoption of oncology CPGs in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), African Journals Online, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and PsycINFO on 3/21/2022, 12/20/2022, 01/26/2024, and 10/03/2025. Publications in all languages and of all study types were eligible for inclusion. Titles, abstracts, and full text were screened by two reviewers with conflicts resolved by a third reviewer. Excluded studies did not use an IS framework or strategy, did not focus on cancer care, or were conducted in a high-income country. Searches identified 17,806 unique publications for title/abstract screening. 182 studies met criteria for full-text review; 35 were included. Twenty-four studies were country-specific, most commonly India (n = 5) and Nigeria (n = 5). The most frequent CPGs referenced were national/country-specific guidelines (n = 13) and Breast Health Global Initiative (BHGI) guidelines (n = 9). Only 16 full-text publications described original research to promote or evaluate evidence-based CPG interventions in LMICs. Established IS frameworks used in more than one study were the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (n = 2) and Consolidated Framework for Implementation Research (CFIR) (n = 2). There is limited research utilizing IS frameworks and strategies to promote CPG adoption and adherence in LMICs and substantial heterogeneity in reporting. Greater utilization of IS frameworks, strengthening implementation capacity and improving consistency in reporting, are needed to improve CPG uptake in LMICs. Open Science Framework (https://osf.io/nb75s).
Physical inactivity (PI) has emerged as a “forgotten pandemic” in global health. Over a quarter of adults worldwide fail to meet recommended physical activity (PA) levels, a proportion that has remained largely unchanged since 2001. This inactivity drives a rising non-communicable disease burden, deepens health inequities, and generates substantial economic costs. Yet preventive action and dedicated funding remain insufficient. Despite international frameworks and national PA plans, with nearly 75
Abstract Background Sex differences in Mycobacterium tuberculosis (Mtb) exposure likely contribute to sex differences in tuberculosis (TB) burden. However, population-level age- and sex-specific patterns of Mtb exposure among adolescents and adults have not been recently characterised in Malawi. We therefore conducted a cross-sectional survey to estimate age- and sex-specific Mtb immunoreactivity prevalence in Blantyre City, Malawi, and to assess whether prevalence diverges by sex with increasing age. Methods We used an open-access dataset of building footprints, known as Open Buildings, to obtain a random sample of households from 33 peri-urban neighbourhoods in Blantyre City. Adolescents and adults aged 10–40 years were recruited, participant characteristics recorded, and venous blood samples collected to determine Mtb immunoreactivity using the QuantiFERON-TB Gold Plus (QFT-Plus) assay. We fitted Bayesian multilevel logistic regression models to estimate the association between age, sex, and other risk factors with Mtb immunoreactivity, and compared predicted immunoreactivity prevalence across age-sex strata. Results Of 2833 participants, 40.0% (1133/2833) were male, the median age was 21 years (interquartile range: 16–28 years), and 8.7% (179/2047) self-reported living with HIV. Overall, 17.8% (503/2833) of participants were Mtb positive, Mtb immunoreactivity prevalence was 17.8% (95% credible interval [CrI]: 16.4–19.2%), corresponding to an annual risk of TB infection of 0.88% (95% CrI: 0.80%-0.95%). Prevalence was similar by sex among 10-19- and 30-40-year-olds. However, among 20-29-year-olds, prevalence was higher among males compared to females: 26.3% (95% CrI: 22.0%-30.8%) and 17.7% (95% CrI: 14.8%-20.8%), respectively. The annual risk of Mtb immunoreactivity conversion increased, on average, at a faster rate among males compared to females from age 10 years, peaking at 21 years, where it was 1.58 (95% CrI: 0.82–2.80) times higher among males compared to females. Tobacco smoking and alcohol drinking, more prevalent among males compared to females, were associated with increased immunoreactivity probability. Conclusions Adolescence appears to be a period of vulnerability for Mtb exposure, during which sex-specific vulnerabilities begin to emerge. Identifying the biological and social drivers of these vulnerabilities could inform targeted strategies to reduce sex disparities in TB.
Flooding can disrupt water, sanitation and hygiene services in low-income rural and peri-urban settings, yet there is limited quantitative evidence on how repeated flood exposure affects safe water and sanitation over time at the level of Community Health Units (CHUs), which are the operational units for primary health care in Kenya. We analysed repeated CHU-level data from ten Community Health Units in Kilifi County, Kenya, across eleven surveillance rounds from 2017 to 2024. For each round, we calculated the percentage of households with safe drinking water and with access to a functional latrine, and linked these outcomes to flood exposure derived from Sentinel-1 radar imagery at 10 m resolution during the relevant CHU-specific survey window. We fitted linear mixed-effects models with CHU random intercepts, adjusting for elevation and land cover composition, and constructed comparative flood-adjusted resilience scores. We analysed 220 CHU-round observations. The flood-by-outcome interaction was negative and statistically significant: a one standard deviation increase in flood frequency was associated with a 5.6
The Expanded Programme on Immunization (EPI) reduces vaccine preventable disease-related childhood morbidity and mortality. Vaccine coverage and timeliness are crucial to maximise protection in children < 5 years old. This is especially important for children living in households affected by human immunodeficiency virus (HIV) and tuberculosis. Tuberculosis Child Multidrug-Resistant Preventive Therapy (TB-CHAMP), a randomised controlled trial of multidrug-resistant tuberculosis (MDR-TB) prevention, enrolled participants at five sites across South Africa between 26 Sep 2017 and 21 Jan 2023. In this secondary exploratory analysis, we analysed the coverage and timeliness of EPI vaccinations due by 12 months of age and associations between delayed/non-vaccinations and pre-defined factors relating to child participant, adult MDR-TB index patient, and household. Early, on-time, and delayed vaccinations were defined as > 5 days before, within 28 days of, and > 28 days after the projected dates, respectively. Modified Poisson regression was used to assess factors associated with delayed/non-vaccination and vaccination completeness. The COVID-19 period was defined as the 6 months after the start of South African lockdown. Of 922 enrolled children, 814 children < 5 years with complete immunisation records were included. There was equal sex distribution, median age was 2.5 years (IQR 1.2–3.8), 35
In the Swedish universal healthcare system, persons living with rare diseases (PLWRD) face major challenges in receiving diagnosis and accessing care,stemming in part from heterogeneity of disease and systemic barriers to care. This contributes to health inequity and a lack of visibility for PLWRD within thehealth system. This Perspective paper provides an overview of the facilitators and challenges during the development and implementation of a national raredisease (RD) quality registry, RaraSwed. The registry collects data on RD diagnosis. Adopting a social innovation and systems thinking methodology, inaddition to governance, have proven beneficial. RaraSwed supports RD research, evidence-based RD care, and Sweden’s National Quality Policy and Strategy(NQPS) for RD. Future modules on patient-reported and physician-reported data on care coordination, treatment and clinical attributes will capture the holisticpatient experience. RaraSwed may contribute to health equity for PLWRD in Sweden and in turn facilitate international RD data harmonisation.
BACKGROUND:The importation of arbovirus diseases into new countries is a global concern. This risk is exacerbated by human movement and climate change effects. In the World Health Organization (WHO) Eastern Mediterranean regional office, three countries - Djibouti, Somalia, and Yemen - are currently classified as potential or moderate risk for yellow fever (YF) outbreaks. METHODS:Here we present a quantitative assessment of the risk of introduction and propagation of yellow fever virus (YFV) transmission in Djibouti, Somalia and Yemen. This modelling has two components: i) projecting the risk of importation of infectious individuals into the countries of interest using a radiation model of human movement and ii) estimating the risk of onward transmission given importation using a dynamic compartmental model of yellow fever virus transmission. Both components are multiplicatively combined to give an overall relative outbreak risk combining both risk of importation and risk of an outbreak given importation. RESULTS:We show that areas such as the western coast of Yemen, regions of Somalia bordering Ethiopia and Kenya, and Djibouti City have potential for YF outbreaks (where the estimated probability of an outbreak given an imported infectious case is over 50%). This is due to environmental suitability for transmission based on factors such as temperature and projected human mobility between endemic and at-risk regions. CONCLUSIONS:Countries bordering existing YF endemic regions are potentially vulnerable to both introduction of YF cases and subsequent outbreak spread. This promotes the awareness of YF importation potential when conducting clinical surveillance in at-risk countries.
Despite Singapore’s robust healthcare infrastructure, adults with intellectual disabilities (AWIDs) and caregivers face insufficient support. Singapore’s multicultural context, ageing population, and income inequality further complicate equitable care. These challenges underscore the need to reassess the healthcare system for this group. Therefore, this study aimed to: (1) catalogue barriers and facilitators affecting health system access and care-seeking for AWIDs, caregivers, and health professionals before intervention; and (2) provide recommendations to address the barriers and enhance facilitators. A qualitative study using focus groups with 19 sectoral professionals and life-event guided interviews with AWID–caregiver dyads or triads (16 AWIDs; 20 caregivers) was conducted to explore viewpoints on care-seeking and health system access. Applied thematic analysis was used in identifying individual or system-level barriers and facilitators through a social constructivist lens. Barriers included individual-level challenges such as having problems when faced with sudden or accumulated changes and transitions and the struggle with insufficient financial resources, particularly affected low-income families and was compounded by insufficient subsidies. System-level challenges included the lack of specialised services for AWIDs, which contributed to mismatched care, while fragmented care and limited care provider capability complicated service delivery. Additionally, fear and distrust of the health system, exacerbated access to care-seeking. All barriers are expressed by both groups. Conversely, a facilitator that enhanced individual-level support, such as the usage of informal networks, helped connect AWID and caregivers to appropriate care. System-level support was stressed by both groups including intersectoral collaboration to address complex issues, while the availability of paid support services improved health outcomes and access. Furthermore, unpaid community support organisations, provided essential social care through organised activities. The facilitators highlighted the potential for improving the healthcare landscape through collective efforts and community engagement. This study highlights the need for individual-level support, including involving more family members in caregiving, and system-level reforms such as integrated, specialised care, and enhanced advocacy. Across all levels, co-created care plans and regular check-ins are important to identify emerging issues and build trust. Implementing these strategies can help Singapore progress towards a more inclusive and responsive healthcare system for AWIDs.
In this article, we describe the analytic design of the coordinated set of outcome-wide analyses used for examining longitudinal associations using data from the Global Flourishing Study (GFS), involving a multinational and multidisciplinary group of scholars. We discuss the benefits of outcome-wide analyses and provide details on controlling for high-dimensional confounders using principal components, accounting for complex sampling designs, imputing missing data, conducting sensitivity analyses for unmeasured confounding, meta-analyzing estimates of associations from across countries, and reporting results. We provide a brief illustrative example of the outcome-wide approach by estimating the association of Wave 1 sense of mastery with a wide range of Wave 2 outcomes. The example illustrates how results can be sensitive to analytic decisions, such as different coding strategies for the predictor and the number of principal components included. We conclude by outlining the major strengths and limitations of the employed methodology.
Abstract Background Poor diet quality related to common mental disorders contribute to global health syndemics. However, there is no synthesis quantifying associations specifically in Low- and Middle-Income Countries (LMIC) where these concomitant health burdens are most prevalent. Methods We drew on a systematic Evidence and Gap Map (EGM) of > 3,000 records from Medline, CAB Global Health and PsycINFO (2000–2024). We selected LMIC studies quantifying healthy diets (validated dietary indices or factor-analytic methods) against validated screening measures of depression, anxiety, and stress, with a healthy versus unhealthy diet comparator. Effect sizes were standardised as mean differences from Hedges’ g and pooled using three-level meta-analysis with robust variance estimation (RVE). Risk of bias was assessed, and sensitivity analyses showed robustness across study designs, dietary measures, and country income strata. Results Eighty-three eligible studies from 23 countries (depression n = 69; anxiety n = 43; stress n = 26), and 65 LMIC sample populations, reported statistical measures for 633,317 unique individuals. The Standardized Mean Differences (SMD) comparing healthy diets to unhealthy diets were -0.29 for depression (95% CI -0.35 to -0.23), -0.25 for anxiety (95% CI -0.35 to -0.16), and -0.24 for stress (95% CI -0.33 to -0.14). Results remained robust when restricted to low Risk of Bias studies. Findings were similar in direction and magnitude across study designs, dietary measurements, diagnostic tools, country income levels, and estimates adjusted for socio-economic status. Methodological limitations (e.g., cross-sectional design) and few studies from low-income countries created evidence gaps. Conclusions Healthy diets were consistently associated with lower depression, anxiety, and stress symptoms in LMIC. These findings call for integrated dietary and mental health programming in LMIC (and in any setting with disproportionate health vulnerabilities), and for longitudinal and intervention research across diverse low-income settings beyond Iran and China.
Equitable access to vaccines remains a cornerstone of global health security, yet persistent gaps in regional manufacturing capacity continue to undermine timely and fair distribution. The COVID-19 pandemic exposed the risks of highly concentrated production systems and underscored the need for locally anchored manufacturing models capable of responding rapidly to public health emergencies. The Pasteur Network (PN)-a global consortium of 32 public health and research institutes across Africa, Asia, Europe, and the Americas-offers an operational example of decentralized vaccine manufacturing embedded in national public health systems linking regional manufacturing capacity with public health priorities. Here, we examine the contributions and challenges of members within the PN engaged in vaccine manufacturing. Twelve members currently produce more than 525 million doses annually, covering a broad range of human and veterinary vaccines. Embedded within national health systems, the PN members combine research, development, and partial or end-to-end manufacturing capacities, ensuring close alignment with national public health priorities. Several members within the PN also contribute to global initiatives, including the Coalition for Epidemic Preparedness Innovations (CEPI) manufacturing network, reinforcing their role in global preparedness efforts. Despite these strengths, common barriers persist across the PN, including workforce retention challenges, limited sustainable core funding, supply chain vulnerabilities, fragmented regulatory pathways, and insufficient coordination. We argue that the PN illustrates a scalable, public-health-embedded manufacturing model that complements existing industrial and technology-transfer approaches and should inform future global financing and governance.
Abstract Background Timely access to comprehensive emergency obstetric care (CEmOC) can be vital for ensuring maternal and newborn survival. However, pregnant women in need of CEmOC may not initially present at a CEmOC facility, thereby necessitating inter-facility referral. We assessed inter-facility travel time between potential referring non-CEmOC facilities and receiving CEmOC facilities in the 15 largest Nigerian cities. Methods Data was sourced from the 2018 Nigeria Health Facility Registry, with additional facilities verified in 2022. We applied Google Maps Platform’s internal Directions Application Programming Interface (API) to derive driving times from each 600m2 S2 cell to their respective nearest CEmOC facilities. Geographic coordinates of non-CEmOC facilities were mapped to S2 cells to retrieve travel time to public CEmOC facilities. Travel times were estimated from each S2 cell to the nearest CEmOC facilities by ownership (public and private) under peak traffic scenario (weekdays 18–20 h) and off-peak traffic scenario (weekends 01–03 h). Based on the shortest inter-facility travel time, each non-CEmOC facility was paired with a public CEmOC facility. Median travel time and percentage of non-CEmOC facilities located > 30 and > 60 min to the nearest public CEmOC facility were estimated. Sensitivity analysis comparing the API’s travel time estimates for randomly-selected 10% of non-CEmOC facilities with those from other methods was conducted. Results Altogether, 4,563 and 1,963 non-CEmOC and CEmOC facilities were included, respectively. Percentage of non-CEmOC facilities located > 30 min to the nearest public CEmOC was highest in Port Harcourt (51%) and lowest in Maiduguri (6%). All non-CEmOC facilities were located ≤ 60 min from the nearest public CEmOC facility in Aba, Owerri, and Ilorin. Median number of non-CEmOC facilities connected to a public CEmOC facility was 27, with five public CEmOC facilities connected to > 100 non-CEmOC facilities. For some non-CEmOC facilities, the nearest public CEmOC facilities are in a contiguous city or state. Conclusions Inter-facility referrals in large Nigerian cities show substantial variation in travel time and uneven referral loads, revealing critical pressure points that may delay timely access to CEmOC. Integrating travel time metrics into maternal health planning is essential for improving the efficiency, equity, and resilience of resource-constrained urban referral systems.
