BackgroundTimely and reliable payment of frontline health workers is critical for the implementation of Neglected Tropical Disease (NTD) mass campaigns. However, traditional payment systems can be inefficient and prone to delays, particularly at scale. Digital payment solutions offer a potential pathway to improve efficiency and reliability, yet empirical evidence from large-scale campaign settings remains limited.MethodsThis study evaluated changes in payment performance following the introduction and subsequent scale-up of a digital payment workflow integrating DHIS2-based data collection with Nigeria’s NUBAN account verification system. Administrative data from NTD campaigns conducted in 2023 and 2024 in Rivers and Oyo States, Nigeria, were analyzed. Descriptive statistics, Mann–Whitney U tests, and multivariate regression were used to assess differences in payment success and failure rates, processing time, and delay components, controlling for batch size, payment amount, and state.ResultsPayment processing efficiency improved significantly in 2024. Median total processing time decreased from 35 to 12 days, while median operational delay decreased from 33.5 to 10 days. In contrast, median finance-related delays increased from 1 to 3 days, indicating a bottleneck at the financial processing stage. Median payment success remained 100% in both years, while the mean failure rate decreased from 1.14% to 0.54%, and absolute failed transactions declined from 690 to 332 despite increased transaction volume. Regression analysis confirmed a significant reduction in processing time in 2024 after adjustment for batch size, payment amount, and state.ConclusionThe integrated digital payment workflow was associated with substantial improvements in payment-processing efficiency while maintaining consistently high payment reliability as operations expanded. However, persistent delays in the financial processing stage highlight the need to strengthen downstream financial workflows and coordination with financial service providers.
IntroductionMicrobial community structures and dissemination of antimicrobial resistance (AMR) are shifting in tropical coastal ecosystems amid rapid urbanization and anthropogenic pressure. However, integrated genomic surveillance of pathogens, resistome, and bacterial hosts along the Gujarat coastline remains incomplete, limiting environmental risk assessment based on the One Health approach. In this study, integrated shotgun metagenomics was performed to understand the microbial diversities, priority pathogens, antimicrobial resistance genes (ARGs), and organism-level ARG- host associations in the Gujarat Coast and the anthropogenic factors influencing the resistome structure. MethodsIn present study, whole metagenome shotgun sequencing was performed on surface-water samples collected from ten coastal sites, comprising both enriched and control sites. Taxonomic profiles were obtained using Kraken2 and antimicrobial resistance genes using AMRFinderPlus. The resistance determinants were cross-referenced with other sequences in the contigs and then compared with the Comprehensive Antibiotic Resistance Database (CARD), an online resource containing over 200,000 antibiotic resistance genes. Spatial variation and resistance patterns were assessed using alpha diversity, Bray–Curtis ordination, hierarchical clustering, and functional resistome profiling. ResultsSpatial variation was highly apparent, as Pseudomonadota and Bacillota dominated most sites, and anthropogenically influenced sites had site-specific enrichment of WHO priority bacterial genera. The high-priority Pseudomonas, and the critical-priority Enterobacterales (Escherichia, Enterobacter, Citrobacter) were found mainly in Ghogha, Daman, and Dumas. Some genera of fish pathogens, such as Aeromonas and Photobacterium, were found to be distributed locally, whereas some genera associated with tropical diseases, such as Vibrio and Burkholderia, were present at low levels. The resistome consisted mainly of antimicrobial resistance genes, with significant metal resistance and virulence-associated genes, consistent with potential co-selection under multiple environmental stressors. All alpha diversity, principal coordinates analysis, and hierarchical clustering statistics identified geographic location as the primary factor influencing resistome composition, and not enrichment treatment. A total of 699 bacterial host species were found to contain bacterial ARG, only 72 of which were linked to CARD, resulting in a large number of new ARG-host associations in the environment and a significantly increased diversity of host species for potential ARG reservoirs. DiscussionThis study represents a single-time-point pilot survey across ten coastal sites; findings are descriptive, genus-level, and based on genotypic resistance detection. To our knowledge, this study provides the among the first genomic baseline of pathogens, resistome, and ARG-host associations along the Gujarat coastline. The results highlight the usefulness of One Health surveillance of metagenomic data at the contig level and the need for specific environmental monitoring and antimicrobial resistance mitigation in anthropogenic hotspots.
BackgroundSoil-transmitted helminthiasis infections are targeted for elimination as a public health problem by 2030 under the Kenya Master Plan for neglected tropical diseases (2023-2027) and the Kenya health policy (2014-2030). Preventive chemotherapy via mass drug administration remains the primary control strategy. This study aimed to determine the programmatic effectiveness of albendazole among school-age children attending primary schools in Kisii, Narok, and Vihiga Counties that have participated in the National School-Based Deworming Programme since 2012.MethodsA prospective longitudinal study comprising repeated cross-sectional surveys was conducted between March and July 2019. Counties were purposively selected based on sustained high infection prevalence (>30%) or low relative reduction in prevalence (<50%) in the 2018 national evaluation survey. Primary schools with historical prevalence exceeding 30% were sampled, and children were screened using the Kato-Katz technique at baseline. Baseline-positive children (n = 573) were enrolled and monitored across three sequential post-treatment follow-up rounds. Cure rates and egg reduction rates were evaluated against baseline using weighted Poisson regression models with robust variance estimation, with non-linear parameter transformations and 95% confidence intervals derived using delta method.ResultsAt Follow-up 1, albendazole demonstrated high effectiveness against Ascaris lumbricoides, achieving a cure rate of 94.80% (95% CI: 92.61-97.00%) and an egg reduction rate of 95.54% (95% CI: 92.36-98.71%), surpassing the World Health Organization performance benchmark (>=95%). For Trichuris trichiura, the cure rate was 65.41% (95% CI: 56.49-74.34%) and an egg reduction rate of 53.79% (95% CI: 15.95-91.62%), with lower egg reductions observed in specific subgroups. For hookworm, initial cure rate was 76.74% (95% CI: 26.84-126.63%) and egg reduction rate was 99.40% (95% CI: 97.89-100.90%). Over subsequent monitoring, cure and egg reduction rates fluctuated, reflecting local environmental re-exposure and transmission dynamics.ConclusionsSingle-dose albendazole demonstrated high initial effectiveness against Ascaris lumbricoides at the first follow-up, meeting the (>=95%) World Health Organization egg reduction threshold. However, observed treatment effectiveness fluctuated across subsequent survey rounds without re-treatment, and Trichuris trichiura exhibited a sub-optimal response with subgroup variations that failed to meet threshold. Overall, while single-dose albendazole maintains robust effectiveness against roundworm, its localized programmatic effectiveness against whipworm remains limited in these persistent transmission foci.
IntroductionNeglected tropical diseases (NTDs) remain marginalized within the global health innovation system, with limited investment in research and development for diagnostics, treatments, and vaccines adapted to low- and middle-income country needs. This study aimed to examine the initiation, evolution, and outcomes of clinical capacity strengthening at the Leishmaniasis Research and Treatment Center (LRTC) and to derive lessons for future initiatives in Ethiopia and other Leishmaniasis East Africa Platform countries (Sudan, South Sudan, Uganda, and Kenya).MethodThis study analyses the trajectory of visceral leishmaniasis (VL) treatment and research activities at LRTC and the role of the partnership with the Drugs for Neglected Diseases Initiative (DNDi) in strengthening research and health system capacity for VL in Ethiopia. Using a qualitative case study design, we conducted key informant interviews with a semi-structured interview guide to capture diverse perspectives from stakeholders involved in the partnership. Participants were selected purposively based on their involvement as a beginning, mid, or mature phase partner. We used conventional content analysis.ResultsThe DNDi–LRTC partnership substantially strengthened Ethiopia’s capacity to address VL. Key findings were organized into three themes: health system strengthening, partnership successes, and partnership challenges. The collaboration improved infrastructure and advanced training, fostering a stronger foundation for clinical research and enabling more rigorous research outputs. Additionally, effective treatment protocols were developed and integrated into national health policies, leading to better patient outcomes. Through awareness and advocacy, research findings were successfully embedded into national strategies, securing additional resources for VL management. The partnership also facilitated productive collaborations with other stakeholders in clinical research, clinical trials, and action on access, broadening its overall impact. However, challenges such as bureaucratic delays, communication gaps, and infrastructure limitations were identified, pointing to areas where further capacity strengthening would benefit future efforts.ConclusionThe DNDi–LRTC partnership significantly enhanced clinical research capacity, treatment outcomes, and policy uptake for VL in Ethiopia. Despite these achievements, structural and operational challenges remain. Addressing these will be essential to sustain impact and optimize future partnerships. This case study provides practical insights for designing effective and sustainable collaborations in NTD research and health system strengthening.
IntroductionFemale Genital Schistosomiasis (FGS) remains severely overlooked within neglected tropical diseases (NTDs), disproportionately affecting women in sub-Saharan Africa (SSA). Despite its high prevalence and association with adverse reproductive health outcomes and increased HIV susceptibility, FGS receives minimal attention in research, policy, and clinical practice. Understanding how FGS is or isn’t prioritised within policy implementation is critical for addressing this gap. Therefore, this study examined how FGS is recognised, prioritised, and rendered visible or invisible within South Africa’s evolving NTD policy and implementation processes across different levels of the health system.MethodsA qualitative approach guided by Institutional Ethnography and Lipsky’s Street-Level Bureaucracy was adopted to map the institutional relations shaping NTD activities and understand how frontline discretion influences the prioritisation of FGS. Thirteen semi-structured interviews were conducted with stakeholders at the national, provincial, district, and facility levels, complemented by non-participant observation during a Communicable Disease Control (CDC) stakeholder meeting. A hybrid (deductive–inductive) approach to thematic analysis was used to examine how policy texts, governance structures, and everyday implementation practices collectively contribute to the marginal positioning of FGS within the NTD Master Plan.ResultsFour interrelated themes showed how FGS invisibility was produced across policy, programme, clinical and data systems. Awareness was uneven and unsupported by pathways for diagnosis, referral and routine care. Although some stakeholders held a view that FGS was included within general schistosomiasis programming, they conceded that it was not explicitly named in the draft Master Plan and lacked a defined mandate, programme ownership, operational guidance and routine indicators. Consequently, even when FGS became visible to individual actors, recognition rarely generated sustained institutional action.DiscussionFemale genital schistosomiasis will become visible when awareness is embedded within a policy framework that mandates action, supported by clinical guidelines that define practice, equipped with approved diagnostic tools that enable identification, and anchored within an institutional home that has the authority and the resources to coordinate a response.
