Gender influences health outcomes by affecting exposure to risk factors, healthcare access, and health-seeking behaviours. Yet, many studies fail to consider how these gendered experiences interact with other social factors, such as age, socioeconomic status, and ethnicity. Our study systematically mapped existing research to identify gaps in understanding how these factors affect service delivery outcomes related to antimicrobial resistance (AMR) for infectious diseases of poverty. We conducted a systematic review and evidence gap map analysis following PRISMA 2020 guidelines. A comprehensive search was conducted across five major databases (MEDLINE, EMBASE, Scopus, Cochrane Library, and Web of Science) for studies published up to March 31, 2024. To synthesise the evidence, we developed and applied a specialized ‘Guide for an Intersectionality Approach’, adapted from established frameworks, to evaluate how gender identity, gender roles, and norms intersect with social factors like age, socioeconomic status, and ethnicity to influence AMR service delivery outcomes in Low- and Lower-Middle-Income Countries (LLMICs) for malaria, tuberculosis (TB) and neglected tropical diseases (NTDs). Out of 38,310 identified records, 14 studies met the inclusion criteria, all of which focused exclusively on TB; no eligible evidence was found for other infectious diseases of poverty like malaria or NTDs. While all included studies provided sex-disaggregated data, there was a significant lack of deeper intersectional analysis, with zero studies exploring non-traditional gender roles, power dynamics, or the compounded effects of intersecting social stratifiers. Findings indicated sex parity in diagnostic access but revealed male-specific vulnerabilities in treatment retention and a 4.06-fold higher risk of mortality for men. Conversely, women faced higher risks of treatment delays in certain contexts and often relied on informal antibiotic sources. There is a lack of studies evaluating how social determinants shaped by gender dynamics (roles, norms, relations, and power) influences inequities and vulnerabilities caused by AMR in LMICs. This gap limits our understanding of how these intersections affect antibiotic use, healthcare access, and treatment adherence. Future research should use intersectionality as an analytical framework and mixed-methods approaches to develop more inclusive and equitable health interventions that address the compounded inequities and vulnerabilities associated with gender and other social factors. The online version contains supplementary material available at 10.1186/s12889-026-26990-5.
The inequitable global distribution of resources for research parallels the unequal global distribution of morbidity and mortality due to infectious diseases. Significant gaps in research capacity prevail, and equitable and accessible opportunities for research remain a priority. We argue for the democratisation of research: without equitable participation in, and ownership of, research, by those who are implementing the research or are part of the communities being researched, contextualised research needs and health system bottlenecks will remain unresolved. This perpetuates an inequitable power balance related to research and innovation. Equitable research capacity is fundamental to tackling global health challenges and reducing health inequity. We emphasise the evolution from externally driven, high-income-centric models of research capacity strengthening towards inclusive, context-sensitive approaches that prioritise local ownership, diversity and sustainability. A paradigm shift from 'imposing technical support' to 'fostering ownership of knowledge' has catalysed new models of engagement, such as implementation research capacity among health professionals and communities, and regionally anchored postgraduate training. Institutionalised, inclusive research can align with national priorities and yield measurable improvements in health outcomes. However, persistent inequities rooted in gender, geography and institutional hierarchies continue to constrain participation and impact. Addressing these requires deliberate strategies to democratise access, diversify partnerships and support under-represented institutions and individuals. Allowing dynamic roles in long-term partnerships and regional networks on a continuum between academic partners and capacity-strengthening recipients can support mitigation of intersectional inequities and lead to capacity strengthening.
Children of female sex workers (CFSW) are a particularly marginalized population of children who experience similar negative health, social, and economic outcomes as their mothers. In low- and middle-income countries (LMIC), the level of vulnerability and adversity is exacerbated by stigma and structural inequities that result in abject poverty, chronic food insecurity, hazardous living conditions, and exposure to violence. The current study aimed to explore the causes of death among CFSW in Kenya, Nigeria, and the Democratic Republic of the Congo (DRC). It seeks to analyze death trends within the context of leading causes of death in the general child population. An exploratory, interview-based cross-sectional investigation of the causes of death among CFSW. Interviews with mothers who are female sex workers (MFSW) were conducted across eight cities in the three study countries in 2022 (Kenya, Nigeria) and 2023 (DRC). Data collected included participant sociodemographic information and detailed accounts of the circumstances surrounding the death of their children. Descriptive analysis was employed to organize and present the data. A total of 188 child deaths reported by 156 MFSW with a mean age of 26.9 years were included for analysis. The overall mean number of deceased children per mother was 1.21, and the highest was in Nigeria (1.32). Newborn and infant deaths (under-1) accounted for 71.3% of all deaths. Neonatal conditions comprised the overall leading cause of death (n = 50, 26.6%), followed by infectious diseases (n = 41, 21.8%) and malnutrition (n = 37, 19.7%). Other identified causes of death included accidents (n = 7, 3.7%), overdose (n = 7, 3.7%), and murder (n = 3, 1.6%). The present analysis provides important insights into the causes of death among this hard-to-reach, marginalized group of children in LMIC. Regular surveillance of child death trends can inform targeted policy and programmatic interventions to mitigate risk and address the causes of death among young CFSW in LMICs.
Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.
This article discusses key social determinants of health and how they have shaped infectious disease patterns in Vietnam from 1975 to 2025. It suggests a "paradox of progress": the country's transition from post-war poverty to dynamic middle-income economy has driven a shift from diseases of deprivation to a more complex profile linked to development itself. Economic growth reduces malnutrition and poverty-related illnesses, yet rapid urbanization, lifestyle changes, and inequality fuel rising chronic diseases and some infection risk factors. Vietnam now faces a "triple burden" of communicable, non-communicable, and climate-related threats, underscoring the need for intersectoral approaches beyond biomedical interventions.
The transmission of Schistosoma japonicum is closely related to the surrounding natural environment and socio-economic factors. In recent years, the ecological environmental management program has been implemented in S. japonicum endemic areas around Erhai Lake of China. Relevant protection and governance measures affected the transmission of S. japonicum. This study was conducted to assess the impact of ecological environmental management program on S. japonicum control, and proposed strategic alternatives with a prioritized order of implementation in Erhai Lake. An integrated SWOT-ANP-ADAM analysis is performed to accomplish the set objective in this study. The strengths, weaknesses, opportunities, and threats (SWOT) analysis is conducted to identify the impact factors of ecological environmental management program on S. japonicum control and strategic alternatives. The Analytical Network Process (ANP) was used to evaluate the impact factors, and the Axial Distance-Based Aggregated Measurement (ADAM) method was applied to constructed multi-faceted polyhedron for the ranking the strategic alternatives, thereby better informing decisions for synergistic ecological-disease management. A total of 14 impact factors and 12 strategic alternatives were obtained. The relative importance of the group of impact factors is ranked as strengths, opportunities, weaknesses, and threats, with weights equal to 0.3092, 0.2610, 0.2324, and 0.1975, respectively. The Chinese central government's prioritization of S. japonicum control and ecological environmental management (weight equal to 0.1562), as well as the lack of a top-level cooperative mechanism designed to integrate S. japonicum control and ecological environmental management (weight equal to 0.1424), are the most noteworthy factors. In ecological environmental management program of Erhai Lake, management of agricultural non-point source pollution (weight equal to 0.1209), construction of high-efficiency water-saving irrigation systems(weight equal to 0.0853) reduce the risk of S. japonicum transmission, while the wetland restoration may create more favorable habitats for Oncomelania hupensis, as well as increase the number of wildlife populations posing challenges for S. japonicum control(weight equal to 0.0700). Additionally, construction of the ecological management- S. japonicum control model in an integrated manner is the most important strategy (volume of complex polyhedron equal to 0.0693). Ecological environmental management program in the Erhai Lake has significant strengths and opportunities in promoting S. japonicum control, but also faces certain weaknesses and threats according to the weight of impact factors. This study confirms ecological environmental management as a viable complementary strategy to conventional S. japonicum control. Scientific planning and comprehensive integration can maximize synergies between schistosomiasis control and ecological protection. Additionally, 12 strategic alternatives with prioritized implementation may provide suggestions for decision makers in similar areas to adopt strategic decisions, which are of great practical significance and application value.
Human sparganosis is a neglected foodborne/waterborne zoonosis and a rare infectious disease of poverty (rIDP) that is widely distributed globally and threatens human health. Economic development and the expanded dissemination of public health knowledge have fueled increased global focus on rIDPs. The epidemiology of human sparganosis has shifted on the basis of emerging evidence; moreover, comprehensive contemporary data on its global distribution remain outdated. To address this gap, we conducted a systematic retrospective analysis to map the global case distribution of human sparganosis. We then summarized and analyzed the basic demographic characteristics, infection sites, modes of transmission and diagnostic methods. We systematically searched the China National Knowledge Infrastructure, Wanfang, PubMed, Web of Science, Scopus and Embase databases for case reports, dissertations, reviews and meeting abstracts. The literature search was conducted up to April 30, 2025, without any restrictions on the year of publication. The analysis focused exclusively on articles on human sparganosis cases, with no restrictions on publication language or country of origin. We followed the inclusion and exclusion criteria to identify relevant studies. The relevant information from the identified studies was subsequently collected and summarized. A total of 822 articles involving 3472 valid cases and 16 serological survey articles involving 3148 positive subjects were identified and included. Our analysis revealed the global distribution of human sparganosis. The disease is distributed worldwide, while China, the Republic of Korea and Thailand are the top three countries in terms of reported case concentration. However, some African regions, such as South Sudan, Tanzania and Ethiopia, may have the potential for a greater number of human sparganosis cases. This scoping review provides updates on the global distribution changes and epidemiological status of human sparganosis. East Asia and Southeast Asia continue to be regions where human sparganosis is highly prevalent, while the disease burden in some resource-limited regions may be underestimated. Our findings may receive increasing attention in endemic regions, raise awareness in resource-limited, nonendemic areas. In the future, there is still a need to strengthen the prevention and control of this disease worldwide.
Phlebotomus chinensis is the primary vector of visceral leishmaniasis (VL) in China. However, the lack of a high-quality genome assembly for this species has limited research on its biology, vector-pathogen interactions, and evolutionary adaptations. To address this critical gap, the first chromosome-level genome assembly of Ph. chinensis was constructed. Nanopore long-read sequencing served as the primary method, complemented by Illumina short-read sequencing for base-level error correction and Hi-C mapping for chromosomal anchoring and chromosome-level scaffolding. Genome annotation integrated transcriptome data from adult, larvae and pupae, homologous protein predictions from closely related sand fly species, and ab initio gene prediction. Comparative genomic analyses were further performed to explore evolutionary relationships and genomic differences between Ph. chinensis, Ph. papatasi, and Lutzomyia longipalpis. A total of 127.05 Gb of Nanopore data, 10.57 Gb of Illumina clean data, 52.95 Gb of Hi-C clean data, and 14.95 Gb of RNA-seq data were obtained. The final assembled genome size was 195.21 Mb with a scaffold N50 of 49.30 Mb, and 97.24% of the sequences were successfully anchored to 4 chromosomes. Annotation identified 10,909 protein-coding genes (91.48% of which were functionally annotatable), along with 73 rRNAs, 92 small RNAs, 82 regulatory RNAs, 374 tRNAs, 11,870 simple sequence repeats, 6053 tandem repeats, and 478,622 transposable elements. Phylogenetic analysis revealed that Ph. chinensis is phylogenetically closest to Ph. papatasi, with an estimated divergence time of approximately 27.1 million years ago. Gene family evolution was dominated by contraction, with 229 expanded and 575 contracted gene families identified in the Ph. chinensis branch. Additionally, 209 positively selected genes were detected, which are crucial for immune response regulation and metabolic processes related to its vectorial capacity. Furthermore, 95 P450 genes were identified, classified into four subfamilies: CYP2, CYP3, mitochondrial CYP (mito), and CYP4. A high-quality chromosome-level genome assembly of Ph. chinensis is reported here for the first time. This assembly serves as a critical genomic resource to advance research into the vector biology, insecticide resistance mechanisms, and evolutionary history, and lays a solid foundation for the development of precision VL control strategies in China.
Biomphalaria straminea, an intermediate host of Schistosoma mansoni, is originally native to Brazil but has invaded southern China since 1974. Nowadays, increasing human mobility raises the risk of S. mansoni dissemination. Therefore, this study aims to elucidate the genetic variation and structure of B. straminea in China and develop molecular tools for tracing its geographic origins, which could aid in schistosomiasis prevention and control. We collected 290 B. straminea individuals from Shenzhen City (GDSZ, n = 171), Dongguan City (GDDG, n = 65), and Hong Kong (HK, n = 54). Double digest restriction associated DNA (ddRAD) sequencing was applied to genotype the samples. A subset of single nucleotide polymorphisms (SNPs) was validated by the Sequenom MassARRAY iPLEX assay. The MaxEnt model was employed to predict suitable habitats for B. straminea in China under current and future climate conditions. Analysis of ddRAD sequencing data led to the identification of 80 high-confidence SNPs. B. straminea from GDSZ exhibited higher genetic diversity than those from other locations. The total observed heterozygosity (Ho = 0.35) was higher than the total expected heterozygosity (He = 0.26), resulting in a negative inbreeding coefficient (Fis = - 0.35), indicating that outbreeding has dominated the recent genetic history of B. straminea. Pairwise genetic distance (Fst < 0.05) and number of effective migrants (Nm > 4) indicated low genetic differentiation. The populations in GDSZ, GDDG and HK were genetically similar, with the first two being more closely related. Three high-quality SNPs displayed distinct geographical population specificity and could serve as geographically specific SNP markers. The MaxEnt model predicted an expansion of suitable habitats for B. straminea in China under future climate conditions. High invasion risk in Hainan Province, Guangxi Zhuang Autonomous Region, and Taiwan Province warrants attention. This study provides the first genome-wide insights into the population structure and genetic diversity of B. straminea in China. The populations are genetically similar, suggesting a common invasion source. Applying the geographically specific SNPs could enable rapid prediction of the geographic origin of B. straminea in future invasion events. Future climate conditions are likely to facilitate the spread of B. straminea, increasing the risk of schistosomiasis transmission in China.
Histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDTs) are critical for malaria diagnosis in Africa, particularly in resource-limited settings. However, the spread of Plasmodium falciparum parasites with pfhrp2 and pfhrp3 gene deletions challenges their effectiveness, raising concerns in affected areas. Therefore, this study aimed to assess the prevalence of pfhrp2 and pfhrp3 gene deletions and evaluate the diagnostic performance of HRP2-based RDTs in detecting asymptomatic malaria infections in Tanzania. This cross-sectional community survey study aimed to determine the prevalence of pfhrp2/3 gene deletions from asymptomatic malaria population in Tanzania. Moreover, the study intended to assess the performance of HRP2-based RDT and light microscopy (LM) in detecting asymptomatic malaria infections. The survey was conducted from December 2022 to July 2023 in twelve villages (8 villages from high malaria transmission areas and 4 in low endemicity). Diagnosis was done by RDT, LM and quantitative polymerase chain reaction (qPCR). A multiplex qPCR was employed on P. falciparum mono-infection isolates to assess the prevalence of pfhrp2/3 gene deletions. Unpaired t-tests and one-way ANOVA were performed to evaluate associations between log10-transformed parasitaemia levels and gene deletion profiles. Among 3489 participants, RDT detected 710 (77.6%) of 915 qPCR-positive cases, compared to 492 (53.8%) by LM. Compared with qPCR, RDT produced 143 (5.6%) false positives and 205 (22.4%) false negatives, whereas LM had 60 (2.3%) false positives and 423 (46.2%) false negatives. Overall accuracy was similar for RDT (90.0%) and LM (86.2%), with higher sensitivity for RDT. Agreement with qPCR in asymptomatic cases was substantial for RDT (κ = 0.736), whereas it was moderate for LM (κ = 0.590). Multiplex qPCR revealed pfhrp2 or pfhrp3 deletions in 93 (11.8%) of 787 samples, including 19 (2.4%) dual-deletion isolates, all of which were RDT negative. Deletions were more frequent in high-transmission villages (76 cases, 9.7%) than in low-transmission villages (17 cases, 2.2%). The findings support the continued effectiveness of HRP2-based RDTs in detecting asymptomatic P. falciparum infections in Tanzania, despite the presence of some pfhrp2/3 gene deletions. However, the potential increase in deletion prevalence and the limitations of cross-sectional data highlight the need for ongoing molecular surveillance. Collectively, these findings provide a critical foundation for sustained surveillance and for clarifying the epidemiological significance of asymptomatic malaria in Tanzania.
Guizhou Province has historically been a region severely affected by malaria in China. For decades, vector control has served as a cornerstone of national efforts to control and eliminate malaria. However, the efficacy of this strategy is largely challenged by the development of insecticide resistance. In the present study, the resistance status to organophosphates (OPs) and carbamates (CBs) of Anopheles sinensis field populations across Guizhou Province was investigated with a primary focus on elucidating the underlying mechanisms. From 2017 to 2024, mosquitoes were collected intermittently using mosquito-killing lamps across Guizhou Province. An. sinensis specimens were identified using morphological and molecular methods. Subsequently, we genotyped the ace-1 gene via PCR and measured acetylcholinesterase1 (AChE1) residual activity using biochemical assays. Whole-genome sequencing of individual mosquitoes was performed using Illumina sequencing, and the copy number of the ace-1 gene was quantified by standard genomic DNA quantitative PCR. Two independent-sample t-test and a chi-squared test had been used in this study. Female An. sinensis were collected from 12 field populations across Guizhou Province. Following species identification, point mutations in the ace-1 gene were detected in 551 mosquito samples. Only one point mutation, G119S, was identified across all populations, with the frequency of the ace-1 mutant genotypes (119GS and 119SS) exceeding 66% in 11 out of the 12 populations. Heterozygotes were the predominant genotype. The AChE1 activity was not inhibited by propoxur in 10 populations. A significant departure from Hardy-Weinberg equilibrium was observed in 6 of the 12 populations, indicating an excess of heterozygotes in these populations. Notably, heterogeneous duplication of the ace-1 gene in An. sinensis was detected for the first time through genomic scanning and ace-1 copy number quantification. Resistance to OPs and CBs is widespread in An. sinensis populations across Guizhou Province. Both heterogeneous duplication and point mutation of the ace-1 gene in An. sinensis likely contribute to resistance to OPs and CBs. These findings highlight the necessity of monitoring duplicated resistance alleles in natural populations to formulate region-specific resistance management strategies.
Leptospirosis is endemic in the Philippines; however, its diagnosis remains challenging because of the lack of rapid and accurate diagnostic tools for detecting infection. Physicians must therefore resort to diagnosing leptospirosis through their clinical judgement, and this often results in under- or overestimation of cases. This study aimed to assess and compare the diagnostic accuracy of physicians' clinical judgement and commercially available rapid test kits for leptospirosis against reference methods such as the microscopic agglutination test (MAT) and real-time polymerase chain reaction (qPCR) in the Philippines. A total of 127 serum samples were collected from patients suspected to have leptospirosis at three hospitals in the Philippines from August to December 2024. Rapid test kit results and final diagnoses were retrieved from the patients' charts. MAT was performed on all the samples as a confirmatory method. Moreover, qPCR was performed on 30 randomly selected samples to increase the sensitivity of the reference standard. Sensitivity, specificity, positive and negative predictive values, and 95% confidence intervals were computed to determine the accuracy of both clinical judgement and rapid tests. Among the 75 MAT-confirmed leptospirosis cases, approximately 24.0% were misdiagnosed as other febrile illnesses, such as dengue and typhoid fever, on the basis of clinical judgement, whereas 67.3% of the 52 MAT-negative patients were falsely diagnosed with leptospirosis. Overall, clinical judgement demonstrated high sensitivity (76.0%) but low specificity (33.7%), indicating possible overdiagnosis. The rapid test kits used in the laboratory exhibited significantly lower sensitivity (42.7%) but higher specificity (82.7%), suggesting a high probability of false-negative results. When qPCR was used in conjunction with these methods, relatively similar results were obtained. These findings highlight the diagnostic limitations in detecting leptospirosis in the Philippines, where laboratory testing options remain limited and inaccurate, resulting in physicians often relying on their clinical judgement. Misdiagnosis, whether through clinical judgement or rapid testing, could lead to inappropriate patient management, increased morbidity, and underestimation of leptospirosis incidence.
Many individuals with tuberculosis (TB) experience various psychological problems after TB diagnosis, and they may also have suicidal ideations and suicidal attempts associated with TB-related depression or stigma. Until now, little is known about suicide rates among individuals with TB. We aimed to investigate the trends, characteristics, and contributing factors of suicide deaths among individuals with TB, using a Republic of Korea nationwide cohort. This was a retrospective nationwide cohort study using data of the K-TB-N cohort. We analyzed 310,194 individuals with TB registered in the Korean National Tuberculosis Surveillance System between 2012 and 2021. Suicidal deaths were identified using the International Classification of Diseases 10th revision codes (X60-X84) from the Statistics Korea database. Participants were followed up until death, censoring, or December 2022. We calculated suicide incidence rates, examined temporal distribution of suicide occurrence following TB diagnosis using Poisson regression, and used multivariate Cox proportional hazards models, including age-stratified analyses, to identify factors associated with suicide. Altogether, 1314 (0.42%) died by suicide [1.6% of all deaths (1314/80,323)]. Men and individuals aged ≥ 60 years accounted for 76.9% and 56.1% of suicide deaths, respectively. Overall suicide incidence was 0.77/1000 person-years, more than twice as high in men compared to that in women (1.03 vs. 0.42/1000 person-years), and increased with age (from 0.32 in 20-29 years to 1.59 in ≥ 80 years/1000 person-years). Suicide incidence within one year after TB diagnosis was 2.04/1000 person-years. Notably, 31.3% of the suicides occurred during TB treatment. The incidence of suicide was highest immediately after TB diagnosis and tended to decrease over time. Male sex, older age, pulmonary TB, sputum smear positivity, comorbidities, and mental disorders were significantly associated with higher suicide risk. The risk factors for suicide showed different patterns across age groups (younger adults: pre-existing mental health conditions; middle-aged adults: low income and infectiousness; and older adults: comorbidities and disability). Suicide is a notable cause of death among individuals with TB in Republic of Korea, particularly early after diagnosis. The factors contributing to suicide risk differed depending on sex and age. Routine mental health screening and early targeted psychosocial intervention strategies should be integrated into national TB care programs to reduce preventable deaths.
Mosquito-borne diseases (MBDs) pose a persistent public health threat globally. The "Four Pest-Free Villages" program, which targets mosquitoes, flies, cockroaches, and rats, has been in place in Zhejiang Province, China, for more than 9 years. It was recently improved to version 4.0 as a crucial tactic for long-term vector management. This cross-sectional study, which included eight "Four Pests Control Villages" and eight matching control villages, was carried out in 2024 in 16 villages spread across five cities in Zhejiang Province. To evaluate knowledge, attitude, and practice (KAP) about infectious diseases spread by mosquitoes, a stratified-cluster random sampling technique was used. In every dimension, KAP ratings of 70% or greater were deemed satisfactory. Chi-square tests and multivariate logistic regression analysis were used to find influential factors (α = 0.05). Ten stakeholders, including community managers, public health specialists, and resident representatives, participated in in-depth, semi-structured interviews to further examine the project's efficacy and overall worth. Residents of the "Four Pest-Free Village" (which targets mosquito, fly, cockroach, and rodents) showed significantly higher levels of knowledge (P < 0.01), attitudes (P < 0.05), and preventive practices (P < 0.01) regarding mosquito-borne diseases compared to control villages, according to 1447 valid questionnaires. While older age [odds ratio (OR) = 1.7-1.9], higher education (OR = 2.2), and minority status (OR = 2.4, all P < 0.05) predicted better knowledge and attitudes within "Four Pest-Free Villages", younger residents, migrant workers, and individual farmers showed higher levels of preventive practice (P < 0.05) in control villages; gender effects on practice varied between sites. The "Four Pest-Free Village" program-targeting mosquito, fly, cockroach, and rodents-significantly improved residents' health literacy and their adoption of vector control practices. This underscores the necessity of customized interventions based on demographic variables and the significance of integrating health education programs with environmental management. The results offer useful recommendations for maximizing vector control initiatives and enhancing public health outcomes in both urban and rural regions. To further improve and bolster these tactics, future studies should incorporate more variables and broaden the data sources.
Neglected tropical diseases (NTDs), including but not limited to lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil-transmitted helminths, remain a major public health challenge in Africa. Mass drug administration (MDA) is a key strategy for NTD control and elimination. However, mobile populations such as internally displaced persons (IDPs), nomadic groups, and seasonal workers often face major constraints that reduce MDA effectiveness defined by coverage. Understanding how mobility and its underlying drivers affect MDA implementation is therefore critical to designing inclusive, effective, and equitable intervention strategies. In this review, we aim to map existing evidence on how human population movement influences the outcomes of MDA programs in Africa. Following PRISMA-ScR guidelines, we searched using electronic databases Medline (Ovid), Embase, Web of Science, and manually screened additional sources for studies published in English or French between January 2000 and February 19, 2025. Two authors independently extracted data, resolving discrepancies through discussion, or with a third reviewer. We included studies reporting on MDA interventions and mobile or migrant populations in Africa. Data were extracted using a standardized template and synthesized thematically to describe mobility patterns, barriers to access, implementation gaps, and strategies used to improve MDA reach among mobile groups. The thematic synthesis consisted of organizing the extracted data into recurring themes, comparing trends across studies, and grouping similar observations to develop broader themes that reflect common challenges and approaches related to mobile populations. From 6814 studies identified, twenty (20) met the inclusion criteria. The review identified multiple challenges likely to affect MDA equity and effectiveness. Mobility, particularly among nomad pastoralists, seasonal workers, IDPs, and cross-border populations leads to systematic exclusion from MDA campaigns. Barriers included geographic inaccessibility, limited tailored communication, lack of cross-border collaboration/coordination, and rigid campaign schedules. Promising strategies documented were mobility-informed microplanning, cross-border collaboration/coordination, flexible delivery models, enhanced community engagement and integration with other health interventions. The evidence emphasizes the need for adaptive, equity-focused MDA approaches to effectively reach mobile populations. Population mobility has a significant impact on equitable MDA delivery and can hinder progress toward NTD elimination targets in Africa. Tailored, flexible, and inclusive strategies are urgently needed to ensure mobile populations are reached. Future efforts should focus on developing mobility indicators, pilot-testing adaptive MDA delivery models aligned with movement patterns and strengthening partnerships with neighboring countries and humanitarian organizations.
Hepatic alveolar echinococcosis (HAE) is a severe zoonotic parasitic disease for which ultrasonography is the primary diagnostic tool. However, the heterogeneous imaging characteristics of HAE lesions present significant challenges to accurate diagnosis. To improve diagnostic reliability, this study compared the performance of two established ultrasound classification systems: the Echinococcus multilocularis National Health Commission Classification-Ultrasound (EMNHCC-US) and the E. multilocularis Ulm Classification-Ultrasound (EMUC-US). This study compared EMUC-US and EMNHCC-US systems in 169 HAE cases (179 lesions) and 99 non-HAE controls. Both systems identified heterogeneous echotexture as a universal feature but differed in lesion categorization and diagnostic performance. Inter-observer agreement was moderate for EMUC-US (κ = 0.57) and substantial for EMNHCC-US (κ = 0.73). The EMUC-US system included atypical patterns such as metastasis-like, found in 10.6% of cases, and ossified lesions, found in 6.1%. This contributed to its high sensitivity of 96.7% and a negative predictive value (NPV) of 90.3%. The EMNHCC-US system focused on advanced patterns, identifying infiltration in 49.7% of cases and liquefactive necrosis in 31.8%. It demonstrated superior specificity of 94.2% and a positive predictive value of 95.5%. Receiver operating characteristic analysis confirmed a better overall discriminative ability for EMNHCC-US, with an area under curve of 0.88 compared to 0.72 for EMUC-US. Sensitivity analysis revealed that EMUC-US maintained a near-perfect NPV of approximately 100% across all prevalence levels. In contrast, EMNHCC-US offered a higher PPV in high-prevalence settings. The EMUC-US and EMNHCC-US systems share core features, but EMUC-US includes smaller, atypical lesions (e.g., ossification, metastasis-like), enhancing early HAE detection with higher sensitivity and NPV, ideal for screening. EMNHCC-US focuses on advanced lesions, offering high specificity for confirmation. They are complementary: EMUC-US for sensitive screening, EMNHCC-US for specific diagnosis. Together, they enable a stratified strategy, optimizing case identification and clinical decisions despite lesion heterogeneity.
Minimum essential dataset (MED) enables One Health surveillance by facilitating cross-sectoral data sharing. Yet, existing MED research represents insufficient integration of the One Health concept, and its progress in disease surveillance remains unclear. This study aims to evaluate the current progress and gaps in MED research in disease surveillance through a One Health lens. This scoping review systematically searched Embase, PubMed, Scopus, and Web of Science from the inception of databases to November 30th, 2024 to identify studies published in English. Studies were independently screened by two reviewers for inclusion based on their relevance to the development of MEDs for disease surveillance. The progress and challenges were synthesized based on data extracted from eligible studies. This review includes 28 eligible studies for analysis, all of which focused on infectious diseases. MED development is predominantly concentrated on the human health interface (89.3%), whereas animal and environmental interfaces are comparatively limited (≤ 10.7%). The One Health concept has been adopted in 16 of the eligible studies; however, there is still insufficient interdisciplinary and cross-sectoral collaboration (57.1%). Meanwhile, numerous methods have been employed in the development of MEDs, with qualitative approaches being the most prevalent (42.9%), while data-driven approaches remain scarce. The absence of a standardized approach is recognized as a primary barrier. Thus, we propose a pathway and operational tool to detail the specific steps, which could facilitate future research on MED. This review highlights critical gaps in MED development at the human-animal-environment interface, and proposes a pathway and operational tool to inform future development of MED, including scope identification, establishment, modification and improvement. This study promotes the improvement of disease surveillance system and provides insights to enhance future preparedness for reducing the global public health burden.
Enterobiasis, caused by Enterobius vermicularis, is a common intestinal parasitic infection in children. Ectopic migration to extraintestinal sites, such as the greater omentum, is rare and often misdiagnosed due to nonspecific clinical manifestations and limited proficiency in identifying parasitic structures in paraffin-embedded histological sections. A 12-year-old female presented with a three-day history of lower abdominal pain and a pelvic mass. Emergency laparoscopic resection revealed an ovarian serous cystadenoma and an omental mass. Initial histopathological examination of the omental mass suggested schistosome eggs; however, expert consultation confirmed a section of an adult female E. vermicularis containing eggs measuring up to 50 μm. The patient had no exposure to schistosomiasis-endemic areas but a history of prior pinworm infection, which had been treated with oral albendazole (400 mg once daily for 2 days). Subsequent adhesive tape tests over three consecutive days were negative, and perineal pruritus was resolved, confirming successful cure. The final diagnosis was ectopic enterobiasis of the greater omentum. This case underscores the critical role of accurate morphological identification in distinguishing parasitic infections. Misdiagnosis, even in non-schistosomiasis-endemic areas, reflects insufficient training in parasitic morphology among healthcare professionals. Enhanced training on the morphology of common parasites and interpretation of paraffin-embedded histological sections is essential to improve diagnostic accuracy.
Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is a growing public health challenge, particularly in Indonesia, where TB incidence remains high and DM prevalence is increasing. DM co-morbidity is known to increase the risk of TB incidence and have negative effects on TB treatment outcomes. This study aims to analyze the geographical co-distribution of TB and DM and their sociodemographic determinants in Indonesia, to help inform public health response and targeting of screening programs. Using data from the 2023 Indonesian Health Survey (SKI), a nationally representative, population-based survey, we applied a Bayesian geostatistical model to estimate disease prevalence and assess associations with key sociodemographic factors. The predicted TB prevalence varied from 0.1% to 3.0%, highest in eastern Indonesia, particularly Papua, while DM prevalence ranged from 0.6% to 6.2%, concentrated in Java and Sumatra. Approximately 62 districts showed more than a 50% posterior probability that both TB and DM prevalences simultaneously exceed their respective national thresholds. The proportion of the poor population is significantly associated with higher TB prevalence (0.106; 95% CrI: 0.039, 0.174), while population density has a strong positive correlation with DM prevalence (0.198; 95% CrI: 0.156, 0.241). Proportion of the poor population (- 0.053; 95% CrI: - 0.096, - 0.009) and hospital services (- 0.071; 95% CrI: - 0.116, - 0.027) show a negative association with DM prevalence. Spatial analysis revealed significant regional variations, with high TB-DM co-distribution observed in rapidly urbanizing and high-poverty districts, including parts of West Java, East Java, Sumatra, and Kalimantan in Indonesia. These findings emphasize the need for strengthened TB-DM integration in healthcare services, especially in areas that have a high prevalence of both diseases. Strengthening integrated disease management strategies in local areas can help mitigate the burden of both TB and DM in Indonesia, particularly given likely low case detection and health care access in lower income regions.
Indonesia ranks among the countries with the highest burden of drug-resistant tuberculosis (DR-TB), contributing approximately 7.4% of global cases, many of which are likely underdiagnosed. To support targeted public health surveillance and control efforts, this study aimed to characterize the spatiotemporal distribution of DR-TB incidence in Indonesia, identify geographic hotspots, and examine associations with health system and socioeconomic factors. We conducted a nationwide retrospective analysis using annual DR-TB notification data from 2017 to 2022 across all 514 districts, obtained from the national tuberculosis information system. Multivariable Bayesian spatiotemporal regression models were fitted under alternative likelihood assumptions and space-time random effect structures. Model selection criteria were used to identify the best-fitting models for hotspot detection and estimation of risk factor associations. DR-TB predominantly affected individuals aged 25-54 years, aligning with the working-age population. Hotspots were concentrated in urbanized regions, including the Jabodetabek megacity, Greater Surabaya, and districts in South Sumatra. The best-fitting model identified a protective association between first-line treatment success rates and DR-TB incidence [incidence rate ratio (IRR): 0.508; 95% credible interval (CrI): 0.368-0.702]. In contrast, DR-TB incidence was positively associated with the proportion of the population living below the poverty line (IRR: 1.028; 95% CrI: 1.013-1.044), households with improved sanitation access (IRR: 1.006; 95% CrI: 1.002-1.010), and increased municipal human development index (IRR: 1.068; 95% CrI: 1.049-1.094). DR-TB hotspots were primarily concentrated in urban areas, highlighting the need for targeted interventions. Improving first-line tuberculosis treatment success rates and addressing socioeconomic drivers, such as poverty, are critical for controlling DR-TB. Public health policies should prioritize workplace-based support for improving treatment adherence, provide safeguards for TB patients affected by poverty, and underscore the importance of a multisectoral TB surveillance and control program.