搜索结果：Journal of tropical medicine

Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.

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.

The Kingdom of Saudi Arabia (KSA) has a mixed health financing system consisting of governmental health coverage (GHC) and private health insurance (PHI). In 2016, KSA launched Vision 2030, which aims to reduce government spending and increase reliance on employer-sponsored PHI. This reform may affect the utilization of health services based on citizenship and the type of health coverage (PHI compared with GHC). The current study aimed to identify the characteristics of private health insurance enrollees and the association between different types of health coverage (GHC and PHI) and outpatient service utilization in the KSA. This study used data from the 2018 Saudi Family Health Survey (SFHS), which included 8,276 respondents aged 18 years and above and collected information on outpatient utilization during the previous 12 months. Statistical analyses were conducted using SPSS version 26. Bivariate analyses (chi-square and t-tests) were used to assess differences by nationality and coverage type. Binary logistic regression was used to examine the characteristics of PHI enrollment, and Poisson regression was used to evaluate the association between coverage type and outpatient utilization. This dataset provides a pre-reform baseline for assessing PHI enrollment and outpatient utilization prior to the implementation of the first phase of the reform in 2019. Most respondents were Saudi nationals (76.8%), and 54.9% were male. About 26.2% of respondents had PHI. Among non-Saudis, 72.8% were enrolled in PHI, compared with only 12.1% of Saudis. The logistic regression analysis revealed that having PHI was associated with factors such as a high monthly income, non-Saudi, male, being married, a high level of education, and a perception of good health. We found that having PHI was negatively associated with the utilization of outpatient services (coefficient -0.107; P&#x2009;<&#x2009;0.001) compared with GHC. This finding may reflect barriers to access, a lower perceived need, or limitations in awareness of PHI benefits. In addition, this finding suggests that PHI may be associated with disparities in healthcare access, based on the observed lower utilization of outpatient services among its enrollees compared with those covered by GHC. Other factors associated with the utilization of outpatient services were being female, having a high monthly income, being never married, having chronic diseases, and the perception of poor health. The results of this study may inform future health reform efforts to enhance access to healthcare. These findings should be considered when planning the implementation and evaluation of the health system in KSA.

In the last 2 decades, there has been an increasing number of sexually transmissible enteric infection (STEI) outbreaks among gay, bisexual, or other men who have sex with men (GBMSM). There remain important gaps in our understanding of how STEI transmission is sustained that repeated collection of samples could help to address. This study aimed to assess the feasibility and acceptability of longitudinal samples and epidemiological data collection among GBMSM accessing sexual health services (SHS) through a prospective cohort study. GBMSM (&#x2265;16 years) accessing 2 SHS in Brighton and Sussex were recruited between May and October 2022. Participants provided an initial rectal swab and optional fecal sample and completed an online baseline questionnaire. Weekly follow-up questionnaires and rectal swabs were collected for a further 11 weeks. Sexually transmitted infection (STI) surveillance data were pseudonymously linked to provide additional clinical and demographic information. Selected participants were invited to take part in an optional one-to-one interview. We assessed the number completing study procedures, characteristics of those completing procedures and not, and representativeness of the study sample alongside facilitators and barriers from interviews. A chi-square test was used to compare groups. Overall, 193 participants were recruited. Half (100/193, 51.8%) provided a baseline rectal swab, with a third (34/100, 34.0%) of them providing all 12 swabs. Alongside the baseline swab, 76.0% (76/100) provided the optional fecal sample. Just over a third (71/193, 36.8%) of participants completed a baseline questionnaire, with a fifth (15/71, 21.1%) providing all follow-up questionnaires. Interviews (n=21) found that participation was motivated by the feeling of giving something back for services received and a perceived indirect benefit to self. The study was generally accepted, with over half reflecting on the perceived ease of participation and relatively simple tasks that could be easily integrated into normal routine with an element of flexibility. Most participants were satisfied with the 12-week study length, and having a definitive end point aided the ability to assess if they would be able to participate. Barriers to completing the study procedures included not being aware of what was required, particularly for the follow-up questionnaires. Suggested improvements included concise and easier-to-read instructions, with a section to clearly list out the key procedures of the study. SMS text messaging reminders were sent, but these were seen with variable utility and interpreted in different ways (eg, personal or generic reminders or thank you messages). This study has provided evidence that longitudinal rectal swab sampling and data collection for research purposes are feasible and acceptable among GBMSM attending SHS. This provides an innovative way to address important knowledge gaps about STEI transmission, which will help inform public health measures for infection control. Tangible insights from this pilot can also inform the design of similar studies in other settings.

The control of Buruli ulcer (BU) relies on early case detection to improve disease outcomes. While lesion photographs are currently used in health communication materials, they have many drawbacks. Medical illustrations, though proven effective in many contexts, remain unutilised for skin NTDs. We therefore aimed to assess their acceptability in health communication materials in BU-endemic districts of Ghana. We conducted eleven focus group discussions, using a guide developed from the PICO framework and the Theoretical Framework of Acceptability (TFA). Participants were shown photographs and clinically approved medical illustrations of different presentations of BU. All participant groups confirmed that images of BU play a key role in health communication. However, photographs of the disease may frighten the viewer, either deliberately or not, especially when they show advanced stages of the BU resulting in revulsion and anxiety. All agreed that illustrations were acceptable and do not evoke the same negative emotional response, whilst still providing accurate information for detection. Health providers expressed the view that the psychological distress associated with real-life images are beneficial for prompt healthcare-seeking; however, the views of community members contradicted this. Health providers and CBSVs currently manage such negative reactions through a variety of methods. However, these strategies do not always work as some viewers shy away from the materials. Medical illustrations have a potentially important role to play in BU health messaging. As well as their role in communicating the characteristic features of the disease without distracting elements or ethical issues, they are also particularly well-suited to depict BU in the later stages to produce health communication materials that are sensitive to the emotional states of viewers. We encourage health communicators to place materials within appropriate social and cultural contexts, to promote their effectiveness and uptake of the health messaging.

Toxoplasma gondii is the etiologic agent of toxoplasmosis, a widely distributed zoonosis with relevance in human and veterinary medicine. The aim of this study was to assess the prevalence of T. gondii infection in Brazilian miners working informally in French Guiana. To this end, 480 individuals were recruited from resting places in the municipality of Oiapoque, Amap&#xe1;, Brazil. Whole blood samples on filter paper were analyzed for IgM and IgG antibodies by ELISA. Nested PCR of the GRA7 gene was used to detect parasite DNA. Sociodemographic information, characteristics of the mining sites, and lifestyle data were collected using epidemiological questionnaires analyzed using univariate and multivariable models. The results showed that 79.3% of the individuals were IgG seropositive, while 0.8% were IgM seropositive. These were also IgG seropositive. In addition, T. gondii DNA was detected in 2% of the samples analyzed by nPCR, all of which were IgG seropositive and none of which were IgM seropositive. The high seropositivity observed, without association with sociodemographic or occupational variables, suggests that T. gondii exposure may be driven by environmental conditions related to Amazonian mining. These findings highlight the need for further investigation of environmental transmission sources and support targeted public health interventions, including improved water safety, sanitation, surveillance, and health education tailored to mining communities.

Malaria continues to be a significant global health burden, with over 249 million cases and 619,000 deaths reported in 2022, primarily affecting tropical and subtropical regions. The emergence of drug-resistant strains of Plasmodium falciparum has reduced the efficacy of artemisinin-based combination therapies (ACTs), necessitating the exploration of alternative treatment strategies. This study investigates the antimalarial efficacy of Tinospora crispa extract (TCE) and artesunate (ART) against Plasmodium berghei ANKA infection in ICR mice. Both ART and TCE demonstrated dose-dependent antimalarial activity, with effective doses (ED50) of 200.31&#x2009;mg/kg and 1.96&#x2009;mg/kg, respectively. The combination of ART and TCE exhibited synergistic effects, achieving significantly higher parasitemia inhibition compared to monotherapy, with combination index (CI) values&#x2009;<&#x2009;1 at ED50, ED50/2, and ED50/4. Furthermore, combination therapy provided enhanced protection against packed cell volume (PCV) reduction and body weight (BW) loss, along with prolonged mean survival time (MST) compared to untreated and single-treatment groups. These findings highlight the potential of combining TCE with ART as a novel antimalarial strategy, offering synergistic benefits that may mitigate drug resistance and improve treatment outcomes. Further studies are warranted to explore the molecular mechanisms underlying these interactions and to evaluate the efficacy of this combination in clinical settings.

Malaria is a major public health problem, prevalent in Africa and endemic in Ghana. Besides the use of artemisinin combination therapy, plant medicine is well-recognised and accepted in Ghana. Decoctions of Azadirachta indica (AI) leaves and Khaya senegalensis (KS) stem bark are traditionally used for treating malaria. However, these decoctions are bitter, bulky and unstable compared to solid dosage forms. This study sought to formulate decoctions from these plants into capsules to tackle these setbacks. The maximum wavelength of absorption and the amount per dose of both plants' decoctions (120&#x2009;mL) were determined. Four absorbents (bentonite, magnesium carbonate, microcrystalline cellulose and kaolin) at four concentrations (25, 50, 75 and 100&#x2009;mg/dose) were used to formulate the decoctions into granules. The granules were assessed to select the best extract-absorbent granules for encapsulation and quality assessment. Antiplasmodial activity and cytotoxicity of the formulated capsules were also determined. AI containing 35&#x2009;mg/dose of kaolin with a percentage release of 97.31&#x2009;&#xb1;&#x2009;0.74% and good flow properties was encapsulated. KS containing 50&#x2009;mg/dose of bentonite with a percentage release of 97.54&#x2009;&#xb1;&#x2009;0.88% and good flow properties was encapsulated. Formulated capsules from both plants passed all quality control tests performed, with disintegration times of 10.01&#x2009;&#xb1;&#x2009;0.34 and 4.48&#x2009;&#xb1;&#x2009;0.23&#x2009;min, and cumulative drug release of 78.13&#x2009;&#xb1;&#x2009;0.37% and 95.63&#x2009;&#xb1;&#x2009;1.00%, for AI and KS, respectively. AI (IC50, 2.74&#x2009;&#xb1;&#x2009;0.70&#x2009;&#x3bc;g/mL) and KS (IC50, 24.37&#x2009;&#xb1;&#x2009;4.19&#x2009;&#x3bc;g/mL) had good to moderate antiplasmodial activity (IC50&#x2009;&#x2264;&#x2009;50&#x2009;&#x3bc;g/mL) using the SYBR green assay. Cytotoxicity studies also indicated that both AI and KS were selective for the Plasmodium parasite. The formulated capsules could therefore be used as an alternative to their bitter decoctions.

Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377&#x2008;000 incident childhood cancer cases (95% UI 288&#x2008;000-489&#x2008;000), 144&#x2008;000 deaths (131&#x2008;000-162&#x2008;000), and 11&#xb7;7 million (10&#xb7;7-13&#xb7;2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27&#xb7;0% (15&#xb7;5-36&#xb7;1) globally, from 197&#x2008;000 (173&#x2008;000-218&#x2008;000) in 1990, but increased in the WHO African region by 55&#xb7;6% (25&#xb7;5-92&#xb7;4), from 31&#x2008;500 (24&#x2008;900-38&#x2008;500) to 49&#x2008;000 (42&#x2008;600-58&#x2008;200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26&#xb7;5% (26&#xb7;5-26&#xb7;5) in GBD 2017 to 10&#xb7;5% (8&#xb7;1-13&#xb7;1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47&#xb7;3% (42&#xb7;2-52&#xb7;0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

Tuberculosis (TB) remains a major global health challenge, with an estimated 10.8&#x2009;million new cases and 1.25&#x2009;million deaths in 2023. Despite advances in molecular detection of Mycobacterium TB (MTB), significant diagnostic gaps remain: in 2023, only 48% of newly diagnosed TB cases received rapid diagnostic testing, far below the 100% target. These challenges are intensified in high-burden settings, where sputum collection and distinguishing TB from other illnesses are difficult. The Xpert MTB Host Response (Xpert-HR) assay measures host immune gene expression from blood, shows promise but variable accuracy across studies. Hence, this study will perform an Individual Patient Data Meta-Analysis (IPDMA) to evaluate the diagnostic accuracy, subgroup performance, predictive values and clinical benefit of Xpert-HR compared with conventional sputum-based testing. This systematic review and IPDMA will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy guidelines. Prospective studies including adolescents (>12 years) or adults with presumed TB tested using the Xpert MTB Host-Response assay will be identified through PubMed, Embase and Web of Science. Study quality will be assessed using an adapted diagnostic accuracy tool. Diagnostic accuracy will be pooled using random-effects models, with subgroup analyses where applicable. Decision curve analysis will evaluate clinical utility. Predictive values will be estimated across TB prevalences of 1-10%. Both one-stage and two-stage IPDMA approaches will be explored, and the proportion of unevaluable samples will be reported. The review will be based on deidentified individual patient data to be obtained upon request from the corresponding authors of studies fulfilling all the data sharing agreement. Ethical approval has been obtained from the Ethical Committee of the Medical Faculty of Heidelberg University (Approval No. S-043/2026). The results will be disseminated through publication in a peer-reviewed journal, and through presentations at academic conferences. CRD420251071857.

The objective of this study was to investigate the utility of the days alive and out of hospital (DAOH) metric within a cohort of patients undergoing burr-hole drainage of a chronic subdural haematoma (CSDH). We evaluate the validity of the DAOH metric in a national CSDH cohort and examine how the DAOH metric compares to its constituent outcomes (mortality and hospital bed days) at an organisational level. Retrospective cohort study using Hospital Episode Statistics data linked to the national death registry to identify patients who underwent burr-hole drainage of CSDH in English National Health Service neurosurgical units between 1 April 2013 and 31 March 2020. Construct validity was assessed by measuring the patterns of DAOH across categories of known perioperative risk factors. Variation between units in the risk-adjusted values for DAOH, postoperative mortality and days in hospital was explored using funnel plots. Linear regression and logistic regression were used to derive the risk-adjusted rates. Overall, 16&#x2009;450 patients who underwent at least one burr-hole drainage of CSDH were identified during the time period. The median 30-day DAOH was 16 (IQR, 0-24); the median for the 90-day DAOH was 74 (42-84), and was better at measuring the complete stay associated with the index admission. Worse 90-day DAOH values were associated with older age, increasing comorbidities and greater frailty. Risk-adjusted 90-day DAOH values for neurosurgical units varied more markedly than for its constituent outcomes. The 90-day DAOH looks to be a valid outcome metric for patients undergoing burr-hole drainage for CSDH that is feasible to derive using national hospital data. Future work should explore how to estimate a minimally important clinical difference for DAOH and evaluate its utility as an outcome measure.

Rabies is a deadly neglected tropical disease caused by a Lyssavirus that affects all warm-blooded animals, including humans. While canine rabies is prevalent in Ethiopia, its public health and economic burden is not well understood due to a lack of reliable surveillance data. This study aimed to estimate the economic and public health burden of canine rabies in Chilga district, Northwest Ethiopia. The study was conducted retrospectively over two years, from September 2017 to September 2019. A multistage cluster sampling approach was used to select representative households for data collection. A total of 768 households' heads were interviewed to collect data about rabies in their family members, dogs and livestock. The public health burden of the disease was estimated in disability adjusted life years (DALYs), while the economic burden was estimated by aggregating the costs of rabies in humans and livestock using cost estimation equations. The annual human rabies death in the district was estimated at 37deaths/100,000 populations (95%CI:10-95). The overall public health burden of canine rabies in the district was 1576.5 DALYs/100,000 population (95% CI: 424 - 4025) per year. The economic burden of rabies in the district was estimated at 887.3 ETB/household (95%CI: 688.0-1109.2)/two year. The major portion (76.7%) of the economic burden was contributed by livestock losses. Generally, the study revealed a significant public health and economic burden estimates of canine rabies in the district that needs a control intervention focus on dog vaccination, which could have significant impact in reducing both public health and economic burden.

Vector-borne&#x200b; diseases (VBDs) are a serious threat to public health, globally. Different genera of mosquitoes, acting as disease vectors, transmit diseases such as malaria, filariasis, dengue, chikungunya, Zika fever, and others. Malaria in humans is caused by Plasmodium species transmitted by Anopheles mosquitoes. Odisha is one of the malaria-endemic states in the country contributing to about 25% of the total (1.5-2.0 million) reported malaria cases and 30% deaths annually. Chemical insecticides and interventions have been effective in controlling vectors, and their continued usage resulted in widespread insecticide resistance in mosquito disease vectors, limiting their efficacy. Insecticide resistance data in malaria vector species in Odisha were compiled from the published peer-reviewed literature and other validated sources by search using keywords Anopheles, anopheles species, insecticide, susceptibility, mortality, survival, insecticide resistance, Odisha, Orissa, etc. The inclusion and exclusion criteria were followed to ensure the selection of quality data published between 1993 and 2024. Data from 28 published sources were collated for compilation and adapted for this scoping review. In adult susceptibility tests, mortality rates were categorized as susceptible/resistant to the specific insecticide following the World Health Organization (WHO) criterion: susceptible: > 98% mortality; possible resistance: between 90% and 97% mortality; and confirmed resistance: < 90% mortality. Intensity bioassay data from 10 southern districts were presented for the major vector Anopheles culicifacies. Odisha with 30 administrative districts has five defined ecotypes, coastal plains, central plateaus, central mountainous and highlands region, and western rolling and main flood plains. An. culicifacies, a major malaria vector, is reportedly prevalent in all 30 districts of Odisha, An. fluviatilis in 24 districts, An. annularis in 22, and An. minimus in two districts. An. culicifacies was the most resistant species to DDT (dichlorodiphenyltrichloroethane) (26 districts), malathion (17), and deltamethrin (10 districts). Limited data were available for other Anopheles species. Analyzed data on the status of resistance to different insecticides in anopheles vector species are provided. The emergence of multiple insecticide resistance in An. culicifacies signifies the urgency for effective management strategies. Insecticide resistance management requires regular monitoring and implementation of innovative approaches for vector control, emphasizing the need for insecticides with a novel mode of action and integrated vector management methods. Gaps in the data and ways to address them and issues on insecticide resistance management are discussed.

Malaria in pregnancy poses significant health risks to mothers and their, fetuses, and newborns children in Tropical and subtropical countries including Ethiopia. The delivery of integrating essential malaria services into routine antenatal care is crucial for effective prevention and control. However, evidence on the extent and determinants of this integration in Ethiopia remains limited. This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia. We conducted a secondary analysis of the Ethiopia Service Provision Assessment Survey 2021/22, a nationally representative cross&#x2011;sectional study. The final sample included 4273 pregnant women nested across 662 health facilities. Factors were identified based on the WHO Malaria in Pregnancy framework. Multilevel logistic regression models were applied to identify significant factors influencing integrated service uptake. Only 7.9% of pregnant women attended ANC visits where all components of integrated malaria services were delivered concurrently, with substantial regional disparities. At the client level, women with two previous pregnancies (AOR&#x2009;=&#x2009;1.67, 95% CI: 1.06-2.62), attending three or more ANC visits (AOR&#x2009;=&#x2009;1.58, 95% CI: 1.04-2.40) and client who received an Insecticide-Treated Net during ANC (AOR&#x2009;=&#x2009;2.81, 95% CI: 1.29-6.12) were more likely to attend ANC visits in which integrated malaria services were delivered. Furthermore, clients attending facilities with malaria-trained providers were more likely to receive integrated malaria services during ANC than those attending facilities without such training (AOR&#x2009;=&#x2009;4.24, 95% CI: 1.80-10.00). Rural facility attendance was also positively associated with integrated malaria service delivery compared with urban facility attendance (AOR&#x2009;=&#x2009;2.73, 95% CI: 1.04-7.19). Integrated malaria service delivery during ANC remains unacceptably low in Ethiopia, constrained by regional disparities and multilevel factors. Strengthen continuity of ANC follow up, updating policy on ITN distribution, strengthening providers' capacity, and addressing geographic disparities to accelerate progress toward WHO maternal health targets.

Malignant fungating wounds (MFWs) represent a profoundly distressing complication of advanced cancer, affecting an estimated 5-10% of patients with solid tumors and imposing a disproportionate burden on quality of life, caregiver wellbeing, and therapeutic engagement. Despite their clinical significance, MFWs remain a systematically neglected domain within oncology and palliative medicine. Existing literature addresses wound odor, wound myiasis, and dignity-related dimensions as isolated topics; a unified clinical framework integrating these three domains from both biological and ethical perspectives has been conspicuously absent. This review was designed to address that gap. The review introduces and applies a triple-framework approach to MFW management: (1) a Biological Dimension encompassing anaerobic microbial metabolism and volatile organic compound (VOC) generation; (2) a Clinical Dimension operationalizing evidence-based strategies for odor control and wound myiasis management; and (3) an Ethical Dimension centering dignity-conserving care as an indispensable component of oncologic wound management. This tripartite integration constitutes the primary conceptual contribution of this article. Wound microbiome profiling using 16S rRNA sequencing has identified anaerobic genera including Bacteroides, Prevotella, Peptostreptococcus, and Fusobacterium as principal contributors to the VOC profile responsible for MFW malodor, providing a mechanistic basis for targeted antimicrobial therapy. Biofilm-forming organisms, particularly Pseudomonas aeruginosa and Staphylococcus aureus, create recalcitrant wound environments that resist conventional topical therapies. Topical metronidazole remains the most robustly supported intervention for odor control, with emerging evidence for cadexomer iodine and Manuka honey as biofilm-disrupting adjuncts. Wound myiasis, increasingly reported in tropical and resource-limited settings, benefits from stepwise management combining mechanical debridement, larval asphyxiation techniques, and systemic ivermectin for severe cases. Electronic nose (e-nose) technology and volatile compound analysis represent emerging diagnostic tools for objective odor quantification. Palliative radiotherapy-using hypofractionated regimens such as 20 Gy in 5 fractions or single-fraction schedules in frail patients-offers biologically rational tumor cytoreduction with sustained improvement in odor and exudate. Community-based palliative care models, particularly those adapted for India and sub-Saharan Africa, demonstrate that dignified, evidence-informed MFW care is achievable within low-resource frameworks using trained community health workers and locally compounded or accessible wound care agents. Malignant fungating wounds demand a comprehensive, dignity-centered clinical response that is simultaneously evidence-based, culturally sensitive, and globally implementable. This review synthesizes the pathophysiology, evidence base, and ethical imperatives of MFW care into a unified clinical framework, providing oncologists and palliative care teams with practical algorithms for odor management and myiasis control, and reinforcing the imperative for equitable access to palliative wound care worldwide.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259&#x2009;000 (95% uncertainty interval 202&#x2009;000-335&#x2009;000) global deaths and 2&#xb7;54 million (2&#xb7;20-2&#xb7;93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86&#x2009;600 [53&#x2009;300-149&#x2009;000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98&#x2009;700 deaths (77&#x2009;000-127&#x2009;000) and 594&#x2009;000 cases (514&#x2009;000-686&#x2009;000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

Background: Sub-Saharan Africa is undergoing a rapid epidemiological transition marked by a growing burden of non-communicable diseases, including breast, cervical, ovarian, and uterine cancers, which constitute major causes of morbidity and mortality among women in the region; however, comprehensive assessments of long-term trends and regional heterogeneity remain limited. This study examines the burden and temporal trends of breast, cervical, ovarian, and uterine cancers across sub-Saharan Africa from 1990 to 2023. Methods: A retrospective ecological analysis was conducted using data from the latest Global Burden of Disease 2023 study. Age-standardised incidence rates, mortality rates, and disability-adjusted life year rates were estimated for breast, cervical, ovarian, and uterine cancers across 48 sub-Saharan African countries and four sub-regions. Temporal trends were assessed from 1990 to 2023, with percentage changes calculated to characterise epidemiological transitions. Geographic variation and age-specific patterns were examined to identify high-burden settings and priority populations. Results: Between 1990 and 2023, the burden of all four cancers increased substantially across sub-Saharan Africa, with significant regional and country-level heterogeneity. Breast cancer exhibited the largest absolute burden, with incidence increasing by over 120 percent and mortality by more than 80 percent, particularly in Central and Western Africa. Cervical cancer remained the leading cause of cancer-related mortality among women in Eastern and Southern Africa, despite evidence of stabilisation or decline in selected countries. Ovarian and uterine cancers demonstrated sustained upward trends, especially in Central Africa, with high mortality-to-incidence ratios indicating late diagnosis and limited treatment access. Across all cancer types, Central and Eastern sub-Saharan Africa consistently experienced the highest disability-adjusted life year burdens. Conclusions: The burden of the selected cancers in sub-Saharan Africa has increased markedly over the past three decades, with persistent regional inequities reflecting gaps in prevention, early detection, and treatment capacity. Strengthening cancer surveillance systems, expanding equitable access to screening and vaccination programmes, and improving diagnostic and treatment infrastructure are critical to reversing current trends. These findings provide region-specific evidence to guide cancer control priorities and resource allocation across sub-Saharan Africa.

Zoonotic malaria caused by infection with the monkey parasite Plasmodium knowlesi has emerged across Southeast Asia, particularly in areas previously close to elimination of non-zoonotic malaria. In Indonesia, some rural and remote areas must now consider strategies which target various Plasmodium species in hard-to-reach populations. Indonesia has mostly subsidised care at local health clinics for patients with malaria and other febrile illnesses; however, patients still face out-of-pocket costs. This study estimated household cost of illness due to malaria and non-malarial febrile illness in North Kalimantan and North Sumatra, Indonesia.Household costs were estimated from individual patients as part of health facility-based cross-sectional surveys in eight health clinics across North Sumatra and North Kalimantan between January 2022 and October 2023. Direct costs due to medical and travel expenses, and indirect costs resulting from productivity losses were included. Overall, 2244&#x2009;patients were recruited, including 153 (6.8%) malaria-confirmed cases. Five Plasmodium species were identified using validated PCR conducted on all participants: P. vivax (n=97), P. knowlesi (n=35), P. malariae (n=12), P. falciparum (n=3) and P. ovale (n=1), in addition to five mixed infections. Costs were inflated to 2023 Indonesian Rupiah and reported in US dollars (US$). A mean total cost of US$33 (SD=57) was reported for malaria episodes and US$17 for non-malarial fever episodes (SD=38), primarily composed of indirect productivity losses from time away from usual activities (70% and 61% of total cost for patients with malaria and other febrile illnesses, respectively). Overall, 16% of patients with malaria and 11% of patients with other febrile illnesses experienced catastrophic health expenditure from their illness episode.Despite a largely subsidised health system, patients and families face other medical, travel and indirect costs when seeking care for febrile illnesses. These costs need consideration when designing malaria control policies, particularly in near-elimination settings, with few malaria cases among broader febrile illness.

Novel point-of-care tools tailored to contextual needs are critical for improving sexually transmitted infection (STI) management. The genital inflammation test (GIFT) is a point-of-care test under development to detect genital inflammation. A potential use of GIFT is as a screening tool to identify asymptomatic women who may have a sexually transmitted infection (STI) or bacterial vaginosis (BV), followed by confirmatory STI- testing if GIFT-positive. This study assessed the prospective acceptability of GIFT within national healthcare sectors in South Africa and Zimbabwe, where STI diagnostics are limited. In-depth interviews were conducted with women (n&#x2009;=&#x2009;33), healthcare professionals (HCPs; n&#x2009;=&#x2009;20) and decision-makers (n&#x2009;=&#x2009;12) alongside seven focus group discussions (FGDs) with women (n&#x2009;=&#x2009;16) and HCPs (n&#x2009;=&#x2009;35). Thematic analysis was guided by Sekhon's framework of acceptability. Women showed a strong desire for devices to support sexual health and viewed diagnostic testing positively. However, acceptability declined when GIFT was explained as a screening tool requiring follow-up diagnostics, due to cost and limited availability of STI tests. HCPs and decision-makers similarly questioned its utility in constrained settings, despite recognising its potential as a potential catalyst for cheaper, point-of-care, infrastructure-light STI diagnostics. GIFT's acceptability is shaped by health system limitations, underscoring the need for clear communication, affordable diagnostics, and co-designed care pathways.