The Lancet Global Health

Background Acute malnutrition remains a major public health challenge among children under five in Malawi due to undetected and untreated cases. While several policies and programmes are in place, they face significant resource input and implementation constraints. In this study, we evaluate the potential health impact and cost-effectiveness of three interventions designed to address constraints along the care pathway in childhood acute malnutrition management. These include improving early reco...

BackgroundTyphoid fever incidence estimates are central to policy decisions on vaccine introduction and investments in non-vaccine prevention and control but are often unavailable. We explored whether prevalence metrics from sentinel studies of community-onset bloodstream infections could accurately predict local Salmonella Typhi (S. Typhi) incidence. MethodsUsing a previous systematic review (January 2018-December 2024), we identified studies reporting both typhoid incidence and prevalence of ...

IntroductionAccess to Hepatitis C virus (HCV) testing and treatment remains low globally. HCV self-testing (HCVST) may facilitate diagnosis and cure. We analysed treatment uptake and outcomes following a positive HCVST result in three distinct African epidemic contexts. MethodsA multi-country cohort study nested within HCVST implementation programmes in Cameroon, Nigeria, and South Africa (May 2023-May 2024). Adults ([≥]18 years) with positive HCVST results were followed through confirmatory...

In 2024, mpox cases surged in the Democratic Republic of the Congo (DRC) with cross-border spread to Burundi. We developed a transmission-dynamic model calibrated against surveillance data to understand drivers in enzootic (Clade Ia) and non-enzootic (Clade Ib) areas, and the potential impact of vaccination. In non-enzootic areas we estimated that 58-84% of transmission occurred within sexual networks. MVA-BN vaccination of sex workers could have averted 91% (95% CrI 81%-98%) of infections in Su...

Global health inequities are widely documented in outcomes. However, the research systems that generate knowledge, trials, and discovery have rarely been evaluated as an integrated structure. We introduce the Health Equity Informative Metrics (HEIM) framework, a three-dimensional audit of discovery (biobank output), translation (clinical trial activity), and knowledge (semantic organisation of the scientific literature). Analysing 70 international biobanks, 563,725 registered clinical trials, 13...

BackgroundCurrent syndromic guidelines for diarrhea treatment miss watery Shigella cases, leading to undertreatment of children who may benefit. Incorporating fecal inflammatory biomarkers into diagnosis may improve case identification. MethodsWe conducted an ancillary analysis using samples from six sites (The Gambia, Kenya, Malawi, Bangladesh, Pakistan, and Peru) from the Enterics for Global Health (EFGH)-Shigella surveillance study, a facility-based hybrid study of children aged 6-35 months ...

IntroductionFlooding events, which are strongly linked to climate change and variability, have the potential to disrupt communities and health systems. Vaccination, a highly effective public health intervention, plays a pivotal role in preventing numerous deaths annually, particularly among children. However, the relationship between exposure to flood events and early childhood vaccination remains unexplored. MethodsThis study utilizes validated flood exposure data from the Global Flood Databas...

BackgroundMalawi has one of the highest incidences and mortality due to cervical cancer, which is caused by the human papillomavirus (HPV). Achieving high HPV vaccination coverage is critical for advancing the World Health Organization (WHO) cervical cancer elimination strategy. This study aims to describe the spatio-temporal uptake of the first and second doses of the HPV vaccine in Malawi and to investigate the covariates associated with the uptake. MethodsWe analysed HPV vaccination coverage...

BackgroundMaternal immunization (MI) can prevent major infectious diseases in mothers and children by boosting the immunity of pregnant women. Antenatal care (ANC) delivery platforms could be leveraged to effectively provide MI. Adding MIs into ANC could potentially enhance ANC services, positively influencing both maternal and infant health outcomes and yielding broader benefits. We model these potential ANC-mediated health benefits in five low- and middle-income countries: Ethiopia, Ghana, Ken...

Incidence of norovirus has strong seasonality in temperate and continental climates. Many studies have examined its association with climate variables, but evidence remains disparate. We address this gap by performing a systematic review to summarise and interpret the strength and directionality of associations between climate variables and norovirus incidence. Embase, Scopus, Web of Science and PubMed databases were screened for peer-reviewed studies on 2nd of December 2024. Articles were incl...

BackgroundRotavirus remains a leading cause of childhood diarrhoeal hospitalisation globally. Malawi introduced the monovalent G1P8 rotavirus vaccine (Rotarix(R)) in October 2012 and in April 2016 switched from trivalent to bivalent oral poliovirus vaccine (tOPV to bOPV). More than a decade after Rotarix(R) introduction, evidence on sustained vaccine effectiveness and population-level impact in high-transmission, low-income settings remains limited, and it is uncertain whether programme changes ...

BackgroundLong-acting injectable HIV pre-exposure prophylaxis (PrEP), including Lenacapavir, has the potential to accelerate HIV incidence declines in eastern and southern Africa (ESA). However, high product and delivery costs and constrained budgets necessitate efficient prioritization strategies to maximize impact and achieve cost-effectiveness. MethodsWe used district-level HIV incidence estimates published by UNAIDS to estimate the direct health and economic impact of prioritizing Lenacapav...

BackgroundNontyphoidal Salmonella enterica (NTS) is a major public-health threat in the United States of America (U.S.). Evaluating associations between serovars, exposure sources, and settings in multistate outbreaks can reveal the drivers of NTS transmission and guide prioritization of targeted prevention and control strategies. MethodsWe analyzed multistate animal-contact NTS outbreaks reported to the CDC National Outbreak Reporting System during 2009-2022. We calculated incidence rates per ...

PurposeWe introduce PRE-CISE, a pre-calibration workflow that integrates coverage analysis, local sensitivity, and collinearity diagnostics to streamline model calibration and transparently address nonidentifiability. We demonstrate the benefits of PRE-CISE using a four-state Sick-Sicker Markov testbed and a COVID-19 case study. MethodsPRE-CISE begins with a coverage analysis to verify that model outputs generated with parameter sets drawn from their prior distribution span calibration targets,...

BackgroundAbrupt cessation of USAID and CDC resources to KwaZulu Natal province in South Africa, threatens the progress over decades to address HIV. MethodsWe used a previously developed validated HIV transmission model with input from the KZN Department of Health and local stakeholders to estimate impact of funding cuts on HIV incidence and mortality at 12-months and through 2030. We applied the model to estimate the impact of restoring funds on HIV incidence and mortality. ResultsHIV inciden...

BackgroundIn trials, three-month weekly rifapentine and isoniazid (3HP) showed higher adherence and completion than the six-month daily isoniazid (6H) regimen for TB preventive treatment (TPT). However, programmatic outcome data remain limited. MethodologyWe evaluated the TPT cascade among people with HIV (PWH) aged >15 years newly enrolled in HIV care in western Kenya. Initiation and completion of 6H (Jan to Sept 2022) were compared to 3HP (Oct 2022-Sept 2023) using Chi-square tests. Correlate...

Low participation in public health testing can lead to biased estimates of disease prevalence and inefficient allocation of public health resources. We evaluated the impact of monetary incentives and revisits on participation in door-to-door COVID testing in rural western Kenya. We conducted a cross-sectional study of all residents in 12 villages in rural western Kenya. We offered an incentive of KSh 200 (1.85 USD), KSh 350 (3.23 USD), or KSh 700 (6.47 USD), randomized at the household level, fo...

People who inject drugs (PWID) in India continue to experience high HIV incidence while coverage of HIV and harm reduction services within this population remains suboptimal in many settings, highlighting the need to identify novel service delivery points. To evaluate the effectiveness of spatially focused upscaling of interventions at observed venues where PWID injected drugs together, we developed an individual-based dynamic transmission model of HIV informed by detailed injection network, ser...

As programs for azithromycin mass drug administration to reduce child mortality have begun in some parts of West Africa, it is imperative to understand their financial costs. We combined a micro-costing framework and observations from an implementation-focused sub-study within the AVENIR trials in 80 communities in the Dosso region of Niger to estimate the national health sector costs of a scaled-up programmatic approach for azithromycin biannual distribution to children aged 1-59 months of age ...

BackgroundMalaria transmission in Uganda is heterogenous, so the national malaria program needs information about the distribution of malaria to develop appropriate policies. While population-based community surveys estimate Plasmodium falciparum parasite rate (PfPR), they are too infrequent and sparse for routine malaria management. Health facility data is routinely collected and covers a large geographic scope, but the data is collected passively, variable in quality, and potentially highly bi...