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...

BackgroundHospitals in high-burden tuberculosis (TB) settings are important sites of Mycobacterium tuberculosis (Mtb) transmission, yet the impact of infection prevention and control (IPC) measures targeting crowding is poorly understood. We assessed the effects of simple interventions to reduce spatial clustering and airborne transmission in a Zambian hospital. Methods and findingsFrom June to August 2024, we prospectively collected clinical data on presumptive (symptom-based screening) and co...

BackgroundIn sub-Saharan Africa (sSA), invasive antimicrobial-resistant infections often originate from community-level acquisition. We assessed whether a behavioural intervention bundle targeting sub-optimal antibiotic use and hygiene practices reduced household-level acquisition of extended-spectrum beta-lactamase-producing E. coli (ESBL-E). MethodsWe conducted a cluster-randomised controlled trial in 22 village clusters in Nanoro district, Burkina Faso. We enrolled 12 randomly selected house...

Bedaquiline (BDQ) is a cornerstone antibiotic for treating multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB). Resistance to BDQ (BDQR) can arise through three mechanisms: spontaneous mutation, acquisition during treatment, or transmission of a resistant strain. We developed a transmission threshold model to estimate the contribution of each mechanism to BDQR burden in MDR/RR-TB We integrated four data sources: (i) novel estimates of spontaneous resistance probability; (ii) updated est...

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 ...

BackgroundMarked declines in pediatric HIV have been achieved across sub-Saharan Africa, yet progress among adolescents remains uneven and strongly patterned by place. Drawing on place-based perspectives in health geography, we conceptualize Eastern and Southern Africa (ESA) and West and Central Africa (WCA) not merely as epidemiological regions, but as dis-tinct assemblages of health systems, gender norms, and historical investment trajectories shaping HIV risk and care. Using UNICEF-harmonized...

BackgroundIn Bangladesh, cholera treatment focuses on acute watery diarrhea in symptomatic cases at health facilities, though asymptomatic infections are common. Understanding the role of asymptomatic infections in transmission is crucial for designing appropriate control strategies in this setting. MethodsWe utilized data from household studies conducted in Dhaka, Bangladesh during 2006-2018 where a symptomatic confirmed cholera case and their household contacts were followed for thirty days. ...

BackgroundHigh levels of multidrug and rifampicin resistant tuberculosis (MDR/RR-TB) are a global concern, although they have declined over the last decade. TB patients are at increased risk of acquired rifampicin resistance if they have HIV coinfection, especially at low CD4 counts, but this dynamic has not previously been modelled. MethodsWe extended a previously-developed model that simulates HIV and TB in South African adults, to include the acquisition and transmission of rifampicin resist...

Deaths due to diarrhea among children younger than five have been rapidly decreasing, from an estimated 484,781 in 2010 to 245,966 in 2021. A report by the International Livestock Research Institute in 2012 found that the top 13 most important zoonoses were responsible for 2.2 million human deaths. Questions remain whether the benefits of animal ownership outweigh the potential harms of being exposed to potentially deadly zoonotic pathogens. This study uses national surveys to assess the associa...

BackgroundShort birth intervals raise maternal, perinatal, and child health risks. Sub-Saharan Africa (SSA) has the worlds highest fertility and elevated child mortality. While short intervals effects on child mortality are well established, the reverse link is less studied. The child replacement effect posits that early child death shortens subsequent birth intervals. This study examines and quantifies this association across 26 SSA countries. MethodsThis study pooled recent DHS data from 26 S...

Diarrheal disease is caused by diverse species of viruses, bacteria and protozo that are transmitted from different sources, including from contaminated food. Sustaining progress in reducing diarrheal illnesses and deaths, including vaccines and food safety measures, may require interventions targeting specific pathogens. In 2015, the WHOs published etiology-specific estimates by their Foodborne Disease Burden Epidemiology Reference Group (FERG) of the incidence and mortality of diarrheal diseas...

BackgroundSouth Africas National Tuberculosis (TB) Programme aims to achieve targets set by the World Health Organizations End TB Strategy, including an 80% reduction in TB incidence and a 90% reduction in TB mortality by 2030, compared to 2015 levels. We were tasked to evaluate 1) the impact on TB incidence and mortality of scaling up individual interventions focusing on TB preventive therapy, screening, testing and linkage to treatment as included in the 2023-2028 National Strategic Plan for T...

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...

The growing threat to health systems posed by extreme weather events (EWEs) disproportionately affects people living with HIV (PLHIV) and tuberculosis (TB) in high-burden, low-resource settings. In Zimbabwe, for example, the 2023/2024 El Nino-induced drought intensified food insecurity and reduced access to clinics and medication for vulnerable populations. We conducted a formative evaluation to assess how recent EWEs in Zimbabwe have impacted HIV and TB care in this community and to identify po...

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 ...

BackgroundGiardia is the most common enteric parasite among children in low-resource settings, causing diarrhoea and leading to prolonged infection or asymptomatic carriage. We assessed whether the effect of water, sanitation and handwashing (WSH) interventions on Giardia infection among rural Bangladeshi children varies with seasonal conditions. MethodsWe conducted a secondary analysis of the WASH Benefits Bangladesh cluster-randomized trial, with 450 clusters assigned to four arms in a 2x2 fa...

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...

Research in contextO_ST_ABSEvidence before this studyC_ST_ABSPrevious cost-effectiveness analyses have examined tuberculosis (TB) infection testing and latent TB infection (LTBI) treatment among migrants in high-income, low TB-incidence countries, including the United States, Canada, and Australia. These studies found that cost-effectiveness varied by setting, population risk, and intervention design. Refugees and asylum seekers--populations with higher TB exposure and reduced healthcare engagem...