Transactions of The Royal Society of Tropical Medicine and Hygiene

BackgroundMalnutrition increases risk of acquiring infections but clinical characteristics and hospital outcomes among children in low resource settings with high rates of antimicrobial resistance have not been clearly described. AimOur main aim was to ascertain prevalence of bacteraemia in hospitalised children at Queen Elizabeth Central Hospital, Malawi. MethodsWe conducted a secondary analysis of a prospective study of children who had a blood culture collected during hospitalisation. ResultsOut of 175 children who had blood cultures collected during hospitalisation, 75 had severe acute malnutrition (SAM), 31 moderate acute malnutrition (MAM), and 69 no acute malnutrition (NAM). Twelve (7%) had bacteraemia (8 SAM, 1 MAM, 3 NAM) and seventeen (10%) died (14 SAM, 2 MAM, 1 NAM). Fever, vomiting and convulsions were least common in SAM (69%, 37%, 1%) compared to MAM (90%, 81%, 10%) and NAM (99%, 46%, 29%; p<0.001) children. Mortality was significantly higher in those with than without bacteraemia (33% vs 8%, p=0.004). Most common isolates were Salmonella Typhimurium (31%) and Escherichia coli (23%). High rates of bacterial resistance were noted to gentamicin (58%), a first-line antibiotic, and ceftriaxone (33%), a second-line antibiotic. ConclusionsMortality and bacteraemia rates are highest in hospitalised children with SAM. Despite this, SAM children do not present with typical clinical features, including fever, vomiting and convulsions. Given the high rate of antimicrobial resistance in this setting, a high index of infection clinical suspicion, awareness of local susceptibility patterns and evidence-based antibiotic guidelines are needed to optimise clinical care and antimicrobial stewardship. Lay SummaryMalnutrition increases the risk of having an infection but symptoms and hospital outcomes among children with malnutrition, in countries like Malawi with high rates of antimicrobial resistance, have not been clearly described. This study describes a study of children who had a blood culture collected during admission to Queen Elizabeth Central Hospital, Malawi. Of 175 children who had blood cultures collected, 12 (7%) had a bacteria found ( bactaeriemia) and 17 (10%) died. Fever, vomiting and convulsions were significantly less common in severe malnutrition compared to children with moderate malnutrition and those with no malnutrition. Mortality was significantly higher in those with bacteraemia than without. High rates of bacterial resistance were noted to first- and second-line antibiotics. Mortality and bacteraemia rates are highest in hospitalised children with SAM even though they do not present with typical features of bacteraemia.

BackgroundAnaemia during childhood adversely affects mental, physical and social development of the children, therefore morphological patterns of anaemia in under-five children are considered essential for classification, diagnosis and management. AimThis study aimed at assessing morphological patterns, the prevalence and associated factors of anaemia among under-five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu County, Kenya. MethodA cross-sectional health facility-based study was conducted among 175 children aged 6 to 59 months who attended clinic for the PMTCT programme for the period of January 2020 to December 2020. Pretested and structured questionnaires were used to collect socioeconomic and demographic characteristics of the family and child. Capillary blood sample was collected from each child for malaria parasite and Peripheral Blood Film (PBF) examination. ResultComplete blood counts indicate that microcytic pattern was the most common, representing 30 (42.3%) followed by microcytic hypochromic pattern 20 (28.2%), normocytic normochromic pattern with 11 (15.5%) and lastly dimorphic pattern with 10 (14.0%). High prevalence of anaemia was observed in children who were urban dwellers (50.0%), in children whose mothers aged 18-27 years (44.0%) and had no formal education (48.1%). Besides, the high prevalence rate of anaemia was found among children with a family monthly income of less than 500 Ksh. (46.9%), early (<6 months) introduction of complementary foods (71.4%) ConclusionThis study has revealed that the prevalence of anaemia in children less than five years is high and is a severe public health problem in the study area. Therefore, the policymakers should make a strategy that can reduce poverty and increase the awareness to women on breastfeeding, nutrition, and other associated factors to reduce anaemia.

BackgroundSickle cell disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin S, leading to various complications. This study aimed to assess the spectrum of SCD-related complications and outcomes among pediatric patients at Mbeya Zonal Referral Hospital in Tanzania. MethodsA retrospective cross-sectional study was conducted, reviewing medical records of pediatric SCD patients admitted between June 2019 and June 2023. ResultsThe study found an inpatient prevalence of 7.7% for SCD. Vaso-occlusive pain events (68%), infections (55.3%), and severe anaemia (27.7%) were the leading causes of admission. Low rates of hydroxyurea (11.4%) and penicillin V (28.3%) use was observed. The median haemoglobin level was 6.5 g/dL, indicating significant anaemia. Newly diagnosed patients (50%) had an average age of 5.12 years at diagnosis, suggesting delayed identification. The mortality rate was 3%. ConclusionThese findings highlight the need of improved early diagnosis, management strategies, and access to essential medications for pediatric SCD patients in Tanzania. Implementation of newborn screening programs and increased awareness about SCD management could significantly improve patient outcomes.

BackgroundAnemia continues to pose a substantial global health concern. Previous research in Tanzania mainland has documented high anaemia prevalence among children. However, studies specifically exploring the state of anaemia among school-aged children in Zanzibar remain limited. ObjectiveTo determine the prevalence and determinants of anaemia among children and adolescents aged 5 to 19 years in Zanzibar. MethodsThe Zanzibar National School Health and Nutrition Survey was aschool-based cross- sectional survey among school children and adolescents aged between 5 and 19 years enrolled in primary and secondary schools during the academic year 2022. A multistage systematic sampling was applied to select primary schools, class levels and students. Pre-tested structured questionnaires were used to gather demographic and economic data. Hemoglobin concentration was determined using a hemoglobinometer (HemoCue 301+). Inferencial analysis was done using Chi-Squire test and Modified Poison Logistic Regression. ResultsAlmost half of school children and adolescents 5-19 years in Zanzibar are anaemic with a prevalence of 45.7%. The determinants of anaemia included gender, age, school ownership, meal frequency and family income. Children aged 5-9 years were 1.2 more likely to be anaemic (APR: 1.2, 95% CI: 1.1-1.4; p<0.001). Adolescent girls had 10% times more significant risk of anaemia than adolescent males (APR: 1.1, 95% CI: 1.1-1.3; p=0.001). Children in public schools had a 1.7 times significantly higher risk of being anaemic than their counterparts in private schools (APR: 1.7, 95% CI: 1.2-2.3; p=0.004). Children who consumed breakfast 2-4 times a week had a significantly decreased risk of anaemia (APR: 0.8, 95% CI: 0.7-0.9p=0.015). Wealth quintile, settings, School level, regional differences, urban and rural settings, and deworming status, showed no significant difference in anaemia prevalence. ConclusionDespite massive improvements as compared to previous studies, the findings indicate a persistently higher prevalence of anaemia among school children and adolescents in Zanzibar. Both school-and-community focused interventions are needed to address the burden of anaemia in Zanzibar. The preponderance of anaemia among adolescent girls and those from public schools provides a unique opportunity for targeting such populations with anaemia prevention and control interventions, and schools are uniquely positioned to provide such interventions.

BackgroundPrimaquine is an 8-aminoquinoline antimalarial. It is the only widely available treatment to prevent relapses of Plasmodium vivax malaria. The 8-aminoquinolines cause dose dependent haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals. G6PDd is common in malaria endemic areas but testing is often not available. As a consequence primaquine is underused. MethodsWe conducted a pharmacometric study to characterise the relationship between primaquine dose and haemolysis in G6PDd. The aim was to explore shorter and safer primaquine radical cure regimens compared to the currently recommended 8-weekly regimen (0.75 mg/kg once weekly), potentially obviating the need for G6PD testing. Hemizygous G6PDd healthy adult Thai and Burmese male volunteers were admitted to the Hospital for Tropical Diseases in Bangkok. In Part 1, volunteers were given ascending dose primaquine regimens whereby daily doses were increased from 7.5 mg up to 45 mg over 15 to 20 days. In Part 2, a single primaquine 45 mg dose was given. Results24 volunteers were enrolled in Part 1, and 16 in Part 2 (13 participated in both studies). In three volunteers, the ascending dose regimen was stopped because of haemolysis (n=1) and asymptomatic increases in transaminases (n=2; one was hepatitis E positive). Otherwise the ascending regimens were well tolerated with no drug-related serious adverse events. In Part 1, the median haemoglobin concentration decline was 3.7 g/dL (range: 2.1 to 5.9; relative decline of 26% [range: 15 to 40%]). Primaquine doses up to 0.87 mg/kg/day were tolerated subsequently without clinically significant further falls in haemoglobin. In Part 2, the median haemoglobin concentration decline was 1.7 g/dL (range 0.9 to 4.1; relative fall of 12% [range: 7 to 30% decrease]). The ascending dose primaquine regimens gave 7 times more drug but resulted in only double the haemoglobin decline. Conclusions and InterpretationIn patients with Southeast Asian G6PDd variants full radical cure treatment can be given in under three weeks compared with the current 8 week regimen.

Backgroundanaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. MethodsA retrospective cohort study was conducted using medical records from 321 CLHIV aged 0-14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia. ResultsOverall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, cotrimoxazole (CTX) use during treatment was associated with increased odds of anaemia (Adjusted Odds Ratio, AOR=3.04; 95% CI: 0.95-9.74). Conversely, among females, the type of caregiver was a significant factor; care provided by an aunt was associated with 90% lower odds of anaemia compared to other arrangements (AOR=0.10; 95% CI: 0.01-0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. ConclusionsThe study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.

BackgroundExtreme leukocytosis (EL), defined as an abnormally high white blood cell (WBC) count, is a critical clinical indicator associated with various underlying conditions, such as infections and malignancies. This study investigated the etiological factors and clinical profiles of patients presenting with EL at Mbeya Zonal Referral Hospital (MZRH). MethodsA retrospective cohort study was conducted among patients with WBC counts [&ge;]50x109/L who attended MZRH between January 2021 and December 2022. Data were retrieved from electronic health records and analyzed using Stata Version 16. ResultsA total of 178 patients with EL were included in the study. Malignant conditions accounted for 47.2% of cases, with haematological malignancies comprising 89.3%, predominantly chronic myeloid leukaemia (CML). Infections were the second most frequent cause (43.2%). Patients with malignancies had significantly higher median WBC counts (221 vs. 56 x 109/L, p<0.0001) and were more likely to present with symptoms such as bleeding, bone pain, B symptoms, splenomegaly, hepatomegaly, and lymphadenopathy. Severe thrombocytopenia (platelet count <50 x 109/L) was more common in the malignant group (p=0.0008). ConclusionMalignant etiologies, particularly haematological malignancies, are a leading cause of EL in patients with WBC counts [&ge;]50 x 109/L. Clinicians should maintain a high suspicion of malignancies in such patients and conduct thorough diagnostic evaluations to ensure optimal management.

IntroductionAnaemia is a major cause of morbidity and mortality among children in sub-Saharan Africa. Anaemia has many aetiologies best addressed by different treatments, so regional studies of the aetiology of anaemia may be required. MethodsWe analysed data from Nigerias 2018 Demographic and Health Survey (DHS) to study predictors of anaemia among children ages 6-59m. We computed the fraction of anaemia at different degrees of severity attributable to malaria and sickle cell disease (SCD) using a regression model adjusting for demographic and socioeconomic risk factors. We also estimated the contribution of the risk factors to haemoglobin concentration. ResultsWe found that 63.7% (95% CI: 58.3-69.4) of semi-severe anaemia (<80 g/L) was attributable to malaria compared to 12.4% (95% CI: 11.1-13.7) of mild-to-severe (adjusted haemoglobin concentration <110 g/L) and 29.6% (95% CI: 29.6-31.8) of moderate-to-severe (<100 g/L) anaemia and that SCD contributed 0.6% (95%CI: 0.4-0.9), 1.3% (95% CI: 1.0-1.7), and 7.3% (95%CI: 5.3-9.4) mild-to-severe, moderate-to-severe, and semi-severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared to children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children. ConclusionThis approach used offers a new tool to estimate the contribution of malaria to anaemia in many settings using widely available DHS data. The fraction of anaemia among young children in Nigeria attributable to malaria and SCD is higher at more severe levels of anaemia. Prevention of malaria and SCD and timely treatment of affected individuals would reduce cases of severe anaemia.

IntroductionThe loss of splenic function is associated with an increased risk of infection in sickle cell disease (SCD); however, spleen function is rarely documented among SCD patients in Africa, due partly to the non-availability of sophisticated techniques such as scintigraphy. Methods of assessing splenic function which may be achievable in resource-poor settings include counting red blood cells (RBC) containing Howell Jolly Bodies (HJB) and RBC containing silver-staining (argyrophilic) inclusions (AI) using a light microscope. We evaluated the presence of HJB - and AI - containing RBC as markers of splenic dysfunction among SCD patients in Nigeria. MethodsWe prospectively enrolled children and adults with SCD in steady state attending outpatient clinics at a tertiary hospital in North-East Nigeria. The percentages of HJB- and AI-containing red cells were estimated from peripheral blood smears and compared to normal controls. ResultsThere were 182 SCD patients and 102 healthy controls. Both AI- and HJB-containing red cells could be easily identified in the participants blood smears. SCD patients had a significantly higher proportion of red cells containing HJB (1.5%; IQR 0.7% - 3.1%) compared to controls (0.3%; IQR 0.1% - 0.5%) (P = 0.0001). The AI red cell counts were also higher among the SCD patients (47.4%; IQR 34.5% - 66.0%) than the control group (7.1%; IQR 5.1% - 8.7%) (P = 0.0001). The intra-observer reliability for assessment of HJB-(R = 0.92; R2 = 0.86) and AI-containing red cells (R = 0.90; R2 = 0.82) was high. The estimated intra-observer agreement was better with the HJB count method (95% limits of agreement, -4.5 to 4.3; P = 0.579). ConclusionWe have demonstrated the utility of light microscopy in the assessment of red cells containing - HJB and AI inclusions as indices of splenic dysfunction in Nigerian SCD patients. These methods can be easily applied in the routine evaluation and care of patients with SCD to identify those at high risk of infection and initiate appropriate preventive measures.

IntroductionSoil-transmitted helminth infections continue to pose a major threat to child health in Nigeria, especially in underserved communities. Maternal and Child Health (MNCH) Weeks offer a unique opportunity to deliver deworming interventions alongside other child survival services. However, disparities in coverage and operational execution have raised questions about the effectiveness and equity of such campaigns. This study evaluates the effectiveness of deworming interventions delivered during the June 2025 MNCH Week in Bayelsa State, examining both the reach of Albendazole administration and its balance relative to other services such as vitamin A supplementation. MethodologyA descriptive cross-sectional study design was adopted using secondary data extracted from the MNCH OPS Room Final Report. Data from eight Local Government Areas (LGAs) were analyzed using descriptive statistics and comparative analysis. Coverage rates were calculated using WHO-recommended formulas, and the performance of deworming was assessed against the estimated target population of 562,254 children. Comparative tables and visualizations were generated to examine distribution disparities and identify systemic implementation gaps. ResultsFindings revealed that only 280,000 children received Albendazole, representing 49% coverage, while vitamin A supplementation reached 391,107 children (approximately 69%). Deworming coverage varied significantly across LGAs, with Yenagoa achieving 62.2% and Southern Ijaw recording only 40.9%. In all LGAs, vitamin A consistently outperformed deworming by an average margin of nearly 20 percentage points. Statewide summaries further revealed that program execution lacked balance, and the integration of services was not reflected in equitable delivery. ConclusionThe study underscores the need for strategic reforms in how deworming is operationalized during MNCH campaigns. The disparities observed highlight weaknesses in logistics, training emphasis, community engagement, and intervention prioritization. While MNCH Weeks provide an effective delivery platform, deworming remains undervalued and under-implemented. Targeted policy and operational reforms are necessary to ensure that integrated health campaigns fulfill their promise of delivering equitable and comprehensive care to all children, regardless of geography.

Mid-upper arm circumference (MUAC) or weight-for-height/length Z-score (WHZ) are recommended in wasting diagnosis, but there are discrepancies between these indicators in identifying children as wasted. We compared the extent to which WHZ, MUAC, MUAC-for-age Z-score (MAZ) identify the same children as wasted and assessed the predictors of discordance and concordance in wasting diagnosis by these indicators using data from a longitudinal study of children younger than 3 years at recruitment in Turkana and Samburu counties. Wasting prevalence was consistently lower based on MUAC than WHZ and MAZ. Compared to WHZ, MAZ had higher sensitivity than MUAC, with the sensitivity of MAZ increasing and MUAC decreasing with age. Both indicators had high specificity. WHZ had a better agreement with MAZ than MUAC in wasting diagnosis. Older children were less likely to be classified as wasted by MUAC alone or by both MUAC and WHZ but were more likely to be classified as wasted by WHZ alone, MAZ alone or by both MAZ and WHZ. Compared to girls, boys were less likely to be classified as wasted by MUAC alone but more likely to be classified as wasted by WHZ alone. Stunted children were more likely to be classified as wasted by MUAC alone, MAZ alone, both MUAC and WHZ, and both MAZ and WHZ but not by WHZ alone. Classifications of wasting based on WHZ, MAZ, and MUAC are age, sex, and stunting status dependent. Compared to WHZ, MAZ is a more reliable and valid indicator than MUAC in these settings.

BackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children 0-59 months treated in a South African public hospital setting. MethodsA retrospective cohort study was performed on hospital files of children diagnosed with SAM at Rahima Moosa Mother and Child Hospital, Johannesburg, from 1/10/2014 to 31/12/2018. A total of 148 files could be retrieved from the hospital archives. The diagnosis of SAM based on the World Health Organization definition was confirmed in 126 of these children, and they were included in the study. The onset of RFS among the children included in the study was diagnosed based on published criteria for RFS. Children who developed RFS and those who did not were compared concerning biochemistry and clinical signs and symptoms on admission. ResultsThe median age of the 126 children (63% male) with confirmed SAM was 34 months (IQR: 26.0 to 48.4 months). The mortality rate was 18.2%. Of these children, 8.7% were retrospectively diagnosed as having developed RFS during their recorded hospital stay, despite implementing the WHO treatment guidelines for SAM. A significantly higher percentage of the children that developed RFS presented on admission with hypophosphatemia (p=0.04), severe hypokalemia (p=0.0005), hyponatremia (p=0.004), an international normalized ratio (INR) of above 1.7 (p=0.049), diarrhea (p=0.04), dehydration (p=0.02) and urinary tract infection (UTI) (p=0.04) than those that did not. Edema was more prevalent on admission in children who developed RFS than those who did not (63.6% vs 39.1%), though the difference was not statistically significant (p=0.20). Children who developed RFS stayed in hospital significantly longer than those who did not (18 vs 12 days) (p=0.003). ConclusionIn this population of children with SAM treated in a South African public hospital setting, the presence on hospital admission of low levels of electrolytes, elevated INR, dehydration, diarrhea, and UTI was significantly associated with developing RFS. Recognizing these as possible red flags for developing RFS in children admitted with SAM might contribute to improved outcomes and needs further investigation.

BackgroundUltrasonography is an established and reliable method for assessing the spleen. Because of variation due to genetic and other environmental factors including malaria endemicity, interpretation of splenic sizes requires a knowledge of the normal reference range for a given population. The aim of this study was to determine spleen size in different age groups among healthy people in North-Eastern Nigeria and use this as a reference to determine spleen size amongst sickle cell disease (SCD) patients. MethodsUsing a cross-sectional study design, spleen size was measured in healthy people of different age groups, and steady-state SCD patients (children and adults) using abdominal ultrasonography. Using the age-group specific reference values obtained from the controls, spleens were classified into small, normal size, or enlarged among the SCD patients. ResultsAbdominal ultrasonography was performed for 313 participants, comprising 109 (34.8%) healthy controls and 204 (65.2%) steady-state SCD patients. The spleen was visualized in all the controls. However, 97(47.6%) of the SCD patients had no visible spleen. Small, normal, and enlarged spleens were observed in 16.7% (n=18/107), 63.6% (n=68/107) and 19.6% (n=21/107) SCD patients, respectively. Compared to the control group, splenic length was three-fold higher in the first two years of life in SCD patients, followed by a progressive age-related decline in size. Enlarged spleens were detected among 5(2.4%) SCD patients by manual palpation method compared to 21 (19.6%) using ultrasonography. ConclusionModel-based age-specific reference ranges and percentile curves for splenic dimensions based on ultrasonography among normal controls in North-Eastern Nigeria were established and may be of value in assessing spleen sizes among SCD patients living in malaria-endemic regions of Africa. Regular spleen scans to assess changes in size can help identify SCD patients at risk of splenomegaly complications including subclinical acute sequestration and hypersplenism, and those who are developing splenic atrophy.

BackgroundTungiasis is a neglected tropical skin disease mostly affecting children under 15 years, the elderly and disabled people in the most resource poor populations in Latin America and Sub-Saharan Africa. While most transmission seems to occur at home inside houses, we aimed to identify factors in the school environment that may put children at increased risk of infection. MethodsAs part of a cross-sectional school-based prevalence survey of 21,466 pupils in nine counties of Kenya, observations of school infrastructure were made and the headteacher interviewed in each of 196 schools. In a subset of 97 schools, detailed observations of 322 classrooms were made and 117 teachers interviewed. Mixed effect logistic regression models were used to identify factors associated with tungiasis infection in pupils. ResultsWe found a higher odds of tungiasis infection for pupils in schools where more than 400 pupils were enrolled (aOR 2.24, 95% CI 1.12-4.50, p=0.023), where clean water was not always available (aOR 2.28, 95% CI 1.13-4.60, p=0.021); and if the school buildings were in a bad structural condition (aOR 2.15, 95% CI 1.00-4.62, p=0.050). Of the 5,102 pupils in 97 schools, 99% studied in a classroom with a concrete floor and those with a lot of loose soil or sand on top of the concrete floor had a six times higher odds of infection than those on a clean concrete floor (aOR 6.52, 95% CI 1.61-26.35, p=0.008). Only 45% of (head)teachers in affected schools knew they had infected pupils in their school or grade. Those who did, were aware of the impact it was having on the pupils and yet only three of 76 affected schools had conducted a tungiasis intervention activity within the last year. ConclusionMost schools do not pose a risk of tungiasis for pupils, instead the home environment is the main risk. However, where school buildings are not well maintained and water not always available a multisectoral approach to control tungiasis is needed involving the Department of Health as well as the school management and the Department of Education.

ObjectiveTo evaluate immunological response to Covid-19 vaccines in immunocompromised haematology patients and compare with immunocompetent healthy controls DesignWe compared total Anti-SARS-CoV-2 spike antibody and T cell response in 45 immunocompromised haematology patients with 30 healthy adults following 2 doses of Covid-19 vaccine for 3 -5 months at 30 day intervals SettingSingle Centre, University Hospital, United Kingdom, March 2021-December 2021 Main Outcome measuresPeak quantitative total spike-specific antibody and cellular responses ResultsWe found O_LINon - significant difference in T cell and total Anti-SARS-CoV-2 S antibody response between study and control group patients C_LIO_LISix (13%) study group participants did not have detectable Total Anti-SARS -Cov-2 S antibodies at any time point throughout the study monitoring period. C_LIO_LIThree (7%) of the study group participants had no response, even after additional booster doses of Covid-19 vaccine. C_LIO_LIAll (100%) of the control group had detectable Anti-SARS-Cov-2 S antibodies after 2 doses of Covid-19 vaccine. C_LIO_LINo participant died or was hospitalised due to severe Covid-19 infection during the study period. This included study group participants who had no antibody response at any time point. C_LI ConclusionsThough there was a non - significant difference in T cell and total Anti-SARS-CoV-2 S antibody response between immunocompromised patients and healthy controls this did not result in any severe infection or Covid-19 related mortality in our study cohort. We did not identify any patient-specific factor (age, gender), specific haematological condition or treatment as determinant of response. Covid-19 vaccination was well tolerated without major side effects in both groups. What was already known about this topicprior to starting this study there were no studies to confirm immunological response following Covid-19 vaccination in immunocompromised haematology patients. During the conduct of our study there have been publications from researchers confirming blunted serological response in 62-66% of immunocompromised haematology patients compared to 74-95% in healthy controls. What this study addsOur study did not identify a significant difference in serological or T cell response between immunocompromised and healthy groups. Though 13% of immunocompromised patients had no response to Covid-19 vaccination none of them suffered from severe Covid-19 infection. We believe T cell response to Covid-19 vaccination has an important role in providing protective efficacy against Covid-19.

BackgroundThe 2030 target for schistosomiasis is elimination as a public health problem (EPHP), achieved when the prevalence of heavy intensity infection among school-aged children (SAC) reduces to <1%. To achieve this, the new World Health Organization (WHO) guidelines recommend a broader target of population to include pre-school (pre-SAC) and adults. However, the probability of achieving EPHP should be expected to depend on patterns in repeated uptake of mass drug administration (MDA) by individuals. MethodsWe employed two individual-based stochastic models to evaluate the impact of school-based and community-wide treatment and calculated the number of rounds required to achieve EPHP for Schistosoma. mansoni by considering various levels of the population never treated (NT). We also considered two age intensity profiles, corresponding to a low and high burden of infection in adults. ResultsThe number of rounds needed to achieve this target depends on the baseline prevalence and the coverage used. For low and moderate transmission areas, EPHP can be achieved within seven years if NT [&le;]10% and NT <5%, respectively. In high transmission areas, community wide treatment with NT<1% is required to achieve EPHP. ConclusionsThe higher the intensity of transmission, and the lower the treatment coverage, the lower the acceptable value of NT becomes. Using more efficacious treatment regimens would permit NT values to be marginally higher. A balance between target treatment coverage and NT values may be an adequate treatment strategy depending on the epidemiological setting, but striving to increase coverage and/or minimise NT can shorten programme duration.

Cysticercosis in humans caused by the parasite Taenia solium is one of the World Health Organizations Neglected Tropical Diseases. The parasite is transmitted between the human host and pigs. Efforts to prevent the disease have relied mainly on treatment of people with anthelmintics. However to date there is no practical and effective control method that has been delivered as a public health program. Here we describe a large-scale, minimum inputs T. solium control program implemented as a public health program in Madagascar. Initially pigs were vaccinated for porcine cysticercosis and medicated with oxfendazole, after which only young piglets and pigs imported into the program area were targeted for interventions. After piglet interventions were in place and on-going, a single mass drug administration (MDA) was delivered to the human population with a taeniacide. The outcomes were assessed one year after the human treatment, by comparing pre-and post-intervention levels of human T. solium taeniasis and porcine cysticercosis caused by T. solium. Over a twenty-two-month period, 96,735 pig vaccinations were delivered and during the MDA, 117,216 people received taeniacide. Ninety percent of the pig population were receiving vaccination and medication at the end of the intervention period. Coverage of the eligible human population by the MDA was 62.5%. Human taeniasis was found to be 1.25% prior to the MDA and 0.6% one year after the MDA. Prior to the intervention 30.8% of slaughter-age pigs had viable T. solium infection whereas no viable infection was detected in any pig treated in the program. The program successfully demonstrated effective control of T. solium transmission using minimum inputs and delivered as a public health program. Sustained control and expansion of the program could potentially lead to the elimination of the disease being a public health problem in Madagascar. Author summaryCysticercosis caused by the cestode parasite Taenia solium is one of the World Health Organizations neglected tropical diseases. We implemented One Health cysticercosis control as a public health program in a highly endemic region of Madagascar. The program was designed to require minimum inputs while achieving maximum impacts on control within a short period of time. Pigs were vaccinated with the TSOL18 vaccine and simultaneously treated with oxfendazole. Over a 2-year period, piglets 2-3 months of age were treated. After pig vaccination practices where established, the human population received a single treatment with a taeniacide. The program was evaluated by assessment of porcine cysticercosis and human taeniasis before and 12 months after the human mass drug administration. More than 95,000 pig vaccinations were delivered and 117,000 persons received taeniacide. The intervention entirely eliminated viable porcine cysticercosis in slaughter-age pigs that had received treatment as well as reducing human taeniasis. Continuation and expansion of the program would have the potential to eliminate T. solium from the program area, or even from the entire country.

Background Urogenital schistosomiasis (UGS), caused by Schistosoma haematobium (S. haematobium), disproportionately affects women in sub-Saharan Africa and can lead to haematuria, anaemia, and urinary tract morbidity. Data on the prevalence in women of reproductive age remains limited in contrast to infection among school-aged children in Kenya. This study assessed the prevalence of UGS and its socioeconomic determinants among women in Kilifi County, Kenya. Methods: Urine samples (20-50 mL) were collected from each participant over three consecutive days. Day-one samples were tested for haematuria, proteinuria, nitrites, leukocytes, and pregnancy using dipsticks. On the other hand, 10 mL of urine was examined for S. haematobium eggs via urine filtration on all three days. Results: A total of 599 women aged 15-50 years were enrolled, with complete data available for 336. The mean age was 33 years; 57.7% were <35 years. Most participants were from rural Magarini Sub-county (63%) and engaged in crop farming (62.5%). Primary education was the highest level attained by 59.8% of participants. Frequent contact with stagnant water was reported by 92%. The overall prevalence of S. haematobium infection was 13.7% (95% CI: 10.2-17.8), higher in Magarini (14.9%) than in Rabai (12.0%), though not statistically significant. Younger age, primary education, and frequent water contact were associated with higher infection rates; however, after adjustment for covariates, haematuria showed the strongest independent association with infection. Women with haematuria were 25.2 times more likely to be infected (OR: 25.24, 95% CI: 7.07-82.63, p < 0.001); multivariate analysis confirmed haematuria as the sole significant predictor (OR: 20.83, 95% CI: 5.45-79.57, p < 0.001). Conclusion: UGS prevalence among women in Kilifi County is substantial, with variation between sub-counties. Haematuria demonstrated the strongest independent association with infection and may serve as a simple, non-invasive diagnostic marker. These findings underscore the pressing need for the integration of UGS screening into the reproductive health services and targeted interventions. Authors Summary UGS, caused by the parasitic worm Schistosoma haematobium, is a neglected tropical disease and remains a major public health problem in sub-Saharan Africa. Although control programmes in Kenya primarily target school-aged children, women of reproductive age are frequently exposed through daily water contact and may develop chronic urinary and reproductive health complications. However, data on the infection burden among adult women are limited. In this study, we assessed the prevalence of urogenital schistosomiasis and associated risk factors among women aged 15-50 years in Kilifi County, Kenya. Urine samples were collected over three consecutive days and examined for parasite eggs and indicators of urinary tract disease. We found that urogenital schistosomiasis affected more than one in ten women in the rural sub-counties where the study was conducted. Haematuria was strongly associated with infection and remained the most reliable predictor after accounting for other social and behavioural factors. These findings demonstrate that UGS is an under-recognised health issue among women and highlight the potential value of simple urine-based screening tools. Integrating UGS screening into existing reproductive health services could improve early detection and contribute to more inclusive disease control strategies.

BackgroundStrongyloidiasis, caused by the parasitic intestinal worm Strongyloides stercoralis, infects hundreds of millions of people globally. Current school-based preventive chemotherapy (PC) programs that use benzimidazole derivatives (e.g., albendazole) against soil-transmitted helminths do not effectively treat strongyloidiasis, which requires treatment with ivermectin. We estimate the cost-effectiveness of mass drug administration with ivermectin for the control of strongyloidiasis. MethodsWe developed a mathematical model to simulate the population dynamics of S. stercoralis and the impact of school-based and community-wide PC across a range of epidemiological settings. We simulated 10-year PC programs with varying treatment coverages. We estimated a primary outcome of disability-adjusted life years (DALYs) averted by each PC strategy and calculate the programmatic cost (US$) of each strategy. We estimated cost-effectiveness by comparing strategies by their incremental cost-effectiveness ratios (US$/averted DALY) and expected loss curves. FindingsThe model found community-based PC was the most cost-effective strategy ([&le;]600 US$ / DALY averted), despite costing approximately 5 times as much as school-based PC. Community-based PC targeted at ages 5 and above reduced infection levels close to 0% within 5 to 6 years. School-based PC was predicted to have very little impact. These results were robust across a range of epidemiologic settings above a measured prevalence of 2-5% in school age children. InterpretationAnnual community-based PC is the most cost-effective public health strategy to control strongyloidiasis, being superior to school-based PC due to most of the infections and mortality occurring in adults. A baseline prevalence of 2% of infection in school age children, as measured by Baermann or stool culture, is a suitable minimum threshold for cost-effective implementation of community-based PC. FundingWorld Health Organization.

BackgroundAcute 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 recognition of symptoms by caregivers, increasing attendance at routine growth monitoring visits through community outreach, and scaling up the availability of therapeutic food supplements. Methods and FindingsWe use a newly developed model representing the natural history and management of acute malnutrition, implemented within the Thanzi La Onse (TLO) dynamic individual-based simulation framework, which captures the public health system in Malawi. Each of the three interventions is assessed both individually and in combination, translated into seven scenarios which we evaluate in comparison to the status quo. The optimal strategy combines two interventions, improved caregiver awareness of early symptoms with increased availability of therapeutic food supplements. Over five years, this strategy is predicted to avert 840,470 (95% CI: 682,057-998,883) DALYs with total incremental costs of $34 million. This corresponds to an annual health expenditure increase of $0.32 per capita. At a cost-effectiveness threshold of $76 per DALY averted, the strategy results in an incremental net health benefit of 394,252 (95% CI: 235,839-552,665) DALYs averted. ConclusionsThe cost-effective strategy for addressing constraints in childhood acute malnutrition management is simultaneously improving caregiver recognition of early symptoms and expanding therapeutic food supplement availability. Out of the seven scenarios evaluated, this integrated approach was found to be the optimal strategy within the Malawian public health system, yielding substantial health at modest costs. These findings provide critical evidence to inform national policy and guide investment prioritisation for the management of childhood acute malnutrition.