Transactions of The Royal Society of Tropical Medicine and Hygiene

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.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease (NTD) caused by filarial worms. India accounted for 55% of the global population at risk of LF in 2021. The World Health Organization (WHO) has targeted LF elimination by 2030; however, India aims to achieve LF elimination prior to the global WHO NTD target. Mathematical models are useful tools to evaluate and guide elimination strategies. We propose a new compartmental model--COmpartmental Modelling of Elimination strategies and Transmission of Lymphatic Filariasis (COMET-LF)--to assess the impact of mass drug administration (MDA) on LF elimination. Our model incorporates drug efficacy data from a clinical trial and generates estimates of disease (lymphoedema and hydrocele) prevalence. The model is calibrated to publicly available microfilaria (Mf) and disease prevalence data (2008-2013) from Bihar, India. Predictions of the number of MDA rounds needed for achieving the elimination threshold were generated for various endemic scenarios. The projected estimates were compared with established micro- (LYMFASIM) and macro- (EPIFIL) simulation models for LF transmission. Disease burden estimates and the impact of MDA on disease burden were generated using COMET-LF for different endemic scenarios. Our simulations suggest that the disease burden reduces over much longer timescales - 20 years for a reduction of 8%-11.5% following 5 rounds of MDA. We extended COMET-LF to a meta-population model to investigate the role of migration among neighbouring regions on elimination and resurgence probabilities. We found that high Mf prevalence in the spatial neighbourhood can increase the number of required MDA rounds for elimination up to 3 additional rounds for the two-drug regimen. Furthermore, we assess the impact of migration on the resurgence probability in a non-endemic region which is spatially adjacent to a high-Mf prevalence region and show that there is a significant risk of resurgence if Mf prevalence exceeds 5%. Our model can be easily tailored to specific blocks and districts to guide programmatic intervention for disease management and LF elimination. Author summaryLymphatic filariasis (LF) commonly occurs in tropical regions and is transmitted to humans by mosquitoes infected with larvae of parasitic roundworms. Some patients develop external symptoms including swollen limbs/male genitals that develop from damage to lymph nodes. Others do not develop external symptoms but may transmit the disease to non-infected humans through mosquito bites. LF causes physical disability, disfigurement and mental suffering. India has more than half of the global population at risk of developing LF. Currently, medications that kill the parasites are given yearly to the population at risk. A better understanding of the disease transmission and control measures is important to meet the 2030 elimination target set by the World Health Organization. We developed a new mathematical model (COMET-LF) that takes into account India-specific disease information for more accurate predictions. To validate our model, we compared the predictions with those from established models. COMET-LF can predict the number of years the drug has to be administered to stop LF transmission and the effect of drugs on disease prevalence. COMET-LF also shows that infected patients migrating from neighboring regions can increase transmission to regions where LF is under control. Notably, our model can help policy makers plan targeted control measures for specific regions.

Mass drug administration (MDA) of antifilarial drugs is the main strategy towards the elimination of lymphatic filariasis (LF). Recent clinical trials indicated that the triple drug therapy with ivermectin, diethylcarbamazine and albendazole (IDA) is much more effective against LF than the widely used two-drug combinations (albendazole plus either ivermectin or diethylcarbamazine). For IDA-based MDA, the stop-MDA decision is taken based on microfilariae (mf) prevalence in adults. In this study, we assess how the probability of eventually reaching elimination of transmission depends on the critical threshold used in transmission assessment surveys (TAS-es) to define whether transmission was successfully suppressed and triple-drug MDA can be stopped. This analysis focuses on treatment-naive Indian settings. We do this for a range of epidemiological and programmatic contexts, using the established LYMFASIM model for transmission and control of LF. Based on our simulations, a single TAS one year after the last MDA round provides limited predictive value of having achieved suppressed transmission, while a higher MDA coverage increases elimination probability, thus leading to a higher predictive value. Every additional TAS, conditional on previous TAS-es being passed with the same threshold, further improves predictive value for low values of stop-MDA thresholds. An mf prevalence threshold of 0.5% corresponding to TAS-3 results in [&ge;]95% predictive value even when the MDA coverage is relatively low.

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.

Anaemia is a common presentation feature in patients with visceral leishmaniasis (VL). Blood transfusion remains an important aspect of patient management in VL. However, triggers considered for making decisions on transfusion are poorly understood. This review is based on the Infectious Diseases Data Observatory (IDDO) VL clinical trials library, a database of all published efficacy studies since 1980 and has indexed 160 published trials (1980-2021). Description of blood transfusion was reported in 16 (10.1%) trials (n=3,459 patients). Transfusion was initiated solely based on haemoglobin (Hb) measurement in 9 studies, using a combination of Hb and other health conditions (epistaxis, poor health, or clinical instability) in 3 studies, and the criteria was unclear in 4 studies; Hb threshold ranged from 3-8 g/dL. Overall, the number of patients receiving transfusion was explicitly reported in 10 trials (n=2,421 patients enrolled). Of these, 217 patients underwent transfusion; 58 before treatment initiation and 46 during treatment or the follow-up phase, and the time of transfusion was unclear in 113. The median proportion of patients who received a transfusion in a study was 8.0% [Interquartile range (IQR): 4.7% to 47.2%; range: 0-100%; n=10 studies]. This review describes the variation in current clinical practice and is an important initial step in policy/guideline development, where both the patients haemoglobin concentration and clinical status must be considered.

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.

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.

Sickle cell disease is common in Sierra Leone, yet its long-term population burden is uncertain. We analyzed Global Burden of Disease 2023 estimates for sickle cell disorders in Sierra Leone from 1990 through 2023. We obtained prevalence, deaths, and disability adjusted life years (DALYs), calculated age standardized rates per 100 000, modeled temporal trends with log linear regression, decomposed mortality changes into effects of population growth and rate change, and assessed age specific and sex specific patterns in 2023. Sickle cell prevalent cases increased from 48 689 (95% UI, 42 588 to 56 140) in 1990 to 90 498 (95% UI, 78 126 to 105 815) in 2023, and deaths rose from 408 (95% UI, 288 to 579) to 635 (95% UI, 438 to 862). DALYs increased from 32 518 (95% UI, 23 446 to 45 336) to 50 608 (95% UI, 36 331 to 66 317). Over the same period, age standardized mortality declined from 10.2 to 7.9 per 100 000 (APC, -0.46%; 95% CI, -0.64 to -0.29) and age standardized DALYs from 811.5 to 631.5 per 100 000 (APC, -0.43%; 95% CI, -0.60 to -0.25). In 2023, children younger than 5 years accounted for 153 deaths (95% UI, 93 to 230; 24.1% of all deaths), and persons younger than 20 years for 314 deaths (95% UI, 203 to 446; 49.5%). Males and females had similar prevalence (45 442 vs. 45 056 cases), but males had 371 deaths and 28 855 DALYs versus 264 deaths and 21 753 DALYs in females. Decomposition indicated that population growth alone would have increased deaths by 179.5%, whereas rate reductions offset this by 79.5%. The burden of sickle cell disease in Sierra Leone has grown in absolute terms, driven mainly by rapid population expansion, while age standardized mortality and DALY rates have declined. Concentrated losses in children and young adults and persistent male excess mortality highlight the need to scale up newborn screening and early comprehensive care, expand access to hydroxyurea and infection prevention, and strengthen resilient sickle cell services.

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 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 Findings We 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. Conclusions The 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.

BackgroundMass drug administration (MDA) is the cornerstone for the elimination of lymphatic filariasis (LF). The proportion of the population that is never treated (NT) is a crucial determinant of whether this goal is achieved within reasonable timeframes. MethodsUsing two individual-based stochastic LF transmission models, we assess the maximum permissible level of NT for which the 1% mf prevalence threshold can be achieved (with 90% probability) within 10 years under different scenarios of annual MDA coverage, drug combination and transmission setting. ResultsFor Anopheles-transmission settings, we find that treating 80% of the eligible population annually with ivermectin+albendazole (IA) can achieve the 1% mf prevalence threshold within 10 years of annual treatment when baseline mf prevalence is 10%, as long as NT <10%. Higher proportions of NT are acceptable when more efficacious treatment regimens are used. For Culex-transmission settings with a low (5%) baseline mf prevalence and Diethylcarbamazine+Albendazole (DA) or Ivermectin+Diethylcarbamazine+Albendazole (IDA) treatment, elimination can be reached if treatment coverage among eligibles is 80% or higher. For 10% baseline mf prevalence, the target can be achieved when the annual coverage is 80% and NT [&le;]15%. Higher infection prevalence or levels of NT would make achieving the target more difficult. ConclusionsThe proportion of people never treated in MDA programmes for LF can strongly influence the achievement of elimination and the impact of NT is greater in high transmission areas. This study provides a starting point for further development of criteria for the evaluation of NT.

Anaemia is a condition in which either the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. The global estimate of childhood anaemia indicates that 293.1 million children are anaemic, and 28.5% of these children reside in sub-Sahara Africa. Also, anaemia is a significant public health problem with a high age-standardised death rate of 11.18 per 100,000 in Zambia. We conducted a cross-sectional study involving 392 anaemic children aged one year to 14 years. The study was conducted at the Children Hospital, University Teaching Hospitals, which is a third-level referral Hospital in Lusaka, Zambia. The aim was to determine the most common type of anaemia, its severity, and the most affected age groups among children aged 1-14 years. Out of 392 participants, 219 (56%) were female. Maximum haemoglobin recorded was 10.9g/dl, a minimum of 2.0 g/dl, a mean of 7.8g/dl and a standard deviation of 1.86g/dl. 200 (51%) participants had severe anaemia, and 192 (49%) had moderate anaemia with none having mild anaemia. Microcytic hypochromic anaemia was the commonest (60%), followed by normochromic normocytic anaemia (26%) and the least was macrocytic anaemia in 14% of the participants. An analysis of variance (ANOVA) showed that the difference in mean haemoglobin concentration between age groups was not significant, F (7.94) = 0.83, p > 0.57. A Chi-squared test was used to determine the relationship between anaemia types (microcytic, hypochromic) and age groups. The interaction was not significant (Chi-Square (1) = 1.28, p-value = 0.73. Microcytic hypochromic anaemia was the most prevalent and all age groups were equally affected. We recommend the countrys National Food and Nutrition Commission to revisit the Zambian National Strategy and Plan of Action for the Prevention and Control of Vitamin A Deficiency and Anaemia of 1999 to 2004 and implement the measures stated in the strategic plan.

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.

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.

BackgroundThe elimination programme for visceral leishmaniasis (VL) in India has seen great progress, with total cases decreasing by over 80% since 2010 and many blocks now reporting zero cases from year to year. Prompt diagnosis and treatment is critical to continue progress and avoid epidemics in the increasingly susceptible population. Short-term forecasts could be used to highlight anomalies in incidence and support health service logistics. The model which best fits the data is not necessarily most useful for prediction, yet little empirical work has been done to investigate the balance between fit and predictive performance. Methodology/Principal FindingsWe developed statistical models of monthly VL case counts at block level. By evaluating a set of randomly-generated models, we found that fit and one-month-ahead prediction were strongly correlated and that rolling updates to model parameters as data accrued were not crucial for accurate prediction. The final model incorporated auto-regression over four months, spatial correlation between neighboring blocks, and seasonality. Ninety-four percent of 10-90% prediction intervals from this model captured the observed count during a 24-month test period. Comparison of one-, three-and four-month-ahead predictions from the final model fit demonstrated that a longer time horizon yielded only a small sacrifice in predictive power for the vast majority of blocks. Conclusions/SignificanceThe model developed is informed by routinely-collected surveillance data as it accumulates, and predictions are sufficiently accurate and precise to be useful. Such forecasts could, for example, be used to guide stock requirements for rapid diagnostic tests and drugs. More comprehensive data on factors thought to influence geographic variation in VL burden could be incorporated, and might better explain the heterogeneity between blocks and improve uniformity of predictive performance. Integration of the approach in the management of the VL programme would be an important step to ensuring continued successful control. Author summaryThis paper demonstrates a statistical modelling approach for forecasting of monthly visceral leishmaniasis (VL) incidence at block level in India, which could be used to tailor control efforts according to local estimates and monitor deviations from the currently decreasing trend. By fitting a variety of models to four years of historical data and assessing predictions within a further 24-month test period, we found that the model which best fit the observed data also showed the best predictive performance, and predictive accuracy was maintained when making rolling predictions up to four months ahead of the observed data. Since there is a two-month delay between reporting and processing of the data, predictive power more than three months ahead of current data is crucial to make forecasts which can feasibly be acted upon. Some heterogeneity remains in predictive power across the study region which could potentially be improved using unit-specific data on factors believed to be associated with reported VL incidence (e.g. age distribution, socio-economic status and climate).

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.

BackgrounMalaria transmission is primarily limited to tropical regions where environmental conditions are conducive for the survival of Plasmodium parasites and Anopheles mosquitoes. Adequate rainfall provides breeding sites, while suitable temperatures facilitate vector mosquito life-cycles and parasite development. Evaluating the efficacy of vector control interventions is crucial to determine their effectiveness in reducing malaria transmission. The aim of this study was to explore how these factors affect transmission dynamics at varying levels of vector control efficacy. MethodsWe developed a vector-host compartmental mathematical model to compare three published approaches to incorporating weather influences on malaria transmission. The first approach examines mosquito biting behaviour and mortality rates in larval and adult stages. The second focuses on temperature effects on mosquito life-cycle characteristics throughout the aquatic and adult stages. The third considers how temperature and rainfall influence adult mosquito behaviour, environmental carrying capacity, and survival during the aquatic stages. Model simulations were conducted at different annual vector control coverage levels, to identify variations in transmission patterns and seasonal variability in daily and annual incidence across three climate regions. ResultsThe first approach indicates sustained seasonal transmission, with lower cases per 1,000 in tropical regions compared to semi-arid and sub-tropical regions, even with enhanced vector control reducing cases. The second approach projects extended seasonal peaks in malaria transmission in tropical and semiarid regions, driven by prolonged warm periods, while sub-tropical regions show lower incidence due to cooler temperatures limiting mosquito survival. In contrast, the third approach projects multiple irregular peaks, with transmission ceasing in winter across all regions. ConclusionsSimulations indicate that climatic events like heatwaves or flooding, can trigger mosquito population surges and malaria outbreaks, even in areas previously free of malaria, despite strong vector control efforts. However, the results demonstrate that sustained and effective vector control, particularly in regions with moderate temperatures, can substantially reduce malaria incidence. Effective malaria control requires incorporating weather predictions into intervention plans, and enhancing current vector control strategies with supplementary measures like larval source management. Accurate timing and targeting of these interventions, based on transmission season projections, are crucial for maintaining robust control as weather conditions evolve and to prepare for future challenges.

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.

Many studies have looked at the residual risk of the specific child undenutrition indicators. This study aimed at mapping the shared risk of two of the undernutrition indicators. The shared spatial component model was fitted to two of the child undernutrition indicators using 5066 child records of the 2015 Malawi demographic health survey data. The spatial components were modelled by the convolution prior, with the structured components being assigned the conditional autoregressive distribution. The southern region is at the greatest risk of having stunting and wasting, wasting and underweight, as compared to the central and northern region. The shared risk of stunting and underweight is randomly distributed. Interventions to reduce the shared risk of child undernutrition should focus on the southern region and a little bit in the central region, and attention should be on addressing the issue of overpopulation and effects of climate change.

Childhood malnutrition remains a major public health challenge in Ethiopia, where stunting and wasting co-exist but may arise from distinct spatial and etiological processes. Analyses focusing on a single outcome may overlook the interdependence of these conditions and their geographic heterogeneity. This study aimed to disentangle the determinants of stunting and wasting among children under five years of age using a Bayesian bivariate spatial modelling framework. Data from 5,405 children included in the 2019 Ethiopia Mini Demographic and Health Survey were analyzed. Stunting and wasting were modelled as correlated binary outcomes using Bayesian bivariate hierarchical geostatistical models implemented through SPDE-INLA, accounting for child, maternal, household, and environmental covariates, non-linear age effects, and spatial dependence. Model performance was assessed using the deviance information criterion, Watanabe-Akaike information criterion, and marginal log-likelihood. The bivariate model identified shared socio-economic and biological determinants. Multiple births, male sex, low maternal education, a higher number of under-five children, and household poverty were associated with increased risks of both outcomes. Female-headed households were associated with lower odds of stunting but higher odds of wasting. Spatial analysis revealed elevated residual stunting risk in the northern and central highlands, whereas wasting hotspots were concentrated in northeastern pastoralist regions. Residual spatial correlation was weak ({rho} = -0.12), indicating largely independent geographic patterns. These findings suggest that effective child nutrition policies in Ethiopia require outcome-specific and regionally tailored interventions addressing both chronic and acute forms of malnutrition.

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.