Transactions of The Royal Society of Tropical Medicine and Hygiene

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.

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.

Background Affecting 40% of infants and young children worldwide, anaemia in sub-Saharan Africa hampers cognitive and physical development, often in ways that cannot be reversed. Iron-based micronutrient powders (MNPs) are recommended to combat anaemia, but concerns remain about their safety and effectiveness in malaria-endemic areas. We evaluated the impact of iron-based MNPs on growth measurements and malaria-related anaemia among preschool children in Ghana. Methods We conducted a secondary analysis of a cluster-randomized, double-blind, placebo-controlled trial in the Bono Region, Ghana. Children aged 6-35 months (n=1,958) received daily MNP containing 12{middle dot}5mg elemental iron or placebo for five months. Anthropometric indices, haemoglobin, and malaria parasitaemia were assessed at baseline and endline. Adjusted analysis of covariance (ANCOVA) models estimated effects on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z scores. Binomial regression with identity link estimated risk differences for malaria-induced anaemia. Cluster-robust standard errors were applied at the compound level, and intracluster correlation coefficients (ICCs) were estimated. Results 1,815 (92{middle dot}7%) children completed the endline survey, but 1,806 were included in the final analysis. Baseline characteristics were balanced between groups. Iron-containing MNP had no significant effect on endline HAZ ({beta}=0{middle dot}026, p=0{middle dot}609), WAZ ({beta}=-0{middle dot}015, p=0{middle dot}719), or WHZ ({beta}=-0{middle dot}035, p=0{middle dot}463). However, the intervention reduced the risk of malaria-induced anaemia (risk difference 0{middle dot}050, 95% CI 0{middle dot}004-0{middle dot}096; p=0{middle dot}032). Female sex was associated with higher HAZ ({beta}=0{middle dot}149, p=0{middle dot}005). Conclusion Iron-containing MNP did not improve short-term growth but was associated with a modest reduction in malaria-induced anaemia. These findings support the safe use of iron fortification in malaria-endemic settings while underscoring the need for integrated strategies to address persistent growth faltering and gender specificity.

Introduction: Solitary plasmacytomas (SP) are rare neoplasm of localised proliferation of clonal plasma cells. It can be classified based on site of involvement and bone marrow involvement. It is an indolent disease in the majority of patients. Primary modality of treatment is radiotherapy and surgical excision. Materials and methods: This was a retrospective audit of SP who were treated and followed up at a tertiary care center in eastern India from January 2012 to December 2025. Patients who has solitary plasma cytoma with more than 10% plasma cells, POEMS syndrome, have been excluded from analysis. Results: We identified 46 patients of SP. The median age of the studied population was 53 years (23-75 years). Males were more commonly affected than females (M:F=2.2:1). Most common chief complaints were bony pain (67.4%). SBP was seen in 39 (84.8%) cases whereas SEP was seen in 7 (15.2%) cases. Vertebra was the most common site of involvement (61.4%). Median M band concentration 0.24 g/dL (0.1 to 1.95 gm/dL). IgG was the most common isotype accounting for 60.6% cases. Six cases (13%) had minimal bone marrow involvement. The majority of the patients received local radiotherapy (89.1%). With a median follow up of 5.4 years (95% CI: 1.8 - 9.0), median OS was not reached, median PFS was 9.22 years (95% CI: 5.8-12.6), median time to next treatment (TTNT) was 9.86 years (95% CI: 6.8 - 12.9). Conclusion: Solitary plasmacytoma commonly affects young males. Bones are more commonly affected than extramedullary sites. SP has a lower rate of progression and excellent prognosis when treated with local radiotherapy.

Background During Nigeria's largest recorded diphtheria outbreak, hospital capacity in Kano State was rapidly overwhelmed. Medecins Sans Frontieres introduced home-based care (HBC) for patients with mild disease to prioritise facility-based care for severe cases. We assessed whether HBC was non-inferior to facility-based treatment in terms of mortality, sequelae, and household transmission. Methods We conducted a retrospective matched cohort study. Mild diphtheria cases treated between January 2023 and May 2024 were matched 1:1 by treatment modality (HBC or diphtheria treatment centre [DTC]) on sex, age group, vaccination status, and residence. Conditional logistic regression estimated the association between treatment modality and mortality, with robustness assessed through propensity score weighting, sensitivity analyses, and E-value computation. Findings Of 990 sampled patients, 678 (367 HBC, 311 DTC) were enrolled (68.5%). After adjustment, treatment modality was not independently associated with mortality (HBC vs. DTC: aOR 0.40, 95% CI 0.13-1.30), with similar estimates across sensitivity analyses (E-value 4.40). Clinical complications were the strongest predictor of death (aOR 23.1, 95% CI 1.73-307). Vaccination was protective (aOR 0.28, 95% CI 0.08-0.94) and treatment delay of four or more days increased mortality (aOR 4.15, 95% CI 1.23-14.0). HBC was not associated with increased household transmission or long-term sequelae. Interpretation Vaccination and early treatment, rather than care setting, were the main determinants of survival. When supported by clinical triage and structured follow-up, decentralised care can be used to manage mild cases during diphtheria epidemics in settings with constrained hospital capacity.

Background: Child acute malnutrition remains persistently above emergency thresholds in Chad's Sahelian drylands, with a predictable, but rarely recognized, dry season peak linked to declining pasture and livestock productivity, reduced milk availability and heightened exposure to zoonotic infections. Humanitarian responses remain largely reactive and treatment-focused, with limited evidence on preventive strategies that address drivers embedded in local livelihood systems. We evaluated the effectiveness and return on investment (ROI) of an integrated livestock management intervention designed to prevent the dry-season peak of child acute malnutrition in pastoral and agro-pastoral communities in Chad. Methods: We conducted a cluster-randomised controlled trial in Kanem and Barh-El-Gazel provinces, Chad. Seventy-six villages were randomised (1:1) to intervention or control. Eligible households had at least one child aged 6-59 months and access to milking livestock during the dry season. The intervention (December 2024-June 2025) combined livestock feed supplementation to sustain milk production near households during the dry season, household-level zoonotic risk mitigation, and nutrition counselling. Primary outcomes were the prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM) at the dry-season peak (May 2025), assessed in a prespecified random subsample of 52 clusters. All 76 clusters were assessed post-peak (July 2025). Analyses followed an intention-to-treat approach using mixed-effects models. A societal ROI analysis was conducted over six months with projections to 24 months. Findings: At the dry-season peak, 821 children 6-59 months from 521 households were assessed across 52 villages. GAM prevalence was 22.2% in intervention villages versus 47.4% in controls (adjusted OR 0.29 [95% CI 0.18-0.49]; p<0.001), and SAM prevalence was 4.4% versus 19.4% (adjusted OR 0.17 [0.08-0.37]; p<0.001). Intervention households had higher daily milk availability (+588 mL per household; p<0.001), and children consumed more milk (+102 mL per day; p=0.008). Odds of self-reported diarrhoeal disease and acute respiratory infection were substantially lower among children in intervention villages (aOR 0.21 [0.10-0.44] and 0.22 [0.11-0.46], respectively). Post-peak, women's dietary diversity increased (aOR 3.68 [1.90-7.13]), alongside reduced workload, lower household food insecurity and distress livestock sales, improved livestock condition, and a benefit-cost ratio of 5.40 at six months, rising to 16.40 at 24 months. Interpretation: Protecting livestock productivity and sustaining children's access to milk while reducing zoonotic exposure during the pastoral lean season effectively prevents seasonal peaks of child acute malnutrition. This integrated anticipatory action and One Health livelihood-based approach offers a scalable, dignifying, high-return lifesaving preventive model for pastoral and agro-pastoral humanitarian settings.

Background Nigeria has experienced its largest recorded diphtheria outbreak since late 2022, centred on Kano State, where facility-based surveillance documented over 25,000 confirmed cases. The true community burden remains unknown. We conducted a population-based household survey to estimate community attack rates, mortality, vaccination coverage, and determinants of infection and death. Methods We performed a retrospective household survey (September-October 2024) using spatially randomised cluster sampling (65 clusters, ~15 households each; recall period January 2023 to interview). Survey-weighted analyses, multivariable logistic regression, and sensitivity analyses were used. Findings We enrolled 7,998 individuals from 1,068 households. The community attack rate was 1.1% (95% CI 0.7-1.4), 4.2 times (2.7-5.3) higher than facility-based estimates. The case fatality ratio was 8.8% (1.9-15.6) overall and 21.3% among children under five; two thirds of deaths occurred at home. Delayed care-seeking of four or more days was associated with markedly higher mortality (risk ratio 32.6, 95% CI 2.4-450.0). Vaccination was strongly protective against death (vaccine effectiveness 57%, 95% CI 34- 72%; E-value 4.07). Among campaign-eligible children, routine EPI coverage was 56.6%; the reactive campaign reached few previously unvaccinated children (99.7% overlap with prior recipients), leaving 11.6% of eligible children unvaccinated. Interpretation Community diphtheria burden substantially exceeded facility surveillance estimates, with most deaths occurring outside the health system. Delayed care-seeking and low vaccination coverage were the main drivers of mortality, highlighting the need for improved community surveillance, decentralised care, and better-targeted vaccination.

In co-endemic regions, mixed Plasmodium vivax (Pv) and Plasmodium falciparum (Pf) infections are commonly reported. How mixed species infections compare to single species infections in terms of parasite densities and transmission to mosquitoes is incompletely understood. Parasitemia, gametocytemia, and mosquito infectivity were evaluated among Pv mono-infections (n=284), Pf mono-infections (n=150), and mixed-Pv-Pf infections (n=77) recruited at four Ethiopian health facilities. Parasitemia and gametocytemia were quantified in patient blood samples by qPCR. Mosquito infectivity was assessed using direct membrane feeding assays (DMFA), with Plasmodium species confirmation by PCR. Pf gametocyte prevalence was lower in mixed-infections (64.5%, 49/76) compared with mono-infections (91.8%, 135/147); among gametocyte-positive parasite carriers gametocyte density was also lower in mixed-infections (p<0.001). Pv gametocyte prevalence was similar in mono- and mixed-infections despite lower asexual parasite density in mixed infections (p<0.001). Statistically significant positive correlations between asexual parasitemia and gametocytemia were observed in mono-infections (p<0.001), but not in mixed-species infections (p=0.120 for Pv; and p=0.570 for Pf). Transmission to mosquitoes was high across infections and infection combinations. Among infectious Pv-Pf parasite carriers, 56.3% (27/48) transmitted both species, often with both species being transmitted to individual mosquitoes. The associations between (species specific) gametocyte density and mosquito infection rates was unaffected by the concurrent presence of the other Plasmodium species. Although mixed-species infections may have different parasite and gametocyte densities compared to mono-infections, we observed no evidence for competition between species in mosquitoes. Because mixed infections are often undetected, they represent a hidden risk for sustaining malaria transmission. Author SummaryMalaria remains a major public health challenge in Ethiopia, where Plasmodium vivax and Plasmodium falciparum often occur together in the same patient. While mixed-species infections are common, little is known about how they compare to single-species infections in terms of parasite levels and transmission to mosquitoes. In this study, we examined patients with P. vivax, P. falciparum, or mixed infections across four health facilities. We measured parasite and gametocyte densities in blood samples and tested whether patients could infect mosquitoes. We found that P. falciparum gametocyte levels were lower in mixed infections compared to single-species infections, while P. vivax gametocyte levels were similar regardless of infection type. Importantly, patients with mixed infections were still highly infectious to mosquitoes, and many transmitted both parasite species simultaneously. These findings show that mixed infections, which are often missed by routine diagnosis, can contribute substantially to malaria transmission. Recognizing and addressing mixed-species infections is therefore critical for malaria control and elimination efforts.

Waldenstrom macroglobulinemia (WM) is a rare indolent neoplasm characterized by presence of more than 10% lymphoid cells in BM that exhibit plasmacytoid or plasma cell differentiation that secretes an IgM monoclonal protein. This is a retrospective analysis of 89 patients of WM that describes the clinical and laboratory characteristics, treatment patterns and outcome of patients of WM. The median age of the entire cophort was 66 years with male predominance (67.4%). Most common presentations were symptoms pertaining to anemia (77.5%) and constitutional symptoms (33.7%). Median bone marrow lymphoplasmacytic cells were 41%. Positivity for MYD88 and CXCR4 mutations were seen in 81.8% and 2.4% cases. BR was the most common regimen used (52.8%). Overall response rates were seen at 87.8%. Median overall survival, progression free survival and time to next treatment is 8.49 years, 2.15 years and 3.88 years. BR regimen was associated with highest event free survival.

BackgroundUrogenital schistosomiasis is a major cause of preventable morbidity, primarily in rural, resource-limited regions. After decades of mass drug administration, changing epidemiologic landscapes, and ongoing resource limitations, test-and-treat models may be necessary to meet elimination goals. However, diagnostic capacity remains centralized and laboratory-dependent, and community-led, contextually adapted implementation strategies remain poorly defined. This study describes the accuracy and feasibility of a low-cost diagnostic toolkit and explores community-integrated implementation models. Methodology/Principal FindingsThis mixed-methods study enrolled 418 participants from five endemic sites near Oyan River Dam, Ogun State, Nigeria in July 2025. Urine samples underwent parallel analysis by community health extension workers utilizing the toolkit and by laboratory technicians using standard microscopy. The toolkit consisted of a reusable urine filtration device paired with a under-$2 paper microscope. Semi-structured interviews with community health extension workers and key informants were analyzed using the Consolidated Framework for Implementation Research. Prevalence was 27.5% (115/418). Community health extension workers demonstrated progressive improvement in diagnostic accuracy across five sequential communities (n=237), rising from 52.5% (95% CI 37.5-67.1) to 92.1% (79.2-97.3) over eight study days (Cochran-Armitage Z=3.08, p=0.002). Specificity improved from 53.6% to 96.3% (Z=3.00, p=0.003), final sensitivity reached 81.8% (52.3-94.9), and final Cohens kappa reached 0.803. In the hands of laboratory scientists, Foldscope microscopy achieved 91.0% sensitivity and 99.3% specificity. Conclusions/SignificanceCommunity-led diagnostic task-shifting for urogenital schistosomiasis control is accurate, feasible, and implementation-ready. Consolidated Framework for Implementation Research-guided analysis demonstrated strong end-user acceptability, with local ownership, collaboration, and trust-building as key implementation facilitators. This approach addresses diagnostic gaps in resource-limited endemic settings with relevance to other community health worker-led strategies. Author SummarySchistosomiasis is a parasitic infection that spreads through contact with freshwater and often goes undetected and untreated for years. Most common in sub-Saharan Africa, the disease damages the bladder and genitourinary tract, increasing risk of infertility, bladder cancer, and HIV transmission. It is most prevalent in rural communities where the snail intermediate host thrives in local water sources used daily for fishing, farming, and bathing. One such area is the Oyan River in Nigeria. Here, we found that barriers to diagnosis and treatment of the illness include distance and transportation. In this study, community health workers diagnosed their neighbors and community members using a low-cost toolkit: a <$2 / 2700 microscope, called the Foldscope paired with a small steel filter card we designed, called the SchistoFilter.. We enrolled 418 people across five villages along the Oyan River in Nigeria and trained eight community health workers to use this toolkit at the point of care. By the fifth community visite, they reached 92.1% accuracy. The study team interviewed community health workers and government officials to contextualize this approach, and they were enthusiastic: The tools can be used with confidence, the training is feasible, and what is most needed is a reliable supply chain and supportive oversight.

Background/aims The World Health Organization (WHO) aims to eliminate schistosomiasis as a public health problem (EPHP) across 78 endemic countries by 2030. However, for low-prevalence settings that reach EPHP, guidance on managing transmission to maintain EPHP or move towards Interruption of Transmission (IoT) is limited, partly due to insufficient evidence on drivers of resurgence. In Uganda, some communities inland from Lake Victoria have achieved EPHP for Schistosoma mansoni but not progressed to IoT. This study explored whether routine, short-range travel to the highly endemic lake could sustain transmission in these settings. Methods We conducted a cross-sectional study in five Ugandan villages ~5 km from Lake Victoria. Parasitological data were collected using Kato-Katz and Point-of-Care Circulating Cathodic Antigen tests, alongside questionnaires on lake travel from 585 individuals aged 1-91 years. A structural causal model estimated the total and direct effects of travel frequency, activity type, water contact duration, and drug treatment history on infection. Bayesian regression models and counterfactual simulations predicted infection under hypothetical interventions. Results Reaching IoT in low-risk villages may be undermined by habitual, short-range travel to high-risk sites, driven by the nature and duration of lake contact. Daily lake travel caused a 1.7-fold increase in odds of infection, while occupational activities caused a 3.4-fold increase compared with no lake activity. Counterfactual analysis showed that removing lake contact duration most reduced infection risk among moderate-frequency travellers, while daily travellers showed smaller changes, and some transmission persisted among individuals with little or no lake contact. Simulations demonstrated that modifying lake contact behaviours could reduce individual infection risk but had limited population-level impact. Conclusion These findings indicate that targeting only high-risk villages or individual behaviours is unlikely to achieve sustained, wide-spread IoT, underscoring the need for integrated control strategies that account for mobility, behaviour, and local transmission ecology.

Background Seasonal malaria chemoprevention (SMC) is a malaria intervention in which antimalarial drugs are administered monthly to children under 5 years of age during the high-transmission season. In the district of Moissala in southern Chad, SMC has been implemented since 2013, with an interruption in 2019, resumption in 2020, and expansion to five rounds of treatment in 2021. Recent World Health Organization (WHO) guidelines allow countries to adapt the timing and number of SMC rounds to local transmission patterns, creating a need to identify optimal strategies for each setting. In this study, we used mathematical modeling for three primary purposes: 1) to estimate the effectiveness of SMC in Moissala from 2018 to 2023, 2) to assess the impact of changes to SMC strategies since 2018, and 3) to determine the optimal SMC strategy in Moissala. Methods and findings We adapted a compartmental, climate-informed malaria transmission model to represent malaria dynamics in the presence of SMC. The model incorporates temperature and rainfall data to capture how climate variability influences malaria transmission over time. It was calibrated to routine surveillance data on malaria cases in children under five years old from 2018 to 2023. Using the calibrated model, we simulated malaria cases under alternative scenarios, including the absence of SMC and variations in the number and timing of SMC rounds. These simulations were then used to estimate the overall effectiveness of SMC, assess the impact of past changes in SMC strategies, and identify the optimal strategy in Moissala. Between 2018 and 2023, SMC reduced malaria cases in children under five by 26% (95% credible interval: 21%, 31%) relative to a scenario without SMC, corresponding to an average of approximately 14400 cases averted each year. The interruption of SMC in 2019 led to an estimated increase of 13600 cases (95% credible interval: 11200, 15800), representing a 31% rise during the high-transmission season. Expanding from four to five SMC rounds in 2021 reduced cases by 7% relative to a four-round schedule, while starting the five-round schedule earlier in June rather than July led to an additional 5% reduction. Overall, the most effective strategy from 2018 to 2023 was a five-round schedule beginning in mid-June. Conclusions Seasonal malaria chemoprevention has substantially reduced malaria incidence among children under five in Moissala. The currently implemented strategy of five rounds of SMC starting in June was estimated to achieve the greatest reduction in cases over the study period. Climate-informed modelling and open-source software can support timely decision-making across settings under changing climate and transmission conditions.

AimsTo evaluate the association between platelet indices and platelet count severity in patients with primary immune thrombocytopenia during routine post-treatment follow-up. MethodsThis retrospective observational study included patients with primary immune thrombocytopenia followed at a single tertiary care center between 2011 and 2025. Demographic and laboratory data were obtained from medical records. Platelet count severity was categorized as less than 30 x 10^9/L, 30 to 100 x 10^9/L, and greater than 100 x 10^9/L. Platelet indices, including mean platelet volume (MPV) and platelet distribution width (PDW), were analyzed using the most recent complete blood count obtained during routine follow-up after treatment initiation. Continuous variables were summarized as median and interquartile range. Comparisons across platelet count categories were performed using the Kruskal-Wallis test with post hoc Mann-Whitney U testing. Correlation analysis and simple linear regression were also conducted. ResultsA total of 243 patients were identified, of whom 232 met the inclusion criteria. Platelet distribution width differed significantly across platelet count severity categories (Kruskal-Wallis p < 0.001) and demonstrated a strong inverse association with platelet count. Mean platelet volume also showed a statistically significant difference across platelet count groups (Kruskal-Wallis p = 0.007), although the association was weaker and less consistent compared with PDW. Regression analysis confirmed a significant association between platelet count and PDW. ConclusionPlatelet distribution width is more closely associated with platelet count severity than mean platelet volume in patients with primary immune thrombocytopenia during routine post-treatment follow-up. PDW may represent a useful adjunctive laboratory parameter when interpreted alongside platelet count in routine clinical practice.

IntroductionAnaemia is one of the most prevalent global public health challenges, particularly among women of reproductive age and children. According to the World Health Organization, anaemia is defined as a hemoglobin concentration below 13.0 g/dL in adult men, 12.0 g/dL in non-pregnant women, and 11.0 g/dL in pregnant women. Hemoglobin measurement therefore plays a critical role in diagnosis, classification, and monitoring of anaemia at both clinical and public health levels. Hemoglobin estimation allows early identification and intervention in at-risk populations. MethodologyA cross-sectional study was conducted at Aniniwaa Medical Centre, Kumasi, involving 100 participants who visited the laboratory for a complete blood count. Venous blood samples were collected aseptically into EDTA tubes and analysed first with the fully automated analyser, followed by the two Hb meters. Data were analysed using Chi-square tests, Bland-Altman plots, and descriptive statistics. ResultsResults showed that the prevalence of anaemia varied across methods: 28% by the analyser, 60% by Urit, and 64% by Mission. Both meters demonstrated 100% sensitivity but lower specificities (55.6% for Urit and 50.0% for Mission). Bland-Altman analysis indicated negative biases (Urit = -1.665 g/dL; Mission = -1.55 g/dL), suggesting both underestimated hemoglobin values compared to the reference. ConclusionThe study revealed that while Hb meters offer convenience and portability for field screening, the fully automated analyser remains more accurate and reliable for diagnosing anaemia in clinical settings.

BackgroundSchistosomiasis remains a major public health challenge in sub-Saharan Africa. Recent World Health Organization (WHO) guidance calls for community-wide treatment and fine-scale data to optimise preventive chemotherapy (PC) strategies, yet the practical implications for resource allocation by health ministries are unclear. MethodsWe analysed epidemiological and cost data from Ethiopia and Zimbabwe to compare survey designs and five implementation scenarios. Scenarios varied by data source, administrative unit of implementation, WHO guidance on PC strategies. Outcomes were target population, praziquantel needs, and delivery costs. ResultsGeostatistical surveys reduced sample size by up to 90% and survey costs by [&ge;]72% compared with a design-based approach, while increasing spatial coverage. Applying updated WHO guidance expanded eligibility to pre-school-aged children and adults, and in one scenario increased treatment needs by 72% in Ethiopia and 262% in Zimbabwe. Correspondingly, praziquantel requirements and delivery costs were driven primarily by expanded age eligibility rather than geographic coverage. ConclusionsGeostatistical surveys provide substantial efficiency gains for impact assessments, enabling cost-efficient, granular targeting. However, implementing 2022 WHO guidance was the dominant driver of increases in programme scope and resource needs, underscoring the importance of accurate fine-scale data to guide efficient planning and budgeting toward elimination goals. Author summarySchistosomiasis control programmes are required to use finer-scale data and updated World Health Organization (WHO) guidance to decide where and how often to deliver praziquantel. We analysed national schistosomiasis data and programme costs from Ethiopia and Zimbabwe to compare different approaches to impact assessment surveys and to estimate how treatment needs change under alternative decision rules.We found that model-based geostatistical surveys can reduce the number of people that need to be sampled and the cost of surveys while providing more detailed information for planning at sub-district level. However, when we applied the 2022 WHO schistosomiasis guidance, expanded eligibility (including adults and pre-school-age children and a lower threshold for community-wide treatment) substantially increased the number of people needing treatment. In our scenarios, expanded eligibility drove much larger increases in praziquantel requirements and delivery costs than changes in geographic coverage. Our findings help health ministries to anticipate the operational and budget implications of updated guidance and highlight why accurate fine-scale data are essential for equitable and realistic planning toward elimination.

BackgroundLymphatic filariasis remains a public health concern in many endemic regions, where chronic disease persists despite substantial reductions in transmission. In Ghana, more than two decades of mass drug administration have significantly reduced disease prevalence and transmission; however, chronic manifestations and gaps in community understanding continue to be reported in parts of the north. This study assessed infection status, chronic morbidity burden, and community knowledge in a rural setting in northern Ghana approaching elimination. Methodology/Principal FindingsA community-based cross-sectional study was conducted in Birifor, northern Ghana, from October 2024 to January 2025. A total of 261 residents aged ten years and above were selected using random sampling. Data collection included structured questionnaires, clinical examination for chronic disease, and night blood microscopy for the detection of infection. No microfilariae were detected (0/261; 0%). However, chronic lymphoedema was identified in five individuals (1.9%), all aged over 40 years. Awareness of the disease was high (95.8%), yet only 39.5% of participants demonstrated good community knowledge and perceptions and self-reported preventive practices. Misconceptions regarding transmission, particularly beliefs that the disease is hereditary or caused by spiritual factors, were common. Participation in mass drug administration was high (93.1%). Despite this, chronic disease imposed a notable socioeconomic burden: all affected individuals reported loss of income, and 60% reported additional household income loss due to caregiving. Conclusions/SignificanceThese findings suggest that transmission in the study area is likely very low, although residual infection cannot be excluded; however, chronic disease and gaps in community knowledge persist. Strengthening morbidity management, improving community education, and providing support for affected households are essential. Sustained surveillance and integrated approaches will be critical to prevent resurgence and support long-term elimination efforts. Author SummaryLymphatic filariasis, also known as elephantiasis, is a mosquito-borne disease that can cause long-term swelling of the legs, arms, or genitals. Global efforts have greatly reduced its occurrence, especially through repeated mass drug administration to afflicted communities. However, many people continue to live with chronic swelling caused by past infections, which can affect their ability to work and participate fully in daily life. In this study, we examined the current situation of lymphatic filariasis in a rural community in northern Ghana that has received many years of treatment. We tested people for active infection, assessed signs of chronic disease, and explored what community members know and believe about the disease. We found no evidence of active infection, suggesting that transmission is now very low. However, some individuals were still living with chronic swelling and reported loss of income, while households also experienced financial strain due to caregiving. Although most people had heard of the disease, many did not fully understand how it is transmitted. Our findings show that reducing transmission alone is not enough. Continued education, community support, and access to care are needed to address the long-term impact of the disease and support ongoing elimination efforts.

BackgroundDiarrheal disease is the second leading cause of under-five mortality and morbidity in Sub-Saharan Africa. The World Health Organization (WHO) has developed treatment guidelines to support clinicians in the management of pediatric diarrhea; however, adherence to, and the impact of, these guidelines are not well described in low- and middle-income countries. MethodWe conducted a secondary analysis of data from the Enterics for Global Health study to determine whether adherence to WHO diarrhea management guidelines, specifically zinc supplementation and antibiotic administration (when appropriate), shortened the duration of diarrhea among children aged 6-35 months who presented to selected health facilities with diarrhea. ResultsThis analysis includes 9,397 children aged 6 to 35 months with diarrhea enrolled across all seven EFGH sites. The majority (63.3%) of participants were under 18 months of age and 54.4% were male; 1,214 children (12.9%) presented to care with dysentery. Zinc was frequently administered (96.6%), with over 10 days of mean prescribed treatment duration. Of 5,061 children (53.9%) offered antibiotics, 3,082 (60.9%) received a WHO recommended regimen. Among participants who presented with dysentery, 67.6% were prescribed a WHO-recommended antibiotic. Among participants with watery diarrhea without dysentery, 72.4% were not prescribed any of the recommended antibiotics and were thus considered guideline-adherent. Overall, 6,302 (67.1%) children received guideline-adherent care when combining the zinc and appropriate antibiotic use indicators. In children with dysentery, providing WHO-recommended antibiotics was associated with 1.08 (95% CI: 0.53, 1.53) fewer days of diarrhea than those with dysentery who did not receive antibiotics. Children who were given 10+ days of zinc had on average 0.36 (95% CI: 0.03, 0.70) fewer days of diarrhea. ConclusionWe found that two-thirds of children in this study received guideline adherent care in terms of zinc and appropriate antibiotic use for the treatment of childhood diarrhea, and that adherent treatment was associated with shorter duration diarrhea.

Although the co-occurrence of diarrhea and malnutrition is well documented, research has largely focused on the acute management of diarrheal illness. Despite its importance, longitudinal evidence characterizing post-diarrheal recovery trajectories is sparse. We sought to characterize post-diarrheal nutritional recovery trajectories among children aged 6-35 months who were malnourished at enrollment using data from the Enterics for Global Health (EFGH) Shigella Surveillance study (2022-2024). EFGH enrolled children aged 6-35 months presenting with medically-attended diarrhea and followed them at 4 weeks and 3 months post-enrollment. This analysis included children with baseline wasting, stunting, or underweight (z-score < -2) and complete anthropometric follow-up. Latent class mixed-effects models were used to identify distinct post-diarrheal growth trajectories based on changes in anthropometric z-scores over time. Multinomial modified Poisson regression models examined associations between baseline factors and trajectory membership. Among 9,480 enrolled children, 16.5% (n=1,561) were wasted, 22.7% (n=2,155) stunted, and 21.0% (n=1,994) underweight at baseline. Wasting showed greater recovery potential (80.8%) compared with stunting (38.5%) and underweight (40.3%). Recovery was shaped by factors across multiple levels. Clinical severity markers ( prolonged diarrhea, dehydration, and hypoxemia) increased the risk of nutritional failure. Age also influenced outcomes: infants were more likely to worsen, whereas older toddlers more often experienced stagnation. Interventions including exclusive breastfeeding, oral rehydration therapy, appropriate antibiotics, and zinc supplementation, improved outcomes, while unimproved sanitation undermined recovery. These findings highlight the need for integrated strategies combining infection control, nutritional rehabilitation, and water, sanitation, and hygiene interventions tailored to the childrens developmental stage. Key MessagesO_LIPost-diarrheal nutritional recovery is highly heterogeneous, with wasting showing the greatest potential for improvement, while stunting and underweight often result in persistent growth stagnation. C_LIO_LIBaseline anthropometric deficits alone are insufficient to predict recovery, highlighting the need for dynamic monitoring and individualized management. C_LIO_LIInfants are particularly vulnerable to acute nutritional deterioration, while older toddlers frequently experience growth stagnation. C_LIO_LIModifiable protective factors including exclusive breastfeeding, ORS, zinc, and appropriate antibiotics, improved outcomes, whereas poor sanitation undermined recovery. C_LIO_LIIntegrated strategies, tailored to a childs developmental stage, combining clinical care, nutrition, and environmental interventions are critical to support sustained child growth and development. C_LI

Background Nepal has set a goal to eliminate lymphatic filariasis (LF) by 2030. As of 2024, Nepal has stopped the mass drug administration (MDA) in 56 of the 64 endemic districts and completed two rounds of MDA in six districts with persistent LF ([&ge;]2% antigen prevalence) using the three-drug regimen of Ivermectin, Diethylcarbamazine, and Albendazole (IDA), exceeding 65% coverage. We subsequently conducted an Epidemiological Monitoring Survey (EMS) to assess the impact of the MDA in reduction of LF infection prevalence below the transmission threshold and examine the factors associated with it. Methods We conducted a cross-sectional EMS nine months after MDA in 12 evaluation units (EUs) across six districts, with two sites per EU. We recruited a total of 7,343 individuals aged [&ge;]20 years, sampled using multi-stage sampling, ensuring at least 300 blood samples collected per site. We collected data on demographics and MDA participation. We performed the LF antigen testing for all participants, followed by night blood microfilariae testing in antigen-positive individuals. Statistical analyses included non-parametric tests, Chi-square and Fishers Exact tests, and multivariable logistic regression to assess outcomes after adjusting for potential confounders. Results Nine of 12 evaluation units (EUs) recorded <1% microfilaremia, meeting the WHO threshold for passing EMS, while three EUs failed with [&ge;]1% prevalence in at least one site. Antigen and MF prevalence were 4.47% and 0.34%, respectively (ratio 13:1). Both Antigen and MF prevalences were significantly associated with female sex (AOR= 0.564, 95% CI: 0.441-0.721 and AOR = 0.326, 95% CI: 0.129-0.826 respectively) and participation in the most recent MDA round (AOR = 0.477; 95% CI: 0.385-0.591 and AOR = 0.089; 95% CI: 0.017-0.464 respectively). MDA uptake was influenced by age (<40 years, AOR = 0.72; 95% CI: 0.653-0.793), sex (female, AOR = 1.438; 95% CI: 1.29-1.603), cross-border residence (AOR = 0.616; 95% CI: 0.558-0.681), and occupation (agriculture and housewife, AOR = 1.144; 95% CI: 1.008-1.298). MF prevalence was also associated with younger age (<40 years, AOR = 0.211; 95% CI: 0.071-0.626). Conclusion The survey indicates progress toward LF elimination, with nine of twelve EUs achieving WHOs <1% microfilaremia threshold after two rounds of IDA-MDA. However, transmission persists in three sites, likely linked to poor MDA participation among specific subgroups--particularly males, younger adults, and cross-border populations. Strengthening MDA coverage and compliance across all demographic and occupational groups, with special focus on border areas, is essential to achieve LF elimination in Nepal.

BackgroundMalaria during pregnancy contributes to maternal anemia and adverse birth outcomes in sub-Saharan Africa. This study assessed seasonal malaria burden among pregnant women in Cape Coast, Ghana, during 2019-2021. MethodsRetrospective surveillance analysis of pregnant women attending Cape Coast Teaching Hospital. Malaria was diagnosed by microscopy, and hemoglobin levels were measured. Seasonal trends and demographic characteristics were analyzed using descriptive statistics and chi-square tests. ResultsAmong 334 pregnant women, 294 (88.0%) were tested for malaria. Overall prevalence was 2.04% (6/294; 95% CI: 0.75-4.41%), exclusively Plasmodium falciparum. Prevalence was higher in the dry season (2.26%) than wet season (1.27%), with 67% of cases in Q4 2021. Mean age was 35.0 {+/-} 5.1 years, and 79.4% presented in third trimester. Anemia (Hb <11 g/dL) affected 41.3% of participants despite low malaria prevalence. Sensitivity analyses confirmed robust estimates across analytical approaches. ConclusionsLow malaria prevalence reflects progress toward Ghanas elimination goals, though the unexpected dry season pattern warrants investigation. High anemia burden despite low malaria indicates non-malarial causes require attention. Year-round screening and comprehensive antenatal care remain essential as Ghana transitions toward elimination.