Tropical Medicine & International Health

Sickle cell disease (SCD) is associated with chronic systemic morbidity that extends beyond acute crises. However, data describing the clinical and laboratory adolescents and young adults with SCD at steady state in sub-Saharan Africa are limited. We described clinical and laboratory characteristics of adolescents and young adults with SCD at steady state in Uganda. We conducted a hospital-based cross-sectional study of 60 adolescents and young adults with SCD in steady state at Mulago National Referral Hospital. Descriptive statistics were used to summarize participant characteristics and medication use. The mean age was 16.5 {+/-} 3.3 years, and 34 (56.7%) participants were female. Mean hemoglobin was 9.1 {+/-} 2.2 g/dl. Mean systolic and diastolic blood pressures were 107.9 {+/-} 15.5 mmHg and 60.3 {+/-} 12.6 mmHg, respectively; mean heart rate was 89.5 {+/-} 15.5 beats/min. Fifty-two (86.7%) participants reported using hydroxyurea. These observations show that adolescents and young adults with SCD at steady state exhibit hematologic abnormalities and distinctive hemodynamic profiles that underscore substantial chronic subclinical abnormalities that extend beyond acute complications.

BackgroundCampylobacter is a major cause of childhood diarrhoea across Africa and asymptomatic carriage is frequently reported, however risk factors for Campylobacter presence remain poorly defined. This meta-analysis aimed to calculate the pooled prevalence of Campylobacter in diarrhoeic and non-diarrhoeic stool, assess its association with diarrhoea, identify risk factors for Campylobacter presence and antimicrobial resistance (AMR) patterns. MethodEnglish language studies on Campylobacter in children (<18 years) in Africa were searched. Prevalence of Campylobacter and AMR, Odds Ratios (OR) for Campylobacter presence in diarrhoeic stool and risk factors for Campylobacter were estimated. Heterogeneity was assessed using I2 and bias assessed via funnel plots and Eggers test. ResultsA total of 168 studies were included in the meta-analysis. The pooled prevalence of Campylobacter in diarrhoeic stool was 11.25% (9.41-13.23%), in non-diarrhoeic stool 12.56% (7.79-18.27%), and mixed stool types 33.47% (20.53-47.81%). The OR for Campylobacter presence in diarrhoeic stool versus non-diarrhoeic stool was 1.95 (95% CI: 1.62-2.33). Age affected the OR with children 0-6 months old having an OR 2.57 (1.74-3.81), 7-12 months old an OR 1.60 (1.07-2.40), 13-24 months old an OR 1.02 (0.68-1.52) and 25-60 months old an OR 1.76 (0.77-4.05). Risk factors for Campylobacter presence in stool were children living in rural areas (pooled Adjusted Odds Ratio (pAOR) = 2.59 95% CI 1.43-4.69) and having contact with animals (pAOR 4.28 95% CI: 2.40-7.61). AMR prevalence ranged from 54.85% for ampicillin to 9.85% for chloramphenicol. Heterogeneity was high across all analyses. ConclusionCampylobacter prevalence is high in symptomatic and asymptomatic children across Africa. Contact with animals and living in an urban environment are risk factors for Campylobacter presence. Risk factor identification in the African context would be strengthened with standardized risk factors. Further research is needed to clarify the public health significance of asymptomatic carriage. What is already known on this topic - Campylobacter is a significant cause of diarrhoea in children and asymptomatic carriage is common. However, the burden of asymptomatic carriage and risk factors are not well understood in Africa. What this study adds - This meta-analysis highlights the high burden of asymptomatic Campylobacter carriage, its relation to age, and identified risk factors for Campylobacter in children in Africa. How this study might affect research, practice or policy - Standardising risk factor assessments can guide future control strategies. Further research into the impact of asymptomatic carriage is warranted.

BackgroundDengue virus (DENV) is an increasingly recognized cause of febrile illness in sub-Saharan Africa, yet its epidemiology in Nigeria remains incompletely characterized due to fragmented surveillance and diagnostic variability. We conducted a systematic review and meta-analysis to estimate marker-specific seroprevalence and to evaluate geographic variation, seasonal patterns, and environmental risk factors associated with DENV infection in Nigeria between 2014 and 2024. MethodsFollowing PRISMA guidelines, we searched PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and African Index Medicus for studies reporting laboratory-confirmed dengue infection in Nigeria. Random-effects meta-analysis was used to estimate pooled prevalence and pooled odds ratios (ORs) with 95% confidence intervals (CIs). Between-study heterogeneity was quantified using the I{superscript 2} statistic. Subgroup analyses explored variation by diagnostic marker and geographic region. ResultsThirty-three studies met inclusion criteria. The pooled random-effects IgM seroprevalence was 20.9% (95% CI: 13.0-30.1; I{superscript 2} = 98.6%), while pooled IgG seroprevalence was 19.9% (95% CI: 11.6-29.7; I{superscript 2} = 97.7%). NS1 antigen positivity was 8.9% (95% CI: 2.2-19.4), and PCR-confirmed infection was 7.0% (95% CI: 1.2-16.2; I{superscript 2} = 25.8%). Significant differences were observed across diagnostic markers (p = 0.0002). Regional subgroup analysis demonstrated statistically significant geographic variation for both IgM (p = 0.0179) and IgG (p = 0.0030), with highest pooled prevalence observed in the Southeast and lowest in the Southsouth region. Environmental and behavioral exposures were strongly associated with seropositivity, including proximity to refuse dumpsites (OR = 9.39, 95% CI: 7.44-11.84), non-use of mosquito nets (OR = 8.70, 95% CI: 5.73-13.21), malaria positivity (OR = 5.54, 95% CI: 3.84-7.98), and open household water storage (OR = 2.18, 95% CI: 1.65-2.89). All four DENV serotypes were identified across reporting studies. Transmission intensity increased during rainy seasons. ConclusionsDengue virus transmission in Nigeria is widespread and geographically heterogeneous, with evidence of both recent and cumulative exposure. Strong associations with modifiable environmental and household-level factors underscore the importance of integrated vector control and improved diagnostic capacity. Enhanced surveillance and climate-informed public health strategies are essential to mitigate future outbreak risk. Author SummaryDengue is a mosquito-borne viral infection that is increasing globally but remains underrecognized in much of sub-Saharan Africa. In Nigeria, many febrile illnesses are presumed to be malaria, which can obscure the contribution of dengue virus infection. In addition, limited surveillance systems and inconsistent diagnostic testing have made it difficult to determine the true extent of dengue transmission. To address this gap, we conducted a systematic review and meta-analysis of studies published between 2014 and 2024 to evaluate patterns of dengue exposure, geographic variation, and environmental risk factors in Nigeria. We found evidence of both recent infection (IgM antibodies) and past exposure (IgG antibodies) across multiple regions of the country. Transmission intensity varied geographically, with higher levels observed in some regions, particularly in the Southeast, and lower levels in the Southsouth. Infection risk increased during the rainy season, consistent with enhanced mosquito breeding conditions. Living near refuse dumpsites, storing water in open containers, not using mosquito nets, and having malaria were all associated with higher odds of dengue infection, highlighting the importance of household and environmental conditions in shaping transmission risk. All four dengue virus serotypes were identified, indicating sustained viral circulation. These findings demonstrate that dengue virus infection is widespread in Nigeria and influenced by modifiable environmental and behavioral factors. Improving diagnostic capacity, strengthening routine surveillance, and implementing targeted vector control strategies are essential to reduce transmission and improve outbreak preparedness.

BackgroundAntimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi. MethodsA total of 504 antibiotic dispensing events were prospectively recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and {chi}2 tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics. ResultsOf the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with broad-spectrum agents--including fluoroquinolones and cephalosporins--commonly used for lower respiratory tract infections, urinary tract infections, and sepsis. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases. ConclusionsOTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.

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.

BackgroundOnchocerciasis elimination programs increasingly rely on tests that detect antibodies to the Ov16 antigen, yet the performance of currently available rapid tests remains uncertain. The existing Ov16 rapid test shows inconsistent sensitivity when used on whole blood and does not consistently meet international thresholds for mapping or stopping mass drug administration. Two new Ov16 rapid tests have recently been developed, but their accuracy has not been fully evaluated using methods that account for the lack of a true reference standard. Methodology/Principal FindingsWe pooled data from three field studies conducted in Mozambique, Ghana, and Benin in 2023 to evaluate two novel Ov16 rapid tests alongside the existing test. A Bayesian latent class model was used to estimate sensitivity and specificity without assuming that any test was perfect. Across all model specifications, the GADx rapid test showed the highest sensitivity, consistently exceeding the 89% threshold recommended for decisions to stop mass drug administration (posterior medians: 92.0%-92.8%). The SD Bioline test met this threshold in most models but showed lower sensitivity in one model (83.2%). The DDTD test demonstrated lower sensitivity overall (86.6%-88.4%). Specificity estimates were uniformly high for all tests but remained below the recommended threshold of 99.8% (highest median: 98.8%). Alternative definitions of a positive result for the multi-antigen DDTD test did not materially change its performance. Conclusions/SignificanceThe two novel rapid tests showed improved sensitivity relative to the existing test, particularly the GADx test. However, none of the tests achieved the specificity level needed to support decisions to stop mass drug administration on their own. These findings highlight the need for improved diagnostic tools or confirmatory testing strategies as countries work toward onchocerciasis elimination. Author SummaryIn this study, we evaluated three rapid tests used to detect exposure to the parasite that causes river blindness. These tests are important tools for country programs that are trying to eliminate the disease and decide when to stop giving communities preventive treatment. One challenge is that there is no perfect test to compare new tools against. To address this, we combined data from studies in Mozambique, Ghana, and Benin and used a statistical approach that estimates test accuracy without relying on a single reference test. We found that one of the new tests, made by GADx, identified people with exposure more accurately than the others. The existing test and the DDTD test showed lower accuracy. All three tests correctly identified most people who were not exposed, but not at the very high level needed for programs to confidently stop treatment. Our results show that while new rapid tests are improving, more work is needed to create tools that are accurate enough for elimination decisions. This information can help guide public health programs as they work toward ending river blindness.

IntroductionThe coverage of access to basic drinking water and sanitation facilities in India was estimated to be 93% and 60%, respectively, in 2017. The monitoring of the burden of diarrhoeal illnesses, especially in children, remains important to assess the impact of the expansion of water and sanitation (WaSH) in the Indian setting. This study aimed to estimate the burden of diarrhoea in an established longitudinal pediatric cohort in an urban settlement of Vellore in South India. MethodsThe Surveillance for Enteric Fever in India (SEFI) cohort established in an urban settlement of Vellore, south India, enrolled 6760 children aged between 6 months and 15 years. The cohort was followed up for typhoid and paratyphoid fever between 2017 and 2019. Field research assistants contacted caregivers of these children weekly to elicit any diarrhoeal illness in the child in the preceding week. As a part of SEFI environmental surveillance, drinking water samples from the study households were tested for coliforms. Sociodemographic characteristics, including source of drinking water, sanitation and hygiene practices, were collected. Incidence of diarrhoea was estimated and expressed as the number of diarrhoeal episodes over child-years of observation (CYO). Poisson regression analysis was performed to identify predictors of diarrhoeal episodes. ResultsThe estimated incidence of diarrhoea in the 6501 children followed up between November 1, 2017, and October 31, 2019, was 31.1 episodes per 100 CYO, with children in the age group of 6 months and <5 years having a higher incidence of diarrhoea than those aged between 5 and 15 years (58.6 versus 22 episodes per 100 CYO). Of the 6467 children with information on WaSH available, 5812 (89.9%) used the public distribution system for drinking water. Of the 1804 drinking water samples tested, 1346 (74.6%) had coliform counts >10,000/100 mL. Only about one-third of the cohort (n=2293, 35.5%) lived in households with access to improved sanitation. Multivariable analysis showed that children aged <2 years, residing in crowded settlements, using the public distribution system for drinking water and from households with poor hygiene practices related to excreta disposal of under-five children had a higher risk for diarrhoea. ConclusionApproximately 8 in 10 children in urban Vellore lack access to safely managed drinking water, and thereby, are at a high risk for diarrheal illnesses, especially in the under-5 children. With rapidly expanding urbanisation in the Indian setting, it is pertinent that emphasis be laid on robust planning and provision of safely managed water and sanitation.

The World Health Organization recommends biannual azithromycin mass drug administration (MDA) to infants aged 1-11 months to reduce mortality, following promising results from trials in West Africa. High coverage seen in well-resourced trials may decline as the intervention transitions to a real-world program. As a result, the most vulnerable children facing the highest risk of mortality may be missed. We aimed to identify predictors of non-participation in an azithromycin MDA program to inform programmatic delivery strategies to improve coverage. We conducted a coverage evaluation survey after azithromycin MDA to children aged 1-11 months in Nigers Tahoua region. Data collection teams visited households to assess caregiver-reported participation, reasons for participation and non-participation, and adverse events. Mixed effects logistic regression models were used to analyze community-, household-, and child-level predictors associated with non-participation in azithromycin MDA. Among 40 communities with 811 unique households and 871 children ages 2-12 months old included in analyses, 76% of eligible children received treatment based on caregiver report compared to 96% community health worker-reported coverage. The most frequently stated reasons for non-receipt of treatment were absence (34%), nobody coming to the house (31%), and not receiving enough information (17.2%). In an adjusted model, older children experienced higher odds of receiving treatment (aOR 1.22, 95% CI 1.15 - 1.30, P [&le;] 0.0001), as did children living in more densely populated areas (aOR 1.15, 95% CI 1.04 - 1.28, P = 0.01). Adverse events were reported among 6.8% of children who received treatment, with fever being the most reported symptom. Strengthening community sensitization and preparation activities before MDA is essential to address common reasons for non-participation. Future research to understand why younger children and those living in sparsely populated communities were less likely to be included may help target specific interventions in these populations.

BackgroundMalaria vector control using indoor residual spraying (IRS) is a key intervention in the fight against malaria globally. However, IRS is faced with several challenges limiting wide scale deployment especially in sub-Saharan Africa. This study explored community experiences on implementation of IRS using clothianidin-deltamethrin, and pirimiphos-methyl insecticides in west Nile region of Uganda. MethodsUsing a phenomenological design were individuals involved in the implementation of IRS were purposively included in the study. In-depth interviews were conducted using an interview guide. The interviews were conducted in both the local language of the area (Aringa) and English whenever appropriate. All interviews were audio recorded and transcribed verbatim. The transcripts were then analyzed using thematic analysis using Nvivo ver 14.0 software. ResultsA total of 30 in-depth interviews were conducted. Majority, 60% (18/30) of the study participants were females. The themes that emerged included coverage of the household with the spray, practices of stakeholders, perceptions regarding insecticides, opportunities, and challenges facing implementation of IRS. Perception on effectiveness, involvement of different stakeholders including local leaders, religious leaders and training of spray teams helped enhance acceptance. While smearing or covering of sprayed walls, lack of transparency in recruitment and payment of spray operators, removal of house items, and shortage of spray supplies threaten scaling up of IRS implementation. ConclusionCommunities were highly receptive towards IRS for malaria control with most study participants being positive on its effectiveness. Training of spray operators, involvement of different stakeholders, community compliance with local authorities, and involvement of social behavior change communication (SBCC) help enhance implementation of IRS. However, the deployment faced some challenges including inadequate supplies, removal of house items, and difficulty moving spray materials in the field. The Ministry of health and implementing partners should prioritize strengthening timely community engagement prior to IRS deployment.

IntroductionMalaria research in Zambia has largely focused on pregnant women and children under five, yet adults also play a critical role in sustaining transmission. This study assessed the prevalence and factors associated with malaria among adults aged [&ge;]18 years attending Chongwe District Hospital. MethodologyThe study used an analytical cross-sectional study design. Data was collected using a structured questionnaire capturing socio-demographic information, including age, sex, education level, occupation, and socio-economic status. Environmental and behavioural factors, such as water source and use of insecticide-treated nets (ITNs), were also assessed. Malaria infection was tested using rapid diagnostic tests (RDTs). Data was analysed using SPSS version 26, it was summarised using frequencies and percentages. Further, hypothesis tests such as Chi-square and Fishers exact test were done on categorical variables and multivariable logistic regression was used to test for associations. ResultsA total of 134 participants were enrolled in the study, and consisted of 73 females (54.5%) and 61 males (45.4%). The study revealed an adult malaria prevalence of 14.2% among those who visited the health facility. Those with low education were associated with increased odds (aOR 5.55, P-value 0.048) of malaria compared to those with secondary education. Other variables such as gender, age, occupation, use of ITNs and water source were not statistically significant. ConclusionThis study found that the prevalence of malaria among adults attending Chongwe district hospital for various ailments was higher than the expected prevalence of malaria in Lusaka district. The study further found that malaria was higher among those with lower education compared to those with higher education.

AbstractsO_ST_ABSBackgroundC_ST_ABSAccurate dengue forecasting is vital for public health preparedness. Despite a surge in forecasting approaches, a quantitative ranking of the relative performance and practical utility of dengue forecasting is lacking. MethodsA systematic review and Network Meta-Analysis (NMA) of studies comparing dengue forecasting methods (2014-2024) was conducted. Models were categorised into five groups: Time Series, Deep Learning (DL), Machine Learning (excluding DL), Hybrid, and Ensembles. NMA was applied to the logarithm of the most common forecast error metric to rank relative performance--an "Implementability Score" quantified analyst and data requirements, and computational costs. Results59 studies were included. NMA of Root Mean Squared Error identified k-Nearest Neighbour (k-NN) models as achieving the highest predictive accuracy, followed closely by Vector Autoregression, Kalman Filtering, Generalised Linear Model and Autoregressive Neural Network (ARNN). While DL models showed high potential, they scored lowest in implementability due to poor interpretability and high data requirements. Most studies utilised meteorological covariates, with significant gaps in the use of socio-economic and entomological predictors. ConclusionsAlthough there was some trade-off between accuracy and implementability, traditional statistical models were often comparable in accuracy to machine learning approaches, with advantages in interpretability and data needs. Under-explored areas for future research include the use of ensemble models and the use of socio-economic and entomological data. RegistrationPROSPERO CRD420251016662. Author SummaryDengue is a critical global health threat affecting the worlds population. While many forecasting models exist to help officials prepare for outbreaks, there has been no standardised way to compare their performance. This leaves health experts in resource-limited areas uncertain about which tools are truly reliable or easy to use under their specific local conditions. We conducted a network meta-analysis of studies comparing dengue forecasting methods accuracy, grouping them into five categories: Machine Learning, Deep Learning, Time Series, Ensemble, and Hybrid. Beyond ranking their accuracy, we developed an "Implementability Score" to evaluate the practical feasibility of each model, accounting for technical complexity, data requirements, and software accessibility. Our analysis identified the top-performing models. Notably, traditional statistical models often performed as well as complex Deep Learning algorithms. While advanced models show potential, they are often difficult to implement or explain to decision-makers. There is no "one-size-fits-all" solution; the best model depends on capacity and data in each setting. This study provides a roadmap for public health officials to select tools that are both accurate and feasible.

IntroductionConfidence in caregivers assessment of fever in their children, compared to thermometer readings, could help guide prompt care seeking and appropriate treatment in settings where access to reliable diagnostic tools is limited. Here, we evaluated the accuracy and drivers of caregiver-reported hot-to-touch fever compared to digital thermometry among children in the Enterics for Global Health (EFGH) Shigella surveillance study. MethodsChildren aged 6-35 months with medically attended diarrhea (MAD) enrolled in Kenya, Malawi, Bangladesh, and Peru between August 2022 and August 2024 were included. We trained caregivers to assess and record daily hot-to-touch (subjective fever measurement) and digital (thermometer) axillary temperature (fever defined as [&ge;]37.5{degrees}C) readings over for 14 days post-enrolment. We calculated site specific and overall accuracy of hot-to-touch compared to thermometer-measured fever and used multivariable Poisson regression to identify factors associated with accurate detection. ResultsThe accuracy of caregiver-reported hot-to-touch assessment ranged from 62.1% to72.0% overall and was highest in Bangladesh (83.2%-96.1%) and lowest in Malawi (47.4%-53.4%) over the 14 day assessment period. Accuracy was higher in children with chest indrawing (aPR=1.29, 95% CI: 1.04-1.60) and low respiratory rate (aPR=1.20, 95% CI: 1.11-1.29) and in children from wealthier households (Quintile 5: aPR=1.21, 95% CI: 1.01-1.44). Accuracy was lower among caregivers from households with [&ge;]3 children (aPR=0.88, 95% CI: 0.79-0.99) and for children with low heart rate (aPR=0.76, 95% CI: 0.61-0.94). ConclusionSuboptimal accuracy of hot-to-touch compared to digital thermometers in detecting fever in this study supports the need for digital thermometer use and context-specific strategies to enhance early detection of fever, particularly in communities living in resource-poor settings.

IntroductionNeglected Tropical Diseases (NTDs) comprises over 20 preventable infectious illness that disproportionately affecting low- and middle-income countries, including Ethiopia. Although national control initiatives have expanded since 2013, evidence on recent national and subnational burden trends remains limited. This study aimed to assess trends in mortality and disability-adjusted life years attributable to neglected tropical diseases in Ethiopia at national and subnational level from 1990 to 2023. MethodsWe used data from the Global Burden of Disease 2023 study to estimate age-standardized and age-specific mortality and Disability-Adjusted Life Years (DALYs) attributable to neglected tropical diseases. Results are presented as absolute numbers and age-standardized rates (per 100,000 population), disaggregated by disease, sex, region, and year from 1990 to 2023, with 95% uncertainty intervals. ResultIn 2023, the national age-standardized DALY rate for all NTDs was 708.3 where, schistosomiasis accounted the largest share (228.7; 95% UI: 145.4-375.0), followed by other NTDs (104.4; 95% UI: 59.7-171.4), trachoma (100.0; 95% UI: 67.4-144.9), and rabies (78.3; 95% UI: 9.5-257.9), together contributed to over three-quarters DALYs due to NTDs. The national age-standardized mortality rate was 5.98 mostly contributed by schistosomiasis (2.01; 95% UI: 1.72-2.38) and rabies (1.40; 95% UI: 0.18-4.58). Substantial regional variation was observed, with Addis Ababa recording the lowest (200.5 and 1.2) and Afar the highest (860.3 and 8.9) DALYs and mortality rate due to all NTDs respectively. Between 1990 and 2023, DALYs and mortality rate declined by 87.5% and 91.6%, respectively, although declines slowed after 2010. During 2010-2023, increases in DALYs and mortality due to schistosomiasis were observed in Addis Ababa (+25%) and Harari (+13%), while trachoma increased in Oromia (+9%). ConclusionNTDs continue to impose a substantial burden of disability and mortality in Ethiopia, with pronounced regional disparities and a slowing pace of progress in recent years. The observed stagnation or increases in specific NTDs at the subnational level highlight the need for sustained monitoring and targeted control strategies.

BackgroundIrrational use of antibiotics is a major factor in antibiotic resistance and poor patient outcomes. Globally, 50% of antibiotics are prescribed inappropriately, in Sub-Saharan Africa alone, antimicrobial resistance was linked to approximately 1.27 million deaths in 2019, mainly due to the misuse and overuse of antibiotics. In this study, we collected data to understand the prescribing patterns and factors associated with irrational antibiotic use among hospitalized patients. MethodologyA hospital-based observational cross-sectional study was conducted between October and December 2024 among 655 patients. The study was conducted at a University Teaching Hospital in Rwanda. ResultsAmong 655 inpatients, 1,265 antibiotics were prescribed, equivalent to 1.95 per patient. Out of 1463 inpatients in the hospital, 44.76% received at least one antibiotic. The most prescribed antibiotics were Ceftriaxone (34.6%), followed by Flagyl (20%). The majority of antibiotics (83%) were prescribed in injectable forms. Culture and antibiogram testing were performed in 23.20% of cases, this was associated with deviation from national Standard Treatment Guidelines (STGs) adherence (Adjusted OR = 0.07, CI: 0.03-0.14, p = 0.001). there is a significant likelihood of non-adherence to STGs in internal medicine (Adjusted OR=0.25, CI: 0.10-0.62, p = 0.003) and pediatrics (Adjusted OR=0.33, CI: 0.16-0.67, p = 0.002). ConclusionIn this study, we found improper use of antibiotics, deviating from WHO-endorsed standards and a high empiric prescription of antibiotics. Deviation from national STGs was highly associated with empirical prescription. Improving adherence to diagnostic support and antimicrobial stewardship programs could address the problem.

Anaemia remains a significant public health issue in India, despite five of control programs. Anaemia affects 52-67% of target populations in India despite five decades of control programmes. We conducted a review of reviews and meta-analyses (SRMAs) of regional studies to evaluate daily versus intermittent oral iron and iron-folic acid (IFA) supplementation across age groups. We identified 21 SRMAs (17 high-quality, 4 moderate-quality) and 44 regional studies from India and South Asia. IFA prophylaxis consistently improved haemoglobin levels (4.1-8.8 g/L increase) and ferritin concentrations, reducing anaemia risk by 23-70% across all age groups. IFA prophylaxis consistently improved haemoglobin levels (4.1-8.8 g/L increase) and ferritin concentrations, reducing anaemia risk by 23-70% across all age groups. Daily and intermittent regimens showed similar haematological outcomes in children, adolescents, and women of reproductive age. Among pregnant women, daily supplementation was superior for haemoglobin and ferritin levels, though intermittent dosing had fewer gastrointestinal side effects. These findings support weekly IFA supplementation for non-pregnant beneficiaries as an evidence-based strategy, even in settings where anaemia prevalence exceeds 40%. Further research on long-term safety in non-iron-deficient populations is needed.

BackgroundIndoor residual spraying (IRS) remains one of the integral tools for malaria control and elimination globally. However, communities have mixed perceptions on the usefulness IRS and other malaria control measures. This study explored community perceptions on the effectiveness and safety of insecticides used in indoor residual spraying for malaria control in Uganda. MethodsA qualitative study employing a phenomenological approach was used to collect data among adult ([&ge;] 18 years) individuals in communities where indoor residual spraying was implemented. Household heads, IRS team leaders, spray operators, community leaders, and IRS field spray supervisors were purposively included in the study. In-depth interviews using an interview guide were used to collect data. Thematic data analysis was done using Nvivo ver 14.0 software. ResultsA total of 30 in-depth interviews were conducted. Study participants perceived IRS as effective from the observation of reduction in mosquito population and malaria cases following the spray. Most participants perceived IRS as safe causing only mild effects. The IRS killed other household insects including bed bugs, cockroaches, house flies and ants which helped enhance acceptance. Some of the insecticides used in the spray had strong smell and left stains on the walls. Individuals smeared sprayed walls remove the strong smell and the stains left behind. Participants reported discontinuation of use of bed nets among individuals in sprayed households. ConclusionsThe insecticides used in indoor residual spraying were perceived by participants as effective and safe. However, practices common in communities following IRS deployment such as discontinuation of use of bed nets and smearing of sprayed walls could potentially impact the effectiveness of IRS in malaria control. The Ministry of Health and implementing partners should strengthen community education and establish systems to help monitor implementation and effectiveness of indoor residual spraying for malaria control.

BackgroundMalaria and schistosomiasis are co-endemic across sub-Saharan Africa, resulting in frequent co-infection, yet the shared risk factors driving co-infection remain poorly synthesized. MethodsWe conducted a systematic review and meta-analysis to identify shared risk factors for malaria-Schistosoma co-infection and to narratively synthesize the statistical methodologies applied in the literature. We searched PubMed/MEDLINE, Embase, Web of Science, Global Index Medicus, and Global Health from inception to February 19, 2025 (PROSPERO CRD420250648824). We pooled effect sizes for risk factors across sociodemographic, environmental, and behavioral dimensions. Fixed-effects meta-analysis with inverse variance weighting was used to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CIs). Study quality was assessed using a modified version of the Quality Assessment tool for Observational Cohort and Cross-Sectional Studies by the National Institutes of Health. ResultsWe screened 1,345 records and included 30 studies conducted across 12 African countries. A meta-analysis of 27 studies showed that schistosomiasis infection was associated with 1.27 times higher odds of malaria (OR 1.27; 95% CI: 1.17-1.39). Narrative synthesis identified age as an important predictor, with risk consistently peaking in older children and adolescents (typically 8-17 years). Sex influences were setting-dependent: males had significantly higher odds of co-infection in community-based studies (OR 2.08; 95% CI: 1.64-2.63), whereas no significant association was found in school-based studies (OR 0.87; 95% CI: 0.64-1.19). Direct water contact was strongly associated with co-infection (OR 2.53; 95% CI: 1.60-4.00). Heterogeneity was high (I2 > 80%). Only one study was categorized as high risk of bias. ConclusionThe association between malaria and schistosomiasis appears driven by overlapping environmental and behavioral exposures, specifically water contact in older children. Author summaryMalaria and schistosomiasis are parasitic diseases that frequently infect the same individuals, particularly in sub-Saharan Africa. While it is known that co-infection exacerbates clinical outcomes like anemia, the specific behaviors and environmental conditions that put individuals at risk of co-infection are not well understood. We performed a systematic review of 30 studies to identify risk factors for co-infection. We found that individuals infected with schistosomiasis were 27% more likely to harbor malaria. Our analysis suggests this relationship is largely driven by shared risk factors rather than biological interaction. Risk appears to peak in older children and adolescents (ages 8-17 years). Gender roles influence risk differently depending on the setting: males were at higher risk in community settings, likely due to occupational activities like fishing or farming, but this risk disappeared in school settings where boys and girls have similar daily routines. Direct water contact was a risk factor for co-infection, but it was inconsistently measured across studies. Our findings support the case for investigation of interventions to support integrated disease control for schistosomiasis and malaria.

Deaths due to diarrhea among children younger than five have been rapidly decreasing, from an estimated 484,781 in 2010 to 245,966 in 2021. A report by the International Livestock Research Institute in 2012 found that the top 13 most important zoonoses were responsible for 2.2 million human deaths. Questions remain whether the benefits of animal ownership outweigh the potential harms of being exposed to potentially deadly zoonotic pathogens. This study uses national surveys to assess the association between animal ownership and under-5 diarrhea in sub-Saharan Africa. Our outcome was a two-week reported prevalence of diarrhea. Information about animal ownership, socio-economic status (SES), age of children, and the familys primary water source were used in this analysis. We used Poisson regression with a log link to output prevalence ratios from a mixed-effects model. The study population included 680,752 children under the age of five who lived in rural areas in sub-Saharan Africa between 2005-2022. Our model showed a slight increase of two-week reported diarrhea among children whose families owned animals (PR: 1.02, 95% CI: 1.00, 1.04). Families who owned more animals reported a lower diarrhea prevalence (11.22%) compared to families who owned fewer animals (13.71%). Additionally, children whose families owned no animals had a diarrhea prevalence of 12.09%, compared to children whose families owned more than one species of animal (12.20%). Families who only owned pigs had a diarrhea prevalence of 15.31%. This study continues to highlight the complicated relationship between animal ownership and reported diarrhea prevalence. Further research needs to examine the role of animal ownership in the context of local weather patterns, especially after extreme precipitation events following extended dry period. There remains an open question whether the benefits of animal ownership outweigh the potential pitfalls, especially in consideration of climate change.

BackgroundFor lymphatic filariasis (LF) elimination, the World Health Organization recommends multiple rounds of mass drug administration (MDA). While LF antigen (Ag) is routinely used to monitor progress, recent evidence suggests more time-sensitive indicators are needed during the immediate post-MDA period. In Samoa, triple-drug MDA was distributed in 2018 and 2023. This study aimed to evaluate the impact of Samoas second round of triple-drug MDA on human and mosquito-based indicators. MethodologySurveys were conducted in eight primary sampling units (PSUs) in 2019 (7-9 months after the 2018 MDA), 2023 (4.5 years after the 2018 MDA) and 2024 (10 months after the 2023 MDA). Participants aged [&ge;]5 years from randomly selected households were tested for Ag and microfilariae (Mf). For molecular xenomonitoring (MX), mosquitoes were caught using BG-Sentinel traps at households, sorted into pools by species, and tested for filarial DNA using quantitative polymerase chain reaction (qPCR). Results and key findingsIn 2024, Ag prevalence was 10.3% (95% CI:7.3-14.5) vs 9.9% (95% CI: 3.5-21.0) in 2023 and 9.8% (95% CI:5.6-15.5) in 2019. Mf prevalence was 3.1% (95% CI: 1.8-5.5) in 2024 vs 5.1% (95% CI:1.3-12.4) in 2023 and 3.1% (95% CI:1.3-5.9) in 2019. Odds ratios (OR) of a positive test in 2024 vs 2023 showed no decrease for Ag (OR 1.0; 95% CI:0.7-1.6), but a potential reduction in the proportion of Ag-positive participants who were Mf-positive (OR 0.6; 95% CI: 0.2-1.4) and a significant reduction in the prevalence of qPCR-positive mosquitoes (OR 0.4; 95%CrI: 0.2-0.7). From 2019-2024, there were reductions in prevalence of qPCR-positive Aedes spp. (OR 0.5; 95% CrI:0.3-1.0) and Aedes polynesiensis (OR 0.4; 95% CrI: 0.2-0.8). ConclusionsIn Samoa, LF transmission continues despite two rounds of triple-drug MDA five years apart. Mosquito indicators can provide a more sensitive measure of MDA impact in the immediate post-intervention period and complement human indicators for long-term surveillance. Author summaryLymphatic filariasis is a mosquito-borne disease that can cause severe long-term disability. To eliminate this neglected tropical disease as a public health problem, the World Health Organization (WHO) recommends multiple rounds of mass drug administration (MDA) 12 months apart. Despite antigen (Ag) being the standard indicator for evaluating MDA impact, more time sensitive indicators, such as measuring microfilariae (Mf) in the blood or testing mosquitoes for filarial DNA (molecular xenomonitoring) may provide a more reliable assessment in the months following the intervention. Samoa distributed two rounds of triple-drug MDA in 2018 and 2023. We evaluated the impact of the second round on human and mosquito-based infection indicators including Ag, Mf, and qPCR-positive mosquitoes. We surveyed eight villages in Samoa in 2019 (7-9 months after the 2018 MDA), 2023 (4.5 years after the 2018 MDA) and 2024 (10 months after the 2023 MDA). The two rounds of MDA were insufficient to break the LF transmission cycle. Results from 2024 showed no decrease in Ag prevalence from either 2019 or 2023, although there was potentially a decrease in Mf prevalence. Molecular xenomonitoring (MX) provided an earlier signal of MDA impact than Ag, with a decrease in the prevalence of qPCR-positive mosquitoes observed within 10 months of the 2023 MDA.

BackgroundScabies is a common skin condition and poses a substantial disease burden in resource-poor tropical settings. The Rohingya refugee camps in Coxs Bazar, Bangladesh represent one of the worlds largest and most protracted humanitarian crises. Using three years of data from 2021 to 2023 and applying rigorous analytical methods, this study describes the seasonality of scabies and examines its association with climatic factors. MethodologyThis is a retrospective observational study conducted in the Rohingya refugee camps and adjacent host communities in Ukhiya and Teknaf, Coxs Bazar. All patients clinically diagnosed with scabies and who received treatment at 35 International Organization for Migration (IOM)-supported health facilities between 1 January 2021 and 31 December 2023 were included. Climate data, including daily mean, minimum and maximum temperature and total and maximum rainfall, were obtained from the Bangladesh Meteorological Department. Seasonal-trend decomposition using Loess (STL) was applied. Associations between climatic variables and the decomposed seasonal component of scabies cases, as well as overall scabies case counts, were assessed using Pearson correlation tests. ResultsA total of 323,106 new scabies cases were reported from IOM-supported health facilities between January 2021 and December 2023. Children aged under 5 years and 6-18 years accounted for the highest proportion of cases (32.08% and 38.95%, respectively). The average monthly number of scabies cases was highest in November (12,625) and lowest in May (5,862). Case numbers increased from November to February (high season), with a peak between October and November, and declined between April and June (low season). An inverse relationship was observed between temperature and scabies incidence, with higher case numbers during cooler months and lower numbers during warmer months. Pearson correlation analysis demonstrated a strong and significant negative correlation between the seasonal component of scabies and maximum (r = -0.492, p = 0.002), minimum (r = -0.506, p = 0.002), and mean temperature (r = -0.525, p = 0.001). No significant association was observed between scabies seasonality and humidity or rainfall. ConclusionThis study identified a distinct seasonal pattern of scabies, with higher caseloads during late autumn and winter (October to February) and lower caseloads during summer months (April to June). Temperature showed a strong negative association with the seasonal component of scabies. These findings may inform the timing of public health strategies, including mass drug administration, intensified case management, and social and behavioural change communication, in humanitarian settings.