Tropical Medicine & International Health最新文献

{"title":"Roles and Implementation of Community Health Worker-Led Interventions in Tuberculosis Care in Low and Middle-Income Countries: A Systematic Review.","authors":"Donatus Korbianus Sadipun, Ferry Efendi, Violin Irene Ninef","doi":"10.1111/tmi.70225","DOIUrl":"https://doi.org/10.1111/tmi.70225","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a major global health challenge, particularly in low- and middle-income countries (LMICs). Community health workers (CHWs) are widely deployed to enhance TB care delivery, yet their roles, implementation models and contextual determinants have not been comprehensively synthesized.</p><p><strong>Objective: </strong>To systematically review CHW-led TB interventions in LMICs and to examine contextual determinants influencing implementation and effectiveness.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus and Web of Science were searched for studies published up to 31 December 2025. Quantitative, qualitative and mixed-method studies evaluating CHW-led TB interventions in LMICs were included. Study quality was appraised using Joanna Briggs Institute tools. Data were synthesized thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Findings were organized according to intervention models (community-based DOT, family-supported care and digital/hybrid approaches).</p><p><strong>Results: </strong>Ten studies were included: nine from Sub-Saharan Africa (Ethiopia, Rwanda, Cameroon, Uganda and South Africa) and South/Southeast Asia (Indonesia, India, and Vietnam), and one multi-country analysis of TB-REACH projects. CHWs contributed to health education, treatment adherence support, active case finding and system navigation. Implementation models varied across community-based DOT, family-supported and digital/hybrid approaches. Effectiveness was influenced by patient knowledge, social stigma, CHW training and integration into health systems. Several studies reported improvements in treatment adherence and case detection, including one large Ethiopian pre-post study reporting treatment success improvement from 76% to 95%.</p><p><strong>Conclusion: </strong>CHWs are critical in TB care in LMICs, but effectiveness is context-dependent. Strengthening CHW capacity, culturally responsive implementation and systematic evaluation frameworks are essential. Evidence from comparative and implementation studies suggests that hybrid and digitally supported models show promise for improving scalability and coverage.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasmodium vivax Malaria in Afghanistan: A Scoping Review of Epidemiology, Relapse, Treatment and Elimination Challenges.","authors":"Mohammad Masudi, Ali Rahimi, Mohammad Shafi Saljuqi, Fahim Ahmadi, Reymark P Malinda, Vimar A Romero, Abraham Fessehaye Sium, Kevin Smith P Cabuhat, Nasar Ahmad Shayan, Don Eliseo Lucero-Prisno","doi":"10.1111/tmi.70237","DOIUrl":"https://doi.org/10.1111/tmi.70237","url":null,"abstract":"<p><strong>Background: </strong>Plasmodium vivax predominates in Afghanistan. Recurrent disease and the safety requirements of anti-relapse treatment complicate elimination, while routine case counts provide limited information about completed radical cure.</p><p><strong>Objective: </strong>To synthesize Afghanistan-specific evidence on P. vivax epidemiology, recurrence, treatment, G6PD safety, diagnosis, resistance and elimination, and translate it into measurable service priorities.</p><p><strong>Methods: </strong>This JBI- and PRISMA-ScR-guided nested scoping review reassessed 287 publications and 45 reports from a parent evidence map using a vivax-focused population-concept-context framework. The core search ended on 12 August 2026; 40 publications and 10 institutional reports were included. Two reviewers independently assessed eligibility and charted data, with third-reviewer verification.</p><p><strong>Results: </strong>WHO reported 247,100 P. vivax cases among 257,524 confirmed malaria cases in 2024 (96.0%). An independent national series recorded 887,227 vivax episodes in 2018-2023, peaking in September. In a 593-patient Afghan trial, chloroquine plus 14-day primaquine reduced 1-year recurrence compared with chloroquine alone (hazard ratio: 0.37, 95% CI: 0.25-0.54). Paired primaquine comparisons support an important relapse contribution, but their attribution estimate is assumption-dependent and is not a national relapse rate. Historical treatment studies, G6PD surveys, and molecular findings support continued efficacy and safety surveillance. Evidence is geographically uneven, and supported refugee-camp treatment outcomes do not establish feasibility in contemporary routine services.</p><p><strong>Conclusions: </strong>The priority is to link case characterization to a measurable radical-cure cascade: diagnosis, G6PD assessment, regimen selection, initiation, completion, safety monitoring and recurrence investigation. Phased delivery should combine district- and season-specific targeting with clinical efficacy monitoring and documented cross-border referral.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Diabetes, Hypertension and Obesity in Guinea-Bissau-Results From a Nationwide Study Carried Out From 2022 to 2024.","authors":"Lilica Sanca, Stine Byberg, Diamantino Midana, Nelson Delgado, João F Raposo, Ana M Teixeira, Christine Stabell Benn, Morten Bjerregaard-Andersen, Eugenia Carvalho","doi":"10.1111/tmi.70232","DOIUrl":"https://doi.org/10.1111/tmi.70232","url":null,"abstract":"<p><strong>Background: </strong>Non-communicable diseases (NCDs) are rising rapidly in Sub-Saharan Africa. In Guinea-Bissau, nationwide data are scarce. We aimed to estimate the multi-regional prevalence of type 2 diabetes (T2D), obesity, and hypertension and examine associated risk factors within this resource-limited context.</p><p><strong>Methods: </strong>A multi-regional cross-sectional survey was conducted using a hybrid community- and facility-based sampling approach across urban Bissau, including at the National Diabetes Clinic [CND] and in seven interior regions of the country. Recruitment was conducted between August 3th 2022 and June 8th 2024 across these sites. After a verified 12-h fast, participants underwent capillary glucose, blood pressure, and anthropometric measurements. Diabetes was defined as fasting glucose ≥ 126 mg/dL or previous diagnosis; prediabetes as 110-125 mg/dL; obesity as BMI ≥ 30 kg/m²; and hypertension as blood pressure ≥ 140/90 mmHg. Multivariable logistic regression identified factors associated with diabetes.</p><p><strong>Results: </strong>Among 3929 participants, with median age 41 years, the overall raw diabetes prevalence was 20.8% (817/3929), with 30% being newly screen-detected. The T2D prevalence at the specialized CND was 22.8% (342/1502), compared to 18.0% (174/969) in community settings outside health facilities in Bissau. The prediabetes prevalence was 9.1%; while the obesity prevalence was 14.8%, disproportionately affecting more women, at 20.7% vs. 9.1% in men; and the prevalence of hypertension was exceptionally high at 40.4%. In the multivariable model, key risk drivers included age ≥ 55 years (OR 14.0, 95% CI: 8.57-22.9), family history (OR 3.78, 3.02-4.74), Fula ethnicity (OR 2.47, 1.73-3.53), and low physical activity (OR 1.44, 1.17-1.78).</p><p><strong>Conclusions: </strong>Guinea-Bissau faces a critical, underreported burden of metabolic and cardiovascular NCDs, particularly T2D and hypertension. Given the recruitment pathways, the overall prevalence reflects a high-risk baseline that warrants cautious national extrapolation. Urgent, context-specific public health strategies and decentralized clinical guidelines are required to manage these chronic conditions amidst severe structural resource constraints.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Adult and Old Age Mortality From Parental Survival Histories Collected Over the Phone: A Validation Study From Bangladesh.","authors":"Md Tazvir Amin, Md Mahabubur Rahman, M Moinuddin Haider, Nurul Alam, Georges Reniers, Stephane Helleringer","doi":"10.1111/tmi.70173","DOIUrl":"10.1111/tmi.70173","url":null,"abstract":"<p><strong>Objectives: </strong>Bangladesh, a lower-middle-income (LMIC) South Asian country, relies on survey data for measuring adult mortality. Mobile phone surveys are an appealing alternative to in-person surveys because they are cheaper and can be deployed when enumerator mobility is hindered. In this contribution, we examined the quality of 'Parental Survival History' data collected over the phone by comparing it with data from a Health and Demographic Surveillance System.</p><p><strong>Methods: </strong>We conducted a mobile phone survey from July to December 2021 among residents of the Matlab HDSS. Mobile phone survey data about the respondent's father and mother were individually matched to the HDSS database. Data were compared to the HDSS reference in terms of the vital status of the respondent's parents, their age, the time since death and adult mortality rates.</p><p><strong>Results: </strong>A total of 2231 respondents reported information on their parents. Among these, 90.7% of fathers' names and 95.2% of mothers' names were matched between the mobile phone survey and the HDSS, and the matched dataset was used for subsequent analyses. Concordance in the vital status reports of the parent was very high (both sensitivity and specificity were above 99%). Further, we found that 50% of the parents' ages (current age for those who are alive and age at death for parents who died) were within 5 years below and 3 years above those recorded in the HDSS. Around 4% of parental deaths were erroneously located within or outside an 8-year reference period. The parents' mortality rate was 52.0 (95% CI: 49.3, 54.8) per 1000 person-years in the mobile phone survey and 52.3 (95% CI: 49.6, 55.0) in the HDSS.</p><p><strong>Conclusions: </strong>In this population, parental survival history data were reported with high accuracy in a mobile phone survey, highlighting their potential for measuring adult mortality in resource-constrained settings.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1348-1355"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Sex Hormones and Lipid Profiles Among Adult Tuberculosis Patients in Northwest Ethiopia: A Comparative Cross-Sectional Study.","authors":"Eshet Gebrie, Habtamu Wondifraw Baynes, Birhan Mulugeta, Berihun Agegn Mengistie, Amanuale Zayede, Elias Chane","doi":"10.1111/tmi.70177","DOIUrl":"10.1111/tmi.70177","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculosis (TB) remains a major global health burden, particularly in low- and middle-income countries. Persistent TB-related inflammation has been implicated in significant endocrine and metabolic dysregulation. While previous studies have documented alterations in sex hormones or lipid profiles independently, the potential interplay between these biological systems has not been systematically investigated in patients with active TB. Moreover, comprehensive evidence from sub-Saharan Africa, including Ethiopia, where the burden of TB is substantial, remains limited. Elucidating the hormone-lipid interrelationship may provide important insights into the pathophysiological mechanisms underlying TB-associated metabolic disturbances. Therefore, this study aimed to comprehensively evaluate alterations in sex hormones and lipid profiles and to examine their interrelationships among adult TB patients in Gondar town, Northwest Ethiopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comparative cross-sectional study was conducted among 150 HIV-negative, TB-positive patients (both newly diagnosed and on anti-TB treatment) and 150 age-matched TB-negative adults recruited from five selected health institutions in Gondar Town. Sociodemographic, clinical and behavioural data were collected using structured interviews. Fasting serum samples were analysed for lipid profiles, sex hormones and cortisol using a Beckman Coulter Clinical Chemistry analyser. Group comparisons were performed using t-tests and the Mann-Whitney U test and correlations were assessed using Pearson and Spearman's rank coefficients. Statistical significance was set at p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Male TB-positive patients had significantly lower testosterone (mean difference: -2.6, 95% CI: -3.1 to -2.1), while oestradiol (+15.1, 95% CI: 9.5-20.7), LH (+5.8, 95% CI: 3.2-8.3) and FSH (+6.6, 95% CI: 4.1-9.0) levels were significantly higher compared with tuberculosis-negative individuals (p &lt; 0.001). Female TB-positive patients showed markedly reduced testosterone and progesterone levels (p &lt; 0.001, r = 0.7 and 0.4, respectively). Among females, testosterone levels were lower in underweight than normal-weight individuals (p = 0.006; overall p = 0.008), with no other hormone variations by BMI in either sex. Regarding lipid profiles, TB-positive patients exhibited significantly lower total cholesterol (mean difference: -40.5 mg/dL, 95% CI: -50.1 to -30.9, p &lt; 0.001), while LDL (-15.7 mg/dL, 95% CI: -25.6 to 5.8), HDL (2.5 mg/dL, 95% CI: -3.5 to 8.4) and triglycerides (-0.5 mg/dL, 95% CI: -3.1 to 2.2) showed no significant differences. Among male participants, cholesterol was positively correlated with testosterone (r = 0.658, p &lt; 0.001) and negatively correlated with oestradiol (r = -0.314, p = 0.002), FSH (r = -0.31, p &lt; 0.001), LH (r = -0.223, p = 0.004) and cortisol (r = -0.424, p &lt; 0.001). Among female participants, cholesterol was positively correlated with","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1381-1394"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climatic and Social Drivers of Snakebite Incidence in Pará State, Brazilian Amazon.","authors":"Jorge Emanuel Cordeiro Rocha, Samuel Campos Gomides, Joacir Stolarz-de-Oliveira, Ana Carla Dos Santos Gomes","doi":"10.1111/tmi.70178","DOIUrl":"10.1111/tmi.70178","url":null,"abstract":"<p><strong>Background: </strong>Snakebite envenoming is a neglected public health issue influenced by both environmental and socioeconomic variables. In Pará, the Brazilian state with the highest number of cases, knowledge gaps remain regarding the relationship between these factors and the temporal and geospatial distribution of accidents. This study investigates the influence of the El Niño-Southern Oscillation (ENSO), rainfall, river levels and socioeconomic indicators on snakebite incidence over nearly two decades (2007-2023).</p><p><strong>Methods: </strong>Data were obtained from official public health, environmental and socioeconomic databases. A Generalized Additive Model (GAM) was used to assess social variables, cross-correlation analyses evaluated associations with rainfall and river levels and wavelet analysis was applied to explore temporal patterns linked to ENSO variability.</p><p><strong>Results: </strong>A total of 87,267 cases were recorded during the study period, with the highest incidence in northeastern Pará, particularly in the municipality of Santarém. Snakebite occurrence showed positive correlations with poor sanitation, rural population density and illiteracy rates. Temporal associations were also observed with river levels, rainfall and ENSO variability.</p><p><strong>Conclusions: </strong>The most affected municipalities should be prioritised for preventive education and improved antivenom distribution. The association with poverty indicators underscores the need for structural improvements in health and social assistance systems. Climatic influences highlight the role of environmental variability in shaping snakebite incidence in the Amazon and raise concerns about potential impacts of ongoing climate change on snakebite risk.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1356-1369"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Stitch Too Late: Another Paediatric HIV Outbreak in Pakistan.","authors":"Braira Wahid, Qurat-Ul-Ain Ashraf, Hira Tiwana, Peter Speck","doi":"10.1111/tmi.70187","DOIUrl":"10.1111/tmi.70187","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1293-1296"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Mobile Phone Surveys Supplement Other Mortality Surveillance Methods? Results From a National Study in Bangladesh.","authors":"Aashish Gupta, Gulam Muhammed Al Kibria, Tahsin Shahrin Khan, Chandra Nirod Saha, Farzana Islam Khan, Alain Labrique, Tahmina Shirin, Mohan Diwakar, Georges Reniers, Iqbal Ansary Khan, Dustin G Gibson, Stephane Helleringer","doi":"10.1111/tmi.70181","DOIUrl":"10.1111/tmi.70181","url":null,"abstract":"<p><strong>Objectives: </strong>To test whether mobile phone surveys conducted remotely might generate data on deaths that are not covered by mortality surveillance systems established in laboratories and health facilities, or in institutions involved in the post-mortem management of corpses (e.g., morgues, cemeteries).</p><p><strong>Methods: </strong>We conducted a national survey of mobile phone users in Bangladesh during the COVID-19 pandemic. Respondents were asked to list the deaths that had occurred in their household in recent years. For each death, they were also asked to indicate whether the deceased had been diagnosed with COVID-19 prior to death, whether the death occurred at home or at a health facility, and where the burial took place. Using these data, we represented the overlap between data generated by the mobile phone survey and several potential mortality surveillance systems, which focus on counting deaths in health facilities or communal cemeteries. We described the socio-demographic characteristics of the deaths that were uniquely recorded by the mobile phone survey.</p><p><strong>Results: </strong>From December 2021 to July 2022, 506,659 calls were placed, resulting in 22,731 interviews completed by mobile phone. Respondents reported 1527 deaths that had occurred in their household since 2020. Among those deaths, 99 (6.5%) had received a pre-mortem diagnosis of COVID-19. The proportion of reported deaths that were not covered by other potential mortality surveillance systems, was 32.4% in the large city corporations of Dhaka and Chittagong, 36.3% in other urban areas and 49.6% in rural areas. In urban areas, deaths among men, as well as among youth and the elderly, were more likely to be covered solely by the mobile phone survey.</p><p><strong>Conclusion: </strong>Mobile phone surveys can potentially remedy gaps in the data generated by other recommended mortality surveillance methods.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1408-1418"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidiabetic Drug Use and Expenditure Trends After National Volume-Based Procurement Policy in Nanjing City: An Interrupted Time-Series Analysis.","authors":"Man Yu, Yulu Zhu, Jingxuan Wei, Hongting Yao, Zhuying Jing, Xiaoye Wang, Tiantian Tao, Xin Li","doi":"10.1111/tmi.70192","DOIUrl":"10.1111/tmi.70192","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the impact of China's National Volume-Based Procurement policy (NVBP) on utilisation and expenditures of antidiabetic drugs, with a focus on insulin, using real-world data from Nanjing.</p><p><strong>Methods: </strong>Monthly procurement data from public healthcare facilities in Nanjing were analysed from January 2016 to December 2022. Drug utilisation was measured using the Anatomical Therapeutic Chemical/defined daily dose (ATC/DDD) methodology, and expenditures were measured by total spending and defined daily dose cost (DDDc). Linear regression analysis was employed to assess temporal trends, while interrupted time series (ITS) analysis was conducted to evaluate the impact of five policy implementation batches between January 2019 and December 2022 on changes in drug use and spending.</p><p><strong>Results: </strong>During the 7-year study period, the use of NVBP-related antidiabetic drugs in Nanjing increased significantly, while total expenditures decreased. Before NVBP, expenditures grew annually by 9.1%, but declined by 12.4% per year after policy implementation. Insulin remained the dominant therapy but its utilisation proportion declined by approximately 40%, while metformin and sulfonylurea use increased. Newer antidiabetic drugs saw breakthrough growth post-policy. ITS analyses showed substantial immediate reductions in DDDc across batches, particularly for insulin, with unit costs decreasing by 36.5%. Utilisation responses varied by procurement batch, while domestic insulin products gained market share.</p><p><strong>Conclusions: </strong>The NVBP was associated with substantial reductions in antidiabetic medicine costs and changes in market structure, while utilisation effects varied across procurement batches. The insulin-focused sixth batch achieved marked price reductions and increased substitution towards domestically produced insulin without increasing overall utilisation. These findings suggest that centralised procurement may improve affordability while reshaping pharmaceutical markets.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1483-1493"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under-Five Mortality in Humanitarian Emergencies: A Comparison of Face-to-Face and Mobile Phone Survey Estimates From Burkina Faso.","authors":"Kassoum Dianou, Bruno Masquelier, Stéphane Helleringer, Bruno Lankoandé, Adramane B Soura, Oumar Billa, Yacouba Compaoré, Georges Reniers","doi":"10.1111/tmi.70176","DOIUrl":"10.1111/tmi.70176","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluate the utility of mobile phone surveys (MPS) for estimating child mortality in Burkina Faso, where armed conflict and forced displacements hamper traditional face-to-face data collection on an important share of the territory.</p><p><strong>Methods: </strong>We estimated under-five mortality from truncated birth histories collected in an MPS from September 2021 to October 2022. The sample consisted of telephone numbers collected in a prior face-to-face survey and an additional set of numbers generated through random digit dialling (RDD). We compared regionally disaggregated mortality estimates from the MPS with those from the 2021 Demographic and Health Survey (DHS), which could not cover parts of the national territory due to insecurity.</p><p><strong>Results: </strong>Of 52,650 attempted phone numbers, 11,387 women of reproductive age were interviewed. Of these, 8077 were reached through RDD (36% lived in conflict-affected areas at the time of data collection) and 3310 via previously collected numbers (42% lived in conflict-affected areas). In regions not directly affected by conflict, under-five mortality rates have remained relatively stable over time: from 45 deaths per 1000 live births in 2018-2019 (95% CI: 36-54) to 58 in 2020-2022 (95% CI: 46-69). This finding mirrors the trend observed in the DHS data. In regions affected by armed conflict, however, the MPS data indicate a substantial increase in under-five mortality: From 47 deaths per 1000 live births in 2018-2019 (95% CI: 38-57) to 82 in 2020-2022 (95% CI: 67-98). This mortality reversal in conflict-affected areas is not apparent in the DHS, most likely due to the exclusion of the most insecure survey clusters from its sampling frame.</p><p><strong>Conclusion: </strong>MPS offers a viable alternative or complement to traditional face-to-face surveys for estimating child mortality in populations where insecurity limits face-to-face survey data collection.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1370-1380"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}