International Health最新文献

{"title":"Acute respiratory infection and associated factors among young children presenting to hospital in Sierra Leone.","authors":"Morie Vandi, Troy D Moon, Gustavo Amorim, John S Schieffelin, Robert J Samuels","doi":"10.1093/inthealth/ihag057","DOIUrl":"10.1093/inthealth/ihag057","url":null,"abstract":"<p><strong>Objectives: </strong>Acute respiratory infections (ARIs) are a leading cause of infant morbidity and mortality worldwide, with a substantial burden in Sierra Leone. Although maternal, infant, and environmental factors influence ARI susceptibility, their role in disease severity remains unclear.</p><p><strong>Methods: </strong>We conducted prospective surveillance of children aged <24 months admitted to Kenema Government Hospital from October 2020 to October 2021. Eligible children were enrolled within 48 hours of admission and had at least one acute respiratory symptom. Nose and throat swabs were collected and tested using multiplex reverse-transcription PCR. Statistical analyses were performed in R.</p><p><strong>Results: </strong>Among 502 enrolled children, 376 (74.9%) had ≥1 viral pathogen detected by PCR. Younger age was associated with viral detection (P = .009). Global chronic malnutrition was less common among virus-positive than virus-negative children (36.5% vs 48.0%, P =.030). Infants aged 0-6 months and those breastfed for shorter durations experienced more severe disease. Each additional month of breastfeeding reduced the odds of a higher ARI severity score by 6% (OR 0.94, P = .004).</p><p><strong>Conclusion: </strong>Viral ARIs are a major health challenge among young children in Sierra Leone. Breastfeeding duration and nutritional status were important modifiable risk factors associated with disease severity, highlighting opportunities for interventions.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254093","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":"Relationships between infection, inflammation and biomarkers of micronutrient among school-age children in Malawi.","authors":"Peter A M Ntenda, Walaa M R El-Meidany, Rex B Mbewe, Fentanesh N Tiruneh","doi":"10.1093/inthealth/ihag056","DOIUrl":"https://doi.org/10.1093/inthealth/ihag056","url":null,"abstract":"<p><strong>Background: </strong>Micronutrient deficiencies in vitamin A, iron and zinc continue to threaten the growth, immunity and cognitive development of school-age children (SAC) in low- and middle-income countries. However, infection-related distortion of micronutrient biomarkers and limited evidence leave the burden and determinants in Malawi insufficiently understood. This study investigated the relationships between infection, inflammation and indicators of micronutrient status including retinol-binding protein (RBP), ferritin and zinc among SAC in Malawi.</p><p><strong>Methods: </strong>A secondary analysis of cross-sectional data from the 2015-2016 Malawi Micronutrient Survey was conducted. Infection and inflammation were assessed using caregiver-reported illness, malaria testing, haematuria, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP). Descriptive and inferential statistical analyses were performed. Multivariable generalized linear models were used to examine associations between infection and inflammation indicators and micronutrient biomarkers (RBP, inflammation-adjusted ferritin and serum zinc) while controlling for demographic, nutritional and household covariates. All analyses were conducted using R version 4.3.0.</p><p><strong>Results: </strong>Elevated CRP and AGP were significantly associated with lower RBP and zinc concentrations and with higher ferritin levels. Recent fever and malaria positivity were also associated with alterations in micronutrient biomarker concentrations. Older children (11-14 y) had higher RBP levels. Regional differences were observed, with children in the Central and Southern regions showing lower RBP and ferritin compared with those in the Northern region.</p><p><strong>Conclusions: </strong>Infection and inflammation are important determinants of micronutrient biomarker concentrations among SAC in Malawi. These findings highlight the importance of adjusting micronutrient assessments for inflammation and strengthening integrated public health strategies that combine micronutrient interventions with infection prevention and control to improve child nutritional status.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228969","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":"From dependency to strategic sovereignty: reframing global health financing in a fragmenting world-lessons from Angola.","authors":"Indrajit Hazarika","doi":"10.1093/inthealth/ihag055","DOIUrl":"https://doi.org/10.1093/inthealth/ihag055","url":null,"abstract":"<p><p>Development assistance for health has plateaued while sovereign debt burdens and geopolitical competition have intensified. Reform initiatives such as the Lusaka Agenda and the Accra Reset call for country ownership and sustainability, yet largely remain within existing power structures. This paper presents a conceptual and policy analysis, using Angola as an illustrative case, to examine how global health financing models can move beyond aid effectiveness towards what the paper defines as 'strategic sovereignty'. Strategic sovereignty is conceptualized here as both an analytic lens and a normative policy objective, referring to the capacity of states to align health financing with broader macro-fiscal and geoeconomic strategies while maintaining institutional autonomy and accountability. Using Angola's experience, the paper illustrates how dependency in lower-middle-income countries is increasingly shaped by fiscal volatility, bilateral debt exposure and geopolitical bargaining rather than grant reliance alone. Drawing on available macro-fiscal and health financing data, Angola's oil-dependent economy, high bilateral debt and fluctuating public expenditure patterns highlight constraints on health sector predictability and autonomy. The paper proposes three forward-looking and exploratory pathways towards sovereign health financing: sovereign health financing compacts linked to geoeconomic assets such as the Lobito Corridor; fiscal resilience mechanisms including countercyclical health funds and systems-linked debt-for-health swaps; regionalization of procurement and manufacturing to reduce structural supply dependency. These pathways are presented as policy options rather than empirically validated models. In conclusion, reducing dependency requires embedding health financing within national geoeconomic strategy. While the proposals remain prospective, they aim to frame a policy agenda for further empirical and operational development.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213039","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":"Outpatient antibiotic prescribing for acute respiratory infections in children: an observational study in Nepal.","authors":"Suraj Bhattarai, Ram Hari Chapagain, Rabin Thami, Jaya Dhungana, Biplav Ghimire, Satish Prasad Barnawal, Ramanandan Prasad Chaudhary, Ajit Rayamajhi","doi":"10.1093/inthealth/ihag054","DOIUrl":"10.1093/inthealth/ihag054","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic challenges in children impact antibiotic decisions in low- and middle-income countries, contributing to the burden of antimicrobial resistance. This study assessed antibiotic use practices for childhood acute respiratory infections (ARI) in outpatient settings then compared findings between public and private facilities.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted in two paediatric hospitals of Nepal (one public, one private) between January and July 2022. The standard checklist for ARI case management, adapted from the World Health Organization quality assessment and improvement tool, was applied to observe randomly selected doctor-patient consultations in disguised form with prior consent and ethics approval. Descriptive statistics were used to determine differences between the two facilities.</p><p><strong>Results: </strong>Of 104 outpatient consultations assessed in two sites (52 cases each), the majority (76%) of ARI diagnoses complied with the national protocol for ARI management, and this practice was better in the private than the public facility (85% vs 67%, p=0.039). Antibiotics were prescribed in 64% of children (67/104), with no difference between facilities (p=0.838). Of these, just 9% of cases (6/67) were prescribed the first-line antibiotic (amoxicillin). The provider's decision to prescribe an antibiotic or not was inappropriate in 54% children (56/104), while among those who were prescribed an antibiotic, 81% (54/67) were prescribed the incorrect antibiotic.</p><p><strong>Conclusion: </strong>This study reports high rates of inappropriate antibiotic decisions and prescriptions for paediatric ARI in both public and private facilities, suggesting larger studies are needed to gauge the scope and need of antibiotic stewardship programmes targeted to the providers.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200788","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":"Correction to: Consumption of vitamin A-rich foods among 6-23-month-old children in Jigjiga town: a community-based cross-sectional study.","authors":"","doi":"10.1093/inthealth/ihag060","DOIUrl":"10.1093/inthealth/ihag060","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164592","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":"Programmatic implications of the efficiency of uptake of Onchocerca volvulus microfilariae by Simulium sp. vectors.","authors":"Daniel A Boakye, Mike Y Osei-Atweneboana, Simon K Atta, Irene A Larbi, Charles D Mackenzie","doi":"10.1093/inthealth/ihag037","DOIUrl":"10.1093/inthealth/ihag037","url":null,"abstract":"<p><strong>Background: </strong>The current global aim for onchocerciasis is to eliminate transmission of infection by administering ivermectin once a year or biannually. However, when ivermectin treatment is given annually for 9-10 y, some individuals still carry low microfilariae (mf) levels, which may allow continued transmission.</p><p><strong>Methods: </strong>At four different times (0, 8, 90, 365 days) after treatment with ivermectin, 1608 newly emerged Simulium sanctipauli (Pra form) flies were fed on 35 volunteers, with initial dermal microfilarial loads ranging from 0 to >30 Onchocerca volvulus mf/mg skin. Ten days after feeding, the number and load of mf in these flies were assessed by dissection.</p><p><strong>Results: </strong>Notably, even at the lowest skin-snip mf densities-including those showing zero infection-flies can still ingest O. volvulus mf and become infected; 29% of the 1608 fed flies picked up mf. The lowest skin mf levels were recorded on Day 90 after treatment, at which time vector mf uptake increased by 21% with every unit increase in skin mf density (P < .000).</p><p><strong>Conclusions: </strong>Very low dermal mf levels can still support parasite transmission. Consequently, widespread low O. volvulus infection in human populations with highly productive vector-breeding sites could significantly affect efforts to eliminate transmission.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"i60-i67"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576046","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":"Why we need medical entomologists more than ever.","authors":"Stefanie Meredith","doi":"10.1093/inthealth/ihag005","DOIUrl":"10.1093/inthealth/ihag005","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"i1-i2"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120757","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":"Onchocerciasis elimination mapping in Malawi: mapping of vector Simulium breeding sites using an integrated approach of community knowledge and topographical maps.","authors":"Kareen Atekem, Laston Sitima, Dylo Pemba, Adoum M Oumar, Ben Isake, Steven Gowelo, Chinsisi Chipatso, Kondwani Muheka, Franklin Ayisi, Lassane Koala, Olabanji Surakat, Arwa Elaagip, Dziedzom K de Souza, Anne Heggen, Charles D Mackenzie, Daniel A Boakye","doi":"10.1093/inthealth/ihaf124","DOIUrl":"10.1093/inthealth/ihaf124","url":null,"abstract":"<p><strong>Background: </strong>Large areas in Malawi have not been treated for onchocerciasis. To understand whether to provide treatment in these areas of unknown onchocerciasis endemicity, the Malawi Onchocerciasis Control Program conducted identification and mapping of breeding sites as a prerequisite for onchocerciasis elimination mapping (OEM).</p><p><strong>Methods: </strong>The team employed a community knowledge approach using questionnaires and discussions, alongside the standard method of using topographical maps, to plan and implement river prospections for Simulium vector breeding sites.</p><p><strong>Results: </strong>A total of 188 sites were prospected from 180 rivers, with 122 sites (67.8%) identified from community information and 58 (32.2%) from topographic maps. Of the 188 sites visited, 30 were positive for Simulium damnosum larvae/pupae and 91 were considered potential breeding sites and need to be visited in a different season for confirmation. A breeding site map for OEM areas was developed. Prospection using this approach lasted for 24 days (approximately eight rivers/day) compared with a previous prospection with the same team that used 12 days to prospect 25 rivers (approximately two rivers/day).</p><p><strong>Conclusion: </strong>This demonstrates the potential of using the health system structure and community knowledge for breeding site surveys, shortening the prospection time while effectively identifying fast-flowing rivers and breeding sites.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"i74-i80"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120675","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":"Progress towards interrupting onchocerciasis transmission in the Oulibangala focus, Chad.","authors":"Adoum Mahamat Oumar, Lassane Koala, Anne Heggen, Franklin Ayisi, Arwa Elaagip, Olabandji Surakat, Kareen Atekem, Dziedzom K de Souza, Jamie Tallant, Charles D Mackenzie, Brahim Boy Otchom, Daniel Adjei Boakye","doi":"10.1093/inthealth/ihaf141","DOIUrl":"10.1093/inthealth/ihaf141","url":null,"abstract":"<p><strong>Background: </strong>The onchocerciasis program in Chad is conducting several surveillance activities to verify the interruption of disease transmission and determine whether to stop the mass drug administration program that has been ongoing in the country since 1998.</p><p><strong>Methods: </strong>Entomological surveillance was conducted from June 2021 to February 2022 in the onchocerciasis-persistent focus of Oulibangala, Chad.</p><p><strong>Results: </strong>A total of 6962 Simulium spp. blackflies were collected near Oulibangala (n=5871) and Kaitia (n=1181). Vector blackflies were pooled and tested for Onchocerca volvulus DNA using O-150 polymerase chain reaction.</p><p><strong>Conclusions: </strong>No O. volvulus infections were detected, suggesting potential interruption of transmission in the area.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"i89-i91"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120755","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":"Empowering the next generation: the END Fund's Field Entomology Mentorship Program.","authors":"Anne Heggen, Franklin Ayisi, Adoum Mahamat, Olabanji Surakat, Lassane Koala, Kareen Atekem, Arwa Elaagip, Eve Gatawa, Sashi Leff, Pierre Albrieux, Charles D Mackenzie, Jamie Tallant, Daniel A Boakye","doi":"10.1093/inthealth/ihaf096","DOIUrl":"10.1093/inthealth/ihaf096","url":null,"abstract":"<p><strong>Background: </strong>The END Fund's Field Entomology Mentorship Program addresses a critical gap in trained entomologists supporting onchocerciasis elimination in Africa. Unlike conventional training, this hands-on mentorship equips early to mid-career entomologists with technical expertise in critical onchocerciasis blackfly surveillance activities.</p><p><strong>Methods: </strong>The 3-y program follows a phased approach, gradually increasing mentees' independence while ensuring strong mentorship.</p><p><strong>Results: </strong>In its inaugural year, six mentees engaged in field activities across multiple countries, contributing to the development of elimination strategies, onchocerciasis surveillance and research projects. Mentees highlight the program's transformative impact, fostering leadership, collaboration and strategic problem-solving. Their experiences with their mentors have strengthened national program capacity and the program is building a network of skilled experts dedicated to disease elimination.</p><p><strong>Conclusions: </strong>As the program evolves, mentees will take on more independent roles, ensuring sustainable expertise at the country level. This initiative underscores the importance of investing in local entomological capacity to accelerate onchocerciasis elimination efforts across Africa and other endemic countries.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"i23-i26"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120676","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}