PLOS global public health最新文献

{"title":"Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique.","authors":"Joseph Wells, Joseph Waiswa, Anifa Vala, Bahtisen Golla, Grace Mwashigadi, Hawanatu Jah, Marleen Temmerman, Robin Okello, Isaac Mwaniki, Herminio Cossa, Moses Mukhanya, Esperança Sevene, Yahaya Idris, Onesmus Wanje, Angela Koech, Anna Roca, Laura Braun, Marie-Laure Volvert, Fatima Touray, Umberto D'Alessandro, Peter von Dadelszen, Wendy Graham, Hannah Blencowe","doi":"10.1371/journal.pgph.0005004","DOIUrl":"10.1371/journal.pgph.0005004","url":null,"abstract":"<p><p>Placenta-related complications contribute substantially to maternal and perinatal mortality globally, with the greatest burden in low- and middle-income countries (LMICs). However, the potential influence of inadequate household water, sanitation and hygiene (WASH) on these outcomes remains poorly characterised. We investigated associations between household WASH conditions and selected placenta-related complications, including pre-eclampsia, small-for-gestational-age (SGA) and stillbirth, in The Gambia, Kenya and Mozambique. This secondary analysis was nested within PRECISE (PREgnancy Care Integrating Translational Science, Everywhere), a prospective observational cohort of 5,745 unselected pregnant women. Multivariable modified Poisson regression with robust standard errors was used to assess associations between household WASH exposures and pre-eclampsia, SGA or stillbirth. Missing exposure and covariate data were low (<5%) and handled using multiple imputation. Compared with water piped into the dwelling or plot, other improved water sources (adjusted relative risk [aRR] 1.18, 95% confidence interval [CI] 1.07-1.31, p = 0.002) and unimproved water sources (aRR 1.23, 95% CI 1.00-1.50, p = 0.049) were associated with a higher risk of any selected placenta-related complication. Unimproved sanitation facilities, compared with improved facilities, were also associated with increased risk (aRR 1.15, 95% CI 1.02-1.30, p = 0.019). The findings suggest that household‑level WASH conditions may be associated with selected placenta‑related complications through both direct and indirect pathways. Water sources, whether unimproved or improved, may be contaminated, and collection, transport, and storage further increase contamination risks while adding a physical burden to water collectors. Unsafe sanitation may also increase exposure to enteric pathogens. Given the observed associations, targeted WASH interventions warrant investigation as a potential strategy to reduce placenta-related complications and improve maternal and neonatal health outcomes in LMICs. Future research should explore the mechanisms linking WASH to pre-eclampsia, SGA, stillbirth and other placenta-related complications, and assess the effect of comprehensive WASH interventions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005004"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedside screening of carbapenem-resistant Enterobacteriaceae using selective agar plates: A low-cost, laboratory-independent approach for rural healthcare facilities.","authors":"The Anh Ngo, Hieu Thi Nguyen, Nhung Ngoc Hoang, Thanh Duc Nguyen, Thanh Chi Tran","doi":"10.1371/journal.pgph.0007479","DOIUrl":"10.1371/journal.pgph.0007479","url":null,"abstract":"<p><p>The global surge of carbapenem-resistant Enterobacteriaceae (CRE) poses a critical threat to patient safety in intensive care units (ICUs). In low- and middle-income countries, routine CRE surveillance is often limited by the lack of microbiology laboratory infrastructure and trained personnel in peripheral healthcare facilities, resulting in reliance on empirical broad-spectrum antibiotic therapy and limited capacity to detect silent transmission. This study evaluated the operational feasibility, safety, and phenotypic agreement of a decentralized, laboratory-independent bedside CRE screening protocol using pre-formulated selective chromogenic agar and a low-cost portable incubator. Dual rectal swabs were collected from 220 ICU patients at Viet Tiep Hospital, Vietnam. One sample was processed using standard centralized laboratory procedures as the reference method, while the parallel sample was processed at the bedside by frontline nursing staff, including direct plate inoculation and point-of-care incubation. Diagnostic agreement, inter-reader reliability, procedural contamination, and operational feasibility were assessed. Gastrointestinal CRE carriage was identified in 26 of 220 patients (11.8%), with the KESC group accounting for 76.9% of positive cases. The bedside protocol demonstrated 100% phenotypic concordance with standard laboratory cultures, with 100% sensitivity, specificity, positive predictive value, and negative predictive value. Blinded assessment showed complete inter-reader agreement (κ = 1.0). No environmental cross-contamination was detected on CRE-negative plates (0.0%; 95% CI: 0-4.1%). The decentralized bedside screening model, costing less than US$1 per test, demonstrated high diagnostic agreement and operational feasibility when performed by frontline nursing staff in a non-sterile ICU environment. This approach may provide an affordable alternative for CRE surveillance in resource-limited healthcare facilities where centralized microbiology laboratory infrastructure is unavailable.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007479"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to prevention and healthcare-seeking in a fragile humanitarian setting: Evidence from Yemen during the COVID-19 pandemic.","authors":"Ola El Hajj Hassan, Ahmed Asa'ad Al-Aghbari, Huda Omer Basaleem, Khaled Abdulla Al-Sakkaf, Dalia Hyzam, Ahmad Siyar Noormal, Albrecht Jahn, Fekri Dureab","doi":"10.1371/journal.pgph.0007435","DOIUrl":"10.1371/journal.pgph.0007435","url":null,"abstract":"<p><p>The healthcare system in Yemen is confronted with substantial challenges, especially during pandemics such as COVID-19. In Aden, the COVID-19 pandemic occurred in the context of prolonged conflict, health-system fragility, resource constraints and other ongoing humanitarian challenges.This study aims to explore the barriers community members in Aden face in adopting COVID-19 preventive measures and seeking healthcare during the pandemic, and to identify implications for future outbreak preparedness in fragile humanitarian settings. A qualitative study involving 25 in-depth interviews was conducted with adult community members in Aden. Participants' perceptions of COVID-19 and reported preventive practices were also explored to contextualise the barriers influencing prevention and healthcare-seeking. Interview data were analysed using inductive qualitative content analysis; the Socio-Ecological Model (SEM) was applied as an interpretive framework to contextualise barriers across five interacting levels: intrapersonal/individual, interpersonal, organisational/institutional, community, and public policy/structural. Participants described barriers across five SEM levels: intrapersonal/individual barriers included denial, fear, perceived ineffectiveness of preventive measures and financial constraints; interpersonal barriers included stigma, mockery and social pressure; organisational/institutional barriers included perceived service refusal, concerns about infection prevention and staff preparedness, long waiting times, limited diagnostic testing, increased treatment costs and shortages of medical supplies; community-level barriers included rumours, misinformation and mistrust; and public policy/structural barriers included limited financial support, inadequate implementation of preventive measures, conflict-related constraints and perceived insufficient preparedness. The findings suggest that barriers to prevention and healthcare-seeking were interconnected across the five levels of the socio-ecological context, with individual perceptions and behaviours occurring within interpersonal, organisational, community and wider public policy and structural conditions. Future outbreak preparedness in fragile settings should therefore combine trusted, culturally appropriate risk communication, community engagement, accessible preventive resources, strengthened infection-prevention capacity, diagnostic and referral pathways, and continuity of essential health services.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007435"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing youth suicide as a public health crisis: Where does accountability lie?","authors":"Ananya Mosur Sridhar, Parth Sharma","doi":"10.1371/journal.pgph.0007368","DOIUrl":"10.1371/journal.pgph.0007368","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007368"},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and immediate effects of a multimodal, dance-integrated educational video package on eye health knowledge and intentions in Nigeria: A pre-post pilot study.","authors":"Ngozi Precious Uwagboe, Adaku Israel Obia, Onyinye Lilian Nwaolai, Pemije Gadimoh, Eghosa Osahon Alari, Carolyne Naana Yanney, Nnamdi John Eseme, Uchechukwu Levi Osuagwu","doi":"10.1371/journal.pgph.0005585","DOIUrl":"10.1371/journal.pgph.0005585","url":null,"abstract":"<p><p>Dance, as a culturally embedded and universally accessible form of art, offers a promising medium for health education in settings with diverse literacy levels. This pilot study evaluated the feasibility and immediate effects of a multimodal, dance-integrated educational video package designed to improve eye health knowledge, attitudes, and preventive intentions among Nigerian adults. Between April 11 and June 22, 2025, adults recruited through optometry clinics and community outreach programmes viewed culturally tailored educational videos addressing at least one eye condition (myopia, cataract, or glaucoma) and general eye health, including common myths and preventive practices. Pre-post changes were assessed using paired comparisons, with subgroup analyses by educational attainment. Among 438 participants, 77.7% were aged 18-44 years, 52.5% were female, 75.1% had higher education, 80.0% reported existing health-promoting behaviours, and 79.7% considered regular eye examinations important. Following the intervention, perceived eye health knowledge increased from 42.0% to 68.0% (absolute increase, 26.0 percentage points; relative increase, 61.9%; p = 0.013; Cramér's V = 0.279), while objective eye health knowledge scores increased by 52.4 percentage points (p = 0.013; Cramér's V = 0.069). Self-reported intentions to adopt protective practices, including wearing sunglasses, reducing screen time, and attending regular eye examinations, also increased. Overall intention to visit an eye clinic increased by 10%, although this change was not statistically significant (p = 0.443), likely reflecting high baseline health-seeking intentions. The largest improvements in willingness to attend regular check-ups occurred among participants with secondary education (27.5% to 96.3%, p < 0.001) and those with primary or no formal education (41.4% to 96.6%, p < 0.001). Dance-integrated educational videos were associated with immediate improvements in eye health knowledge and preventive intentions, particularly among participants with lower educational attainment, supporting their potential as a culturally relevant and scalable approach to eye health communication in diverse, resource-limited settings and community-based health promotion programmes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005585"},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap between health insurance eligibility and uptake: A multistate quantitative analysis of entitlement-based verification patterns under India's PM-JAY Scheme.","authors":"Swati Srivastava, Tads Ciecierski-Holmes, Christoph Strupat, Divya Parmar, Nishant Jain, Manuela De Allegri","doi":"10.1371/journal.pgph.0007451","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007451","url":null,"abstract":"<p><p>Publicly-funded health insurance schemes, wherein governments subsidize insurance contributions for disadvantaged groups, are a key strategy under universal health coverage. India's Pradhan Mantri Jan Arogya Yojana (PM-JAY) uses an entitlement-based approach whereby approximately 700 million beneficiaries are automatically eligible for scheme benefits, subject to a simplified identity verification procedure instead of enrolment. This study investigates the determinants of undergoing verification among PM-JAY's target population to identify underserved groups and inform strategies to expand coverage. We used cross-sectional survey data from 2019-2020, covering 50,002 individuals across five states. We examined individual and household characteristics associated with verification using logistic regression models with district-level random effects, and beneficiary experiences with the verification process. About one-fifth of eligible individuals had verified their status within a year of launch. Verification was more likely among older adults, with those ≥60years having higher odds than those 0-15 years of age (adjusted Odd Ratio [AOR] 2.339; 95% CI 2.071-2.641). Those with higher education had higher odds than those with no formal education (AOR 2.303; 95% CI 2.048-2.590), those with prior PFHI enrolment had higher odds compared to those not enrolled (AOR 1.947; 95% CI 1.827-2.075), and those with chronic illness had higher odds than those without (AOR 1.175; 95% CI 1.071-1.289). Women and household members other than spouses were less likely to verify. Disadvantaged castes and minority religions demonstrated relatively higher verification rates. District-level factors explained nearly one-third of variability, indicating that infrastructure and implementation capacity differences influence uptake. Many beneficiaries reported long wait times, varying documentation demands, and informal payments during verification. Addressing these barriers requires gender-sensitive outreach, streamlined household-wide verification, and strengthened local health system capacity. Policy reforms that simplify verification, ensure equitable access, and strengthen health infrastructure are vital to advancing effective universal health coverage for India's most vulnerable populations.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007451"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass azithromycin distribution and nutritional status among children aged 1-59 months: A secondary analysis of a cluster randomized trial.","authors":"Mamadou Ouattara, Huiyu Hu, Mamadou Bountogo, Boubacar Coulibaly, Valentin Boudo, Guillaume Compaoré, Clarisse Dah, Elodie Lebas, Kieran S O'Brien, Benjamin F Arnold, Thomas M Lietman, Ali Sié, Catherine E Oldenburg","doi":"10.1371/journal.pgph.0007473","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007473","url":null,"abstract":"<p><p>Twice yearly distribution of azithromycin has been shown to reduce all-cause child mortality in several contexts. Azithromycin likely reduces mortality via reduction in clinical or subclinical infections. Treating infections may improve child nutritional status to further reduce mortality risk. Here, we used data from a placebo-controlled cluster randomized trial of azithromycin for prevention of child mortality in Burkina Faso to evaluate the effects of twice-yearly azithromycin on mid-upper arm circumference (MUAC) in children aged 1-59 months and weight-for-age Z-score (WAZ) in infants aged 1-11 months. The Child Health with Azithromycin Trial (CHAT) was a 1:1 cluster randomized trial of twice-yearly azithromycin compared to matching placebo for prevention of all-cause mortality in children aged 1-59 months. Measurements were collected every 6 months, including MUAC measurements in all children and weight measurements in infants aged 1-11 months to calculate weight-based dosing. We evaluated MUAC and WAZ at the community level and longitudinally at the individual child level, accounting for the cluster randomized design of the trial. 80,282 children aged 1-59 months, of whom 26,983 were infants aged 1-11 months, in 284 communities were included in analyses. At the community level, we found no evidence of a difference in mean MUAC or WAZ after 36 months or over time. There was no evidence of a difference in change over time in MUAC (P-value for interaction = 0.94) or WAZ (P = 0.18) at the individual level. We found no evidence to support an effect of twice-yearly mass azithromycin distribution on measures of undernutrition in children in this setting in Burkina Faso.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03676764.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007473"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The governance gap: Determinants of health, international humanitarian law violations, and the case for health diplomacy.","authors":"Ellen Beer, José Chen-Xu, Regina Yuen, Andrea Planatscher, Rebecca Gilmour, Zara Ahmed, Cristina Santamaria-Plaza, Nunzio Zotti, Milena Vasic, Mariam Hachem, Francesco Rosiello, Duha Shellah","doi":"10.1371/journal.pgph.0007482","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007482","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007482"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problematic internet use and its associated factors among the students of higher secondary schools of Kathmandu Metropolitan City, Nepal.","authors":"Manish Rajbanshi, Susmita Thapa, Richa Aryal, Jesika Joshi, Birendra Bishwokarma, Dinesh Raj Neupane, Sushan Man Shrestha, Durga Prasad Pahari","doi":"10.1371/journal.pgph.0006511","DOIUrl":"10.1371/journal.pgph.0006511","url":null,"abstract":"<p><p>Problematic Internet Use (PIU) is a growing concern among adolescents in developing countries like Nepal due to increased access to electronic devices and the internet. Excessive use is associated with academic difficulties, inattention, and social isolation. Although it is an emerging concern, there is limited evidence on factors that contribute to PIU among students in Nepal. Thus, this study aimed to assess the prevalence of PIU and its associated factors among higher secondary school students of Kathmandu Metropolitan City (KMC). A cross-sectional study was conducted among 406 students in grades 11 and 12. Participants were selected using multistage random sampling. A self-administered questionnaire, the Internet Addiction Test (IAT), was used for data collection. Bivariate analysis was performed using the Chi-square test and bivariate binary logistic regression analysis. Multivariate logistic regression analysis was used to determine the factors associated with PIU. Variables with a p-value < 0.1 in bivariate analysis were included in the multivariate logistic regression model. The mean (±SD) age of the participants was 17.22 ± 1.03 years. This study found that 42.6% (95% CI: 37.0%-47.0%) of participants had PIU. Participants aged 19 years and above (AOR = 2.16, 95% CI:1.81-5.24), those from non-agricultural family income (AOR = 1.27, 95% CI: 1.07-2.25), and those who preferred YouTube (AOR = 1.70, 95% CI: 1.07-2.72), and Facebook (AOR = 1.65, 95% CI: 1.40-2.06) were at higher risk of PIU. Similarly, participants who used the internet in the evening (AOR = 2.01, 95% CI: 1.09-3.69), at night (AOR = 2.03, 95% CI: 1.21-3.38), and over 8 hours per day (AOR = 2.69, 95% CI: 1.48-4.91) had higher odds of PIU. This study revealed a high prevalence of PIU among adolescents. The study findings highlight the need for targeted interventions, including awareness programs, school-based preventive strategies and regulation of internet use time to promote healthy internet behavior among students.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006511"},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outdoor attractive targeted sugar bait Phase III trials for malaria control in Kenya, Mali, and Zambia: An individual participant data meta-analysis.","authors":"Ruth A Ashton, Daniel P McDermott, Fousseyni Kane, Sophie Sarrassat, Angela Harris, Christen Fornadel, Joseph Wagman, Javan Chanda, Megan Littrell, Feiko O Ter Kuile, Aaron M Samuels, Eric Ochomo, Thomas S Churcher, Joseph Biggs, Sarah G Staedke, Seydou Doumbia, Immo Kleinschmidt, Joshua Yukich, Thomas P Eisele","doi":"10.1371/journal.pgph.0006513","DOIUrl":"10.1371/journal.pgph.0006513","url":null,"abstract":"<p><p>Attractive targeted sugar baits (ATSB) are a potential new class of vector control tool that act through an \"attract and kill\" mechanism on mosquitoes. We conducted a meta-analysis using data from three large-scale Phase III trials of the Westham Sarabi v1.2 ATSB (0.11% dinotefuran) conducted in Kenya, Mali, and Zambia, to determine the effect of the intervention on clinical malaria incidence in children, Plasmodium falciparum infection prevalence, and dominant vector species parity, abundance, landing rate, and sporozoite positivity. The Sarabi ATSB was deployed on exterior walls at the rate of two per residential structure. Aggregated and individual-level meta-analyses were completed for each of the six trial outcomes, comprising 6981 person-years of follow-up for clinical malaria incidence (primary epidemiological outcome) and 19443 Anopheles for parity assessment (primary entomological outcome). Post-hoc analyses included assessment of dose-response relationships between coverage-adjusted intervention density and clinical malaria incidence. There were no statistically significant differences between arms in any of the epidemiological or entomological outcomes. There was statistically significant evidence of a 19% reduction in clinical malaria incidence for every 10 bait stations per hectare increase observed in spatial density (IRR 0.81, 95% CI 0.74-0.89, p < 0.001), provided that the ATSB were in good condition. This finding suggests that there may be deployment approaches or dosing strategies under which ATSB tools could be efficacious, although threshold spatial densities could not be determined from available data. This meta-analysis furthermore highlights important recommendations for future cluster-randomized trials of vector control interventions, including conducting comprehensive baseline data collection to identify cluster outliers or sites with differences in vector bionomics, and collecting a limited set of entomological outcomes in all trial clusters to ensure an adequately powered and balanced analysis of entomological effects.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006513"},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}