PLOS global public health最新文献

{"title":"Pregnancy loss and its predictors among ever-pregnant women in Sub-Saharan Africa: Multilevel mixed effect negative binomial regression.","authors":"Abel Endawkie, Yawkal Tsega","doi":"10.1371/journal.pgph.0004316","DOIUrl":"10.1371/journal.pgph.0004316","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy loss is a significant maternal health issue in Sub-Saharan Africa. Africa has the highest rates of stillbirths globally, with an estimated 2.7 million stillbirths occurring each year on the continent. The pregnancy loss data are underreported and inconsistently recorded in Sub-Saharan Africa. Therefore, this study aimed to determine the number of pregnancy loss and its predictors among ever-pregnant women in Sub-Saharan Africa using a recent round of demographic and health survey (DHS) data.</p><p><strong>Method: </strong>A secondary data analysis was conducted among 235,086 weighted ever-pregnant women in Sub-Saharan Africa using a recent round of DHS data from 2015-2023. Multilevel mixed effect negative binomial regression was conducted. An adjusted incidence rate ratio (AIRR) with a 95% confidence interval (CI) was reported.</p><p><strong>Result: </strong>The median number of pregnancy loss in Sub-Saharan Africa is 2.67, 95%CI (2.64, 2.69). A one-year increase in maternal age [AIRR= 1.05, 95%CI (1.06, 1.07)], primary educational status of the mother [AIRR = 1.10, 95% CI (1.01, 1.22)], women with a partner who has higher education [AIRR= 1.18, 95% CI (1.04, 1.39)], a higher number of under-five children [AIRR =0.95, 95% CI (0.91,0.99)], women have ever pregnant in Cote'divore [AIRR 1.76, 95% CI (1.6, 2)] are associated with the number of pregnancy loss.</p><p><strong>Conclusion: </strong>The findings indicate that there are three pregnancy losses among ever-pregnant women in Sub-Saharan Africa. Notably, a one-year increase in maternal age and higher education levels for both mothers and their partners are linked to an increased risk of pregnancy loss. In contrast, mothers with multiple children generally experience lower rates of loss. Therefore, policy interventions should address the heightened risk of pregnancy loss linked to advancing maternal age and higher education levels for both mothers and their partners. This can be achieved by supporting programs that educate prospective parents about the effects of maternal age on pregnancy outcomes. Furthermore, promoting flexible educational pathways and providing career support can encourage healthier timing for pregnancies. Additionally, initiatives that support families and promote larger family sizes may help reduce pregnancy loss rates in Sub-Saharan Africa.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004316"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804830","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":"Community perspectives on maternal dietary diversity in rural Kenya, Mozambique and The Gambia: A PRECISE Network qualitative study.","authors":"Mai-Lei Woo Kinshella, Shilla Dama, Onesmus Wanje, Rosa Pires, Helena Boene, Papa Jagne, Hawanatu Jah, Angela Koech, Grace Mwashigadi, Violet Naanyu, Yahaya Idris, Fatoumata Kongira, Brahima A Diallo, Omar Ceesay, Marie-Laure Volvert, Hiten D Mistry, Marleen Temmerman, Esperança Sevene, Anna Roca, Umberto D'Alessandro, Marianne Vidler, Laura A Magee, Peter von Dadelszen, Sophie E Moore, Rajavel Elango","doi":"10.1371/journal.pgph.0004411","DOIUrl":"10.1371/journal.pgph.0004411","url":null,"abstract":"<p><p>Pregnant and lactating women in sub-Saharan Africa are vulnerable to micronutrient inadequacies, with risk of adverse pregnancy outcomes. Adequate intakes of diverse foods are associated with better micronutrient status and recommended by the World Health Organization as part of healthy eating counselling during antenatal care. However, our understanding of community knowledge of dietary diversity within the context of maternal diets is limited. We used a descriptive qualitative approach to explore community perceptions of dietary diversity during pregnancy and lactation, as well as influencing factors in sub-Saharan Africa. A total of 47 in-depth interviews were conducted between May and October 2022 in Kenya, Mozambique and The Gambia with a purposively drawn sample of pregnant women and mothers who had delivered within two years preceding the data collection, their male and female relatives, and community opinion leaders. Other methods included participant observation and photovoice. Data were analyzed using a thematic approach on NVivo software. Dietary diversity was found to be well aligned with local perceptions of healthy meals. All participants were able to differentiate between starchy staple grains and additional foods to provide nutrients. While diverse meals were valued for pregnant and lactating mothers, participants across the three countries shared that maternal diets were not more diverse compared to typical household meals. Furthermore, diverse diets were inaccessible for many in their communities, due to challenges in affordability, seasonality, gender norms, knowledge and preferences. Adequate nutrition knowledge, accessibility of foods, and support of household decision-makers, particularly husbands and partners, were all identified as critical to ensure women have adequate diverse maternal diets.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004411"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775091","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":"Distribution and transmission of M. tuberculosis in a high-HIV prevalence city in Malawi: A genomic and spatial analysis.","authors":"Melanie H Chitwood, Elizabeth L Corbett, Victor Ndhlovu, Benjamin Sobkowiak, Caroline Colijn, Jason R Andrews, Rachael M Burke, Patrick G T Cudahy, Peter J Dodd, Jeffrey W Imai-Eaton, David M Engelthaler, Megan Folkerts, Helena R A Feasey, Yu Lan, Jen Lewis, Jennifer McNichol, Nicolas A Menzies, Geoffrey Chipungu, Marriott Nliwasa, Daniel M Weinberger, Joshua L Warren, Joshua A Salomon, Peter MacPherson, Ted Cohen","doi":"10.1371/journal.pgph.0004040","DOIUrl":"10.1371/journal.pgph.0004040","url":null,"abstract":"<p><p>Delays in identifying and treating individuals with infectious tuberculosis (TB) contribute to poor health outcomes and allow ongoing community transmission of M. tuberculosis (Mtb). Current recommendations for screening for tuberculosis specify community characteristics (e.g., areas with high local tuberculosis prevalence) that can be used to target screening within the general population. However, areas of higher tuberculosis burden are not necessarily areas with higher rates of transmission. We investigated the transmission of Mtb using high-resolution surveillance data in Blantyre, Malawi. We extracted and performed whole genome sequencing on mycobacterial DNA from cultured M. tuberculosis isolates obtained from culture-positive tuberculosis cases at the time of tuberculosis (TB) notification in Blantyre, Malawi between 2015-2019. We constructed putative transmission networks identified using TransPhylo and investigated individual and pair-wise demographic, clinical, and spatial factors associated with person-to-person transmission. We found that 56% of individuals with sequenced isolates had a probable transmission link to at least one other individual in the study. We identified thirteen putative transmission networks that included five or more individuals. Five of these networks had a single spatial focus of transmission in the city, and each focus centered in a distinct neighborhood in the city. We also found that approximately two-thirds of inferred transmission links occurred between individuals residing in different geographic zones of the city. While the majority of detected tuberculosis transmission events in Blantyre occurred between people living in different zones, there was evidence of distinct geographical concentration for five transmission networks. These findings suggest that targeted interventions in areas with evidence of localized transmission may be an effective local tactic, but will likely need to be augmented by city-wide interventions to improve case finding to have sustained impact.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004040"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775109","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":"Dynamics in ownership, access and use of long-lasting insecticidal nets in Togo: Evidence from three population-based surveys.","authors":"Gountante Kombate, M'belou Mazimna, Kamba Andre-Marie Soubeiga, Diederick E Grobbee, Marianne A B van der Sande","doi":"10.1371/journal.pgph.0004393","DOIUrl":"10.1371/journal.pgph.0004393","url":null,"abstract":"<p><p>Malaria remains a major public health problem in many countries in Sub Saharan Africa, including Togo, particularly among children under 5 years of age. Therefore, several mass distribution campaigns of long-lasting insecticide-treated bed nets (LLINs), which constitute an essential preventive strategy, have been conducted. The aim of this study is to assess progress in terms of equity of ownership, access and use of LLINs in a context of universal coverage among households in Togo.Data from the Togo Multiple Indicator Cluster Survey (TMICS) of 2010, the Togo Demographic and Health Survey (TDHS) of 2013-2014, and the Togo Malaria Indicator Survey (TMIS) of 2017 were used. For each survey, three main LLIN indicators were calculated: ownership (defined as % of households owning at least one LLIN), access (defined as % of households owning at least one LLIN per two people), and use (defined as use in the night before the survey by any household member). Trends from 2010 to 2017 were assessed by calculating the percentage point change between 2010 and 2017. A multivariate analysis was performed to identify factors associated with the use of LLINs in under five children. Nationally, between 2010 and 2017, LLIN ownership increased from 56.0% [54.4-58.2] to 85.0% [84.1-86.0]. LLIN access increased from 28.3% [27.0-29.2] to 71.0% [70.1-73.1], with little heterogeneity between regions. LLIN use increased from 37.1% [36.2-38.6] to 63.0% [62.5-64.7] in the whole population, with a similar trend observed among under five children. Region and type of housing showed a significant association with the use of LLINs in under five children. Considerable progress with regard to ownership, access and use of LLINs between 2010 and 2017 was observed in Togo, although LLIN coverage remained below the national targets of 100% for ownership and access for each member and 80% for use. The reduced inequity suggests efforts were well targeted to those most in need. These results can support both future policy decisions and downstream analyses of malaria prevention.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004393"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775120","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 catastrophic cost of TB care: Understanding costs incurred by individuals undergoing TB care in low-, middle-, and high-income settings - A systematic review.","authors":"Olivia Alise D'Silva, Samantha Lancione, Oviya Ananthakrishnan, Angelina Addae, Suvesh Shrestha, Hannah Alsdurf, Kednapa Thavorn, Nompumelelo Mzizi, Anca Vasilu, Alexander Kay, Anna Maria Mandalakas, Alice Anne Zwerling","doi":"10.1371/journal.pgph.0004283","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004283","url":null,"abstract":"<p><p>Eliminating the burden of catastrophic costs experienced by individuals undergoing tuberculosis (TB) treatment is one of the World Health Organization (WHO) End TB Strategy targets. To help inform decisions on TB patient burden and cost-effective TB care, we conducted a systematic review to summarize current evidence around the burden of catastrophic costs incurred by individuals undergoing TB treatment and identified the main drivers of costs to aid in developing mitigation strategies. A literature search was performed in August 2024 using Embase, Web of Science, Scopus and Medline targeting studies using WHO, or WHO adapted patient costing questionnaires to measure direct (medical and non-medical) and indirect costs associated with TB care. Key cost data and patient baseline characteristics were extracted. The study protocol was registered in PROSPERO (Registration number: CRD42021293600). The systematic review included 76 studies; with 70% published over the last 5 years. Total mean costs per person for TB care ranged from $7.13 - $11,329 USD; pre-diagnostic costs ranged from $30.37 - $1,442 USD; and post-diagnostic costs ranged from $33.64 - $5,194 USD. Costs were consistently higher amongst persons with drug resistant TB (DR-TB) and those identified through passive case finding (PCF). Hospitalization and loss of income were the largest drivers of cost. Despite many countries offering free TB treatment, patients still incurred significant catastrophic costs. Our review suggests that active case finding, improving access to DR-TB testing, and adopting social protection interventions may help mitigate the burden of out-of-pocket expenditures incurred by people suffering with TB.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004283"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-led strategies for communicable disease prevention and management in low- and middle- income countries: A mixed-methods systematic review of health, social, and economic impact.","authors":"Pitchaya P Indravudh, Kathleen McGee, Euphemia L Sibanda, Elizabeth L Corbett, Katherine Fielding, Fern Terris-Prestholt","doi":"10.1371/journal.pgph.0004304","DOIUrl":"10.1371/journal.pgph.0004304","url":null,"abstract":"<p><p>Control of infectious diseases is a global health priority and a target of the 2015-2030 Sustainable Development Goals (SDGs). Community participation is fundamental to advancing primary health care and meeting SDGs. We conducted a mixed-methods systematic literature review of quantitative and qualitative evidence to understand the health, social, and economic impact of community-led strategies for communicable disease prevention and management in low- and middle- income countries. We searched seven electronic databases through 31 December, 2023 for cluster-randomised trials and economic evaluations of community-led communicable disease control. Reference searches identified additional studies associated with eligible database records. Data extraction and narrative synthesis summarised evidence on impact, costs, and cost-effectiveness, described the nature and extent of community participation, and examined implementation, mechanisms of impact, and contexts. Risk of bias of was assessed using the Cochrane Risk-of-Bias Tool and the Drummond checklist. Our database search yielded 14,269 records. Following database and reference screening, we included 49 records across 16 unique cluster-randomised trials, mostly from sub-Saharan Africa. Communicable disease strategies included provision of biomedical products, environmental modifications, and education and outreach. Based on evidence with moderate risk of bias, we found that community-led strategies can improve health behaviours for diarrhoeal diseases, HIV, malaria, and neglected tropical diseases. Evidence for impact on mortality and morbidity, health care access and utilisation, and community and social outcomes was less conclusive. Impact depended on the intensity of implementation by community actors. Factors facilitating implementation included motivation, trust, and health systems engagement. Contextual influences included attitudes and norms around communicable diseases. Economic studies were few and many omitted societal costs and consequences. This review supports community-led communicable disease control as a potentially effective strategy to improve health behaviours and contribute to SDGs. Operational guidance for implementation and evaluation is critical to support rapid evidence generation in this important area.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004304"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775098","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":"Adolescents' screen time displaces multiple sleep pathways and elevates depressive symptoms over twelve months.","authors":"Sebastian Hökby, Jesper Alvarsson, Joakim Westerlund, Vladimir Carli, Gergö Hadlaczky","doi":"10.1371/journal.pgph.0004262","DOIUrl":"10.1371/journal.pgph.0004262","url":null,"abstract":"<p><p>Recently the Swedish Public Health Agency published recommendations of a maximum of two-to-three hours of daily leisure screen time for adolescents aged 13-18, partly to promote better sleep (2024-Sep-02). Biologically and socially, adolescence is characterized by belated sleep times, and depressive effects of screen time can arise through sleep displacements. Theorized links between screen time, sleep, and depression, merited examination of four sleep mediators to determine their relative importance and determine which of them mediate future depression. Hypotheses were preregistered. Three-wave psychometric health data were collected from healthy Swedish students (N = 4810; 51% Boys; ages 12-16; N = 55 schools; n = 20 of 26 Stockholm municipalities). Multiple imputation bias-corrected missing data. Gender-wise Structural Equation Modelling tested four sleep facets as competing mediators (quality, duration, chronotype, social jetlag). The primary model result included the three first mediators to achieve acceptable fit indices (RMSEA = 0.02; SRMR = 0.03; CFI = 0.95; TLI = 0.94). Screen time deteriorated sleep within three months and effect sizes varied between mediators (Beta weights ranged: 0.14-0.30) but less between genders. Among boys, screen time at baseline had a direct adverse effect on depression after twelve months (Beta = 0.02; p <0.038). Among girls, the depressive effect was mediated through sleep quality, duration, and chronotype (57, 38, 45% mediation). Social jetlag remained non-significant. This study supports a modernized 'screen-sleep-displacement theory'. It empirically demonstrates that screen-sleep displacements impact several aspects of sleep simultaneously. Displacements led to elevated depressive symptoms among girls but not boys. Boys may be more prone to externalizing symptoms due to sleep loss. Results could mirror potentially beneficial public health effects of national screen time recommendations.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004262"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775083","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":"Accessibility and quality of care for adults with hypertension in rural Burkina Faso: results from a cross-sectional household survey.","authors":"Stephanie Lacey, Maria Lisa Odland, Ali Sié, Guy Harling, Till Bärnighausen, Pascal Geldsetzer, Lisa R Hirschhorn, Justine I Davies","doi":"10.1371/journal.pgph.0003161","DOIUrl":"10.1371/journal.pgph.0003161","url":null,"abstract":"<p><p>Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of care for people with hypertension in Burkina Faso using the Institute of Medicine (IoM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-sectional household survey data collected from a population-representative sample of 4000 adults ≥40 years in Nouna, Burkina Faso in 2018. For people with hypertension, effectiveness was assessed through care cascades describing the proportion who were screened, diagnosed, treated, and achieved hypertension control; timeliness was defined as access to care within the last three months. Patient-centredness was described using experiential quality process and outcome measures (dichotomised as higher or lower quality [score above or below and including the median, respectively]; a shared understanding and decision-making (SUDM) variable was described. Equity was assessed for effectiveness, timeliness, and patient-centredness in multivariable analyses including socio-demographic factors. In total, 1006 participants with hypertension were included. Hypertension prevalence was 34.8%; 62.3% had been screened, 42.9% diagnosed, 15.0% treated, and 6.8% were controlled; 26.8% had accessed care within the last three months. Overall, 61.8% of participants had a positive view of the health service. Clarity of communication and opinion of medical provider knowledge were the best-rated experiential quality process variables, with 40.1% and 39.7% of participants´ responses indicating higher quality care respectively. The mean SUDM score was 68.5 (±10.8), range 25.0-100.0. Regarding equity, screening was higher in females, adults with any education, those who were married or cohabiting, and those in the higher wealth quintiles. There were no associations seen between SUDM and sociodemographic variables. Although the prevalence of hypertension was high in this population, the quality of care was not commensurate, with room for improvement in all four IoM Domains assessed.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0003161"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775080","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":"Validation of routine lymphatic filariasis morbidity surveillance in the Upper West Region, Ghana.","authors":"Hope Simpson, Kofi Agyabeng, Bright Alomatu, Ernest Mensah, Solomon Atinbire, Melissa Edmiston, Kofi Asemanyi-Mensah, Joseph Opare, Rachel L Pullan","doi":"10.1371/journal.pgph.0004336","DOIUrl":"10.1371/journal.pgph.0004336","url":null,"abstract":"<p><p>In Ghana and other countries pursuing elimination of lymphatic filariasis (LF), suspect cases of lymphoedema and hydrocele are routinely enumerated by community health workers (CHWs) during mass drug administration (MDA). These data, in addition to cases captured through the routine out-patient department are used for burden estimation and health service planning. To date there has been no systematic evaluation of the reliability of these data in Ghana. In December 2022, we conducted a cross-sectional survey of LF morbidity in two evaluation units in the Upper West Region of Ghana, including 19,180 participants. Participants with swelling affecting the scrotum or limbs were examined by clinicians to confirm whether symptoms were due to LF. Participants were asked whether their household had been visited by a CHW during the previous MDA. Suspect cases were asked whether they had reported their condition to a CHW or sought care elsewhere. We estimated the prevalence of each condition according to survey data and pre-existing routine data collected by CHWs and compared estimates. Lymphoedema prevalence rates were 87.3 and 61.2 per 10,000 in the two evaluation units, and hydrocele prevalence rates were 111.3 and 65.3 per 10,000 males. Routine enumeration underestimated lymphoedema prevalence by 81% in both cases, and underestimated hydrocele prevalence by 41%-52%. Nearly all households were visited during the previous MDA, but only 60.7% of lymphoedema and 28.3% of hydrocele cases had reported symptoms. 61.8% of lymphoedema and 42.9% of hydrocele cases had sought care from health facilities. Routine surveillance underestimates the prevalence of LF morbidity in the study area. Process modifications, including re-training of CHWs and health workers should be considered to improve data for service planning and validation of LF elimination. Anticipating cessation of MDA, continuous health service delivery, with periodic coverage evaluation, should be prioritised to strengthen passive surveillance.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004336"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775177","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":"Treatment outcomes in people with diabetes and multidrug-resistant tuberculosis (MDR TB) enrolled in the STREAM clinical trial.","authors":"Meera Gurumurthy, Narendran Gopalan, Leena Patel, Andrew Davis, Vignes Anand Srinivasalu, Shakira Rajaram, Ruth Goodall, Gay Bronson","doi":"10.1371/journal.pgph.0004259","DOIUrl":"10.1371/journal.pgph.0004259","url":null,"abstract":"<p><p>There is limited evidence on the effect of DM co-morbidity in those undergoing treatment for MDR-TB. We report post-hoc analyses of participants from the STREAM Clinical Trial (Stage 1 and 2 combined). Participants who self-reported diabetes, had random blood glucose ≥200mg/dl at baseline, or reported taking concomitant medication for diabetes were classified as the DM group. In total, 896 (n=84 DM, n=812 non-DM) and 976 (n=87 DM, n=889 non-DM) participants were included respectively in the efficacy and safety analyses reported here. Summary statistics for efficacy and safety outcomes were calculated. Hazard ratios (HR) for time-to-event outcomes were estimated using Cox-proportional hazard models. Compared to the non-DM group, the DM group were significantly older, more likely to be male and had a higher BMI. The DM group experienced a significantly higher proportion of serious adverse events (SAEs) (41% vs. 22%, p<0.001) but was comparable to the non-DM group on all other safety (grade 3-5 adverse events, deaths, unscheduled visits) as well as all efficacy parameters (proportion with unfavourable outcome, proportion FoR, time to FoR and culture conversion) assessed. The STREAM clinical trial experience indicated that it is possible to achieve similar treatment outcomes in people with MDR-TB who have a DM co-morbidity. However, this sub-population experienced more SAEs, underscoring the importance of close monitoring to manage their impact and improve MDR-TB treatment outcomes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004259"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765930","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}