PLOS global public health最新文献

{"title":"Maternal healthcare quality, continuity, and experiences among pregnant adolescents and adult women in Ethiopia, Kenya, and South Africa: A cohort study.","authors":"Beatrice Amboko, Irene Mugenya, Emily Odipo, Rose Jepchumba Kosgei, Wen-Chien Yang, Shalom Sabwa, Gebeyaw Molla Wondim, Nompumelelo Gloria Mfeka-Nkabinde, Londiwe Mthethwa, Nokuzola Cynthia Mzolo, Margaret E Kruk, Catherine Arsenault, Jacinta Nzinga","doi":"10.1371/journal.pgph.0004729","DOIUrl":"10.1371/journal.pgph.0004729","url":null,"abstract":"<p><p>The capacity of health systems to provide quality care for pregnant adolescents remains underexplored. This study examined the quality, continuity, and experiences of maternal healthcare among pregnant adolescents (<20 years) compared with adult women (20 + years) in Ethiopia, Kenya, and South Africa. It also explored factors associated with mistreatment and obstetric complications among adolescents using data from the Maternal and Newborn Health eCohort study. We followed 3,051 pregnant women from their first antenatal care (ANC) visit until six weeks postpartum. We used descriptive analyses to compare care quality and outcomes and logistic regression to identify factors among adolescents. The study included 380 adolescents and 2,671 adults. Adolescents had lower first-trimester ANC attendance (22% vs. 30%, p = 0.003), fewer follow-up ANC visits (mean 3.1 vs. 3.8, p < 0.001), and lower adherence to iron-folic acid supplementation (59.0% vs. 69.4%, p < 0.001). Continuity of care was also lower (53% vs. 59%, p < 0.001). Adolescents experienced more mistreatment during delivery (26.9% vs. 18.6%, p = 0.003). Obstetric complications occurred in 31% of adolescents compared with 25.9% of adults. Mistreatment was associated with rural residence (adjusted odds ratio (aOR): 2.61, 95% CI: 1.11-6.13, p = 0.028), public facility use (aOR: 4.33, 95% CI: 1.44-13.1, p = 0.009) and intimate partner violence (IPV) (aOR: 3.31, 95% CI: 1.16-9.39, p = 0.025). Protective factors included being in Kenya (aOR: 0.19, 95% CI: 0.05-0.75, p = 0.018), privacy during delivery (aOR: 0.44, 95% CI: 0.21-0.92, p = 0.030) and high perceptions of quality of care (aOR: 0.37, 95% CI: 0.18-0.76, p = 0.007). Obstetric complications were associated with rural residence (OR: 2.25, 95% CI: 1.09-4.63; p = 0.028) and antenatal depression (OR: 2.43, 95% CI: 1.19-5.00, p = 0.015). These findings highlight gaps in adolescent maternal healthcare. Strengthening adolescent-responsive and respectful care within primary healthcare, alongside integrated mental health and IPV support, may improve adolescents' maternal healthcare experiences and outcomes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0004729"},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119703","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":"Integration of oral health promotion in primary school health programs: A scoping review.","authors":"Nikita Surani, Nathalia Carolina Fernandes Fagundes, Harmanpreet Kaur, Rebecca Gokiert, Arnaldo Perez-Garcia, Maryam Amin","doi":"10.1371/journal.pgph.0007390","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007390","url":null,"abstract":"<p><p>Children experience significant oral health problems, compromising learning and quality of life. Schools are effective in promoting children's overall health, within which oral health can be integrated. This scoping review aimed to map integration of oral health within primary school health programs. The review was guided by Arksey and O'Malley's framework and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR). JBI Manual for Evidence Synthesis was referred to for data extraction. A systematic search was performed across six databases with no restrictions on dates and locations. The review included 31 articles published between 1981 and 2025. Over 70% studies were concentrated exclusively in high-income and upper-middle income regions. Quantitative methods were reported in twenty-one studies. All studies reported programs targeting children. Only 12 included parents or guardians, mostly as passive recipients. Most common intervention delivery agents were teachers, identified in 25 studies. Unhealthy diet and poor hygiene were frequently targeted common risk factors, identified in 18 and 11 studies respectively. Tobacco use, stress, and injury were largely overlooked. Twenty-seven studies reported activity-based learning to promote general health. Classroom education, followed by interest holder engagement and structured toothbrushing were used to promote oral health, focusing on student skill-building and empowerment, alongside teacher involvement. None of the studies applied integration-specific or implementation science frameworks or models. Twenty-six studies assessed child-level oral health outcomes. In contrast, only seven reported changes in knowledge, attitudes, and practices among educators and parents. Ten reported program-related outcomes. Structured programs engaging children, targeting risk factors related to hygiene and diet alongside interest holder engagement and curriculum integration hold promise. This review highlights the need for theoretically informed, comprehensive, policy-focused, multi-level, multi-risk factor approaches to support sustainable integration of oral health into school health programs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007390"},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119326","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":"Factors associated with microbiological non-compliance in ready-to-eat foods: A seven-year analysis of official food safety surveillance data in a tropical low- and middle-income country.","authors":"L Marcela Montilla Rodríguez, Jorge Alejandro Obando Bastidas, Hugo Andrés Rodríguez Fajardo, Astrid Magaly Mora López, Shirley Viviana Tique Aragón, Dora Patricia Rozo Cruz, Edgar Calderón Vega, Norma Cristina Pavas Escobar, Laura Nathalia Obando Vargas, Jean Paul Farfán, Marina Sthella Gonzalez Robayo","doi":"10.1371/journal.pgph.0006492","DOIUrl":"https://doi.org/10.1371/journal.pgph.0006492","url":null,"abstract":"<p><p>Food safety is an important component of global public health, particularly in low- and middle-income countries (LMICs). This study aimed to identify factors associated with microbiological non-compliance in ready-to-eat (RTE) foods using seven years of official surveillance data from the Colombian Orinoquía region. RTE foods were defined as foods intended for immediate consumption without additional cooking or thermal processing. A retrospective analysis was conducted on 1,868 samples collected between 2017 and 2023, of which 1,846 were included in inferential analyses. Microbiological non-compliance, defined as failure to meet at least one regulatory microbiological criterion, was the primary outcome. Associations were assessed using multivariable logistic regression, complemented by descriptive and exploratory analyses, including heatmaps and principal component analysis. Microbiological non-compliance was identified in 39.5% of the evaluated samples. Hygiene indicators predominated, particularly total coliforms (29.0%), aerobic mesophilic bacteria (12.7%), and Escherichia coli (12.3%), whereas foodborne pathogens were infrequently detected. Raw or highly handled foods had higher odds of microbiological non-compliance than thermally processed foods (OR = 8.40; 95% CI: 6.59-10.72). Higher odds were also observed for samples from rural or dispersed municipalities (OR = 1.31; 95% CI: 1.01-1.70) and samples collected in 2020 (OR = 1.78; 95% CI: 1.16-2.74). Exploratory analyses revealed heterogeneous microbiological profiles across temporal, territorial, operational, and food-related dimensions, with a consistent predominance of hygiene indicators. Overall, microbiological non-compliance was mainly associated with food matrix type, territorial characteristics, and sampling year. The predominance of hygiene indicators supports incorporating hygienic quality and process control alongside pathogen detection into microbiological surveillance. These findings provide evidence to support risk-based food safety surveillance and targeted prioritization strategies in tropical low- and middle-income settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0006492"},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119950","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":"From visit counts to quality care: A qualitative study on early implementation of a new model for antenatal care in Kavre district, Nepal.","authors":"Samita K C, Rajani Shakya, Abha Shrestha, Abha Shrestha, Emma Radovich","doi":"10.1371/journal.pgph.0005076","DOIUrl":"https://doi.org/10.1371/journal.pgph.0005076","url":null,"abstract":"<p><p>In 2016, WHO updated its antenatal care (ANC) guidelines, increasing the minimum number of ANC visits from four to eight and recommending practices for those visits. Nepal adopted this new ANC model in 2022, but limited research has examined how the model has been implemented. This study explored the perspectives of pregnant women, ANC providers and local policymakers on the rollout of the new ANC model in Kavre district of Nepal. We conducted an exploratory qualitative study involving interviews with pregnant women, ANC providers and local policymakers along with semi-structured facility observations. Six primary care level government health facilities offering ANC services were purposively selected from three municipalities of Kavre district, Nepal. Data included eight interviews with pregnant women, seven with providers and three with local policymakers along with field notes from observations in six facilities. Interview transcripts and observation field notes were coded manually and analyzed thematically. Three major themes emerged from the analysis of the interviews and observations. Providers and policymakers viewed the new ANC model mainly as increase in visit frequency for documentation rather than enhanced quality care. Although orientation on the increased number of visits was presented to providers, most providers lacked understanding on the content and purpose of each visit. Pregnant women, particularly those in rural areas, reported logistical, financial and physiological challenges in completing all recommended visits and accessing care at referral sites. Implementation of new ANC model in Kavre district largely remained focused on visit quantity rather than quality. Strengthening provider's capacity, ensuring availability of guidelines, enhancing understanding of its purpose and implementation, and fostering person centered care are essential to achieve the intended benefits of the model.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005076"},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119989","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":"Evaluating a biochemical TB medication adherence test: Insights from image-based reporting through a patient companion app.","authors":"Kiara Lee, Enrique Chen Liang, Alejandra Tolentino, AuDuyen Trinh, Daniel Leon, Kyle Goodwin, Jennifer Sprecher, Fernando Rubinstein, Barry Lutz, Sarah Iribarren","doi":"10.1371/journal.pgph.0007182","DOIUrl":"10.1371/journal.pgph.0007182","url":null,"abstract":"<p><p>Tuberculosis (TB) treatment requires strict adherence over the long course of treatment. To support adherence, we developed the TB Treatment Support Tools (TB-TST), which combines a urine-based lateral flow assay (LFA) with a mobile application for patient education, support, and communication with treatment supporters. In a pragmatic randomized controlled trial participants uploaded images of the LFA. A blue-purple color change indicates detection of an isoniazid metabolite consistent with recent medication ingestion. This study assessed real-world interpretability and usability of the TB-TST LFA by analyzing the quality and characteristics of user-submitted images. We conducted structured qualitative coding (visual content analysis) of 1,655 submitted test images to identify recurring issues affecting interpretation. Eligible participants were aged 16 or older, newly diagnosed with TB, and had access to a mobile phone. An iteratively developed codebook identified three primary issue categories: 1) color variations in the test or control strip, 2) photo quality issues, and 3) test cartridge/test-strip artifacts. Most (72%) images were consistent with a clear positive (blue-purple) color change or clear negative. Variations that were not clear positives included no color change (white), yellow/orange, and green/teal hues. Blurriness was the most common image quality issue. The most common test artifact was visual evidence consistent with dye bleed/possible cross-strip contamination between the control and the test strips. Despite challenges in image submission and test appearance, relatively few images were difficult to interpret, supporting the feasibility of user-submitted LFA images for monitoring recent isoniazid ingestion. Opportunities to improve performance and usability include enhanced user guidance for image capture, refinement to cartridge design to reduce artifacts, clearer interpretation protocols for atypical color outcomes, and automated image-based reading. Integrating qualitative image analysis with engineering design principles can inform user-centered improvements to home-based LFAs connected to digital adherence technologies.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007182"},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119830","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":"Reclaiming the new era in global health: A proposal for an equity-centered paradigm.","authors":"Pooja Yerramilli, Mickey Chopra","doi":"10.1371/journal.pgph.0007379","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007379","url":null,"abstract":"<p><p>Global health is facing unprecedented upheaval, with significant donor disruptions requiring a reconfiguration of the global health landscape. While recently proposed frameworks for the next phase of global health represent meaningful progress in grappling with this context, their central weakness is not technical but normative. In this Essay, we argue that if the new global health architecture is defined without meaningful interrogation of its central purpose, then the system will reproduce the very problems it aims to solve. On the other hand, explicitly centering health equity as the organizing principle of the new \"global health\" brings to the foreground the shared struggles and movements of marginalized communities worldwide. In doing so, it demands a more fundamental, global reckoning with the structural determinants - politics and power - that produce ill health across and within countries. From this logic flows substantive shifts in global health functions, predicated on a social-ecological model: from substitution to mutual aid; from technical assistance to knowledge sharing; from global public goods to multisectoral common goods for all; and from mechanisms that facilitate global coordination to ones that also critically address the distribution of power and resources.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007379"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119761","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":"Evaluating smartphone-based cough frequency monitoring for tuberculosis screening and triage in Uganda: A mixed-methods evaluation.","authors":"Patrick Biché, Francis Kayondo, Annet Nalutaaya, James Mukiibi, Mariam Nantale, Joowhan Sung, David W Dowdy, Achilles Katamba, Emily A Kendall","doi":"10.1371/journal.pgph.0005201","DOIUrl":"https://doi.org/10.1371/journal.pgph.0005201","url":null,"abstract":"<p><p>Symptom-based tuberculosis screening usually depends on self-reported cough, which is subjective. Passive smartphone cough monitoring offers a more objective alternative. This study assessed the diagnostic accuracy and implementation feasibility of smartphone-based cough frequency monitoring for identifying likely TB cases in Uganda. Adults (≥15 years) screened in community settings or tested at Kampala health facilities underwent microbiological testing and 48 hours of cough monitoring with the Hyfe Research app. TB status was determined by Xpert MTB/RIF Ultra and culture, with inverse probability weighting to adjust for differential enrollment. Cough frequency was compared between participants with and without TB, and accuracy assessed using weighted ROC curves. Staff interviews, analyzed thematically, explored provider-side implementation challenges. Of 884 enrolled participants, 197 had both valid recordings and TB status (101 community, 96 facility). Median cough frequency was higher among those with TB: 2.2 coughs/hour (IQR 0.8-6.1) vs 0.9 (0.4-2.0) in the community, and 6.7 (2.6-27.5) vs 2.4 (0.9-4.8) in facilities (Wilcoxon P < 0.0001 for both). AUCs were 0.69 (95% CI 0.58-0.79) in the community and 0.76 (95% CI 0.60-0.88) in facilities. For self-reported cough at 90% sensitivity, specificities were 55% (95% CI 29-88%) and 36% (95% CI 17-68%), respectively. Recorded cough frequency correlated moderately with self-reported cough severity, Saint George's Respiratory Questionnaire scores, and staff-observed coughs. Staff cited device visibility, stigma, and security concerns as barriers. Smartphone-recorded cough frequency was associated with TB status but did not meet accuracy thresholds for stand-alone screening or triage, and implementation problems limited data collection. Addressing these operational barriers will be critical to future development and deployment of cough monitoring tools for TB screening.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0005201"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119916","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":"Prevalence and incidence of non-communicable diseases among older adults living with HIV on antiretroviral therapy in Northern Haiti: A retrospective cohort study.","authors":"Ronald Thiersaint, Romaine Nephtalie Mésidor, Valérie Pelletier, Chesnel Parny Norcéide, Jean Géto Dubé, Harold Prévil, Kesner François, Jean Baptiste T Koama, Michael A Melchior, Macarthur Charles","doi":"10.1371/journal.pgph.0007175","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007175","url":null,"abstract":"<p><p>The growing burden of non-communicable diseases (NCDs) among aging people living with HIV (PLHIV) represents a major public health challenge, yet data to guide integrated care in Haiti remain limited. To address this gap, we conducted a retrospective cohort study of PLHIV aged 40 years and older receiving care at two hospitals in northern Haiti. Using electronic medical record data from routine HIV clinical visits between July 1 and September 30, 2015, we compared NCD prevalence at ART initiation and after ≥12 months of follow-up. We also identified baseline risk factors associated with incident NCDs, with a secondary analysis focused specifically on predictors of incident renal insufficiency. Among 318 participants, 65.7% had one or more NCD at ART initiation, increasing to 70.8% after ≥12 months. The prevalence of hypertension rose from 37.1% to 47.2% and diabetes from 7.9% to 12.6%, while overweight/obesity remained stable (14.5% to 15.7%). In contrast, renal insufficiency prevalence decreased from 31.1% to 22.6%. In the adjusted analysis, female sex was the sole independent predictor for developing at least one incident NCD (AOR: 3.29; 95% CI: 1.40-7.72). In the secondary analysis for incident renal insufficiency, female sex (AOR: 5.88; 95% CI: 1.78-19.50) and elevated systolic blood pressure (AOR: 1.052; 95% CI: 1.005-1.101) were the only significant predictors. A high proportion of older PLHIV in northern Haiti are affected by NCDs. These findings underscore the need for integrated care models, particularly for older women living with HIV, who appear to be at the highest risk for developing new NCDs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007175"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119645","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":"Co-occurrence of anaemia and malaria among children under five in Uganda: A joint modeling analysis.","authors":"Grace Kakaire, Robert Too, Gregory Kerich, Mathew Kosgei","doi":"10.1371/journal.pgph.0007387","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007387","url":null,"abstract":"<p><p>Childhood illnesses such as anaemia and malaria continue to pose significant health risks for children under five in sub-Saharan Africa. These conditions often co-occur, reflecting complex interdependencies driven by shared biological and environmental factors. Traditional analytical approaches typically assume independence between health outcomes, potentially overlooking meaningful associations. This study aims to identify the dependence structure among anaemia and malaria in children under five using a joint modeling approach. Data were drawn from the most recent Malaria Indicator Survey (MIS), comprising 5,755 children. A bivariate probit model was estimated using a Gaussian copula framework with probit margins for each outcome. This approach allowed for the simultaneous modeling of the marginal probability of each illness and the latent correlations among them. The model incorporated a range of child-, household-, and maternal-level covariates. Average Marginal Effects (AMEs) were calculated to facilitate interpretation. The copula correlation (ρ) between anaemia and malaria from the copula structure was estimated to quantify the dependence between the two illnesses. Descriptive analyses revealed substantial co-occurrence: 13.8% of children experienced both illnesses simultaneously. The joint copula model detected significant positive copula correlations (ρ ≈ 0.19) between anaemia and malaria. Several covariates displayed differential effects in the joint versus separate models. For instance, the association between maternal anaemia and child malaria risk reversed direction once interdependence was accounted for. Joint modeling yielded more stable and plausible estimates across outcomes. This study highlights the critical importance of accounting for outcome dependence in the analysis of child morbidity. The significant correlations among malaria and anaemia suggest that these illnesses are influenced by common or interacting risk factors. Joint modeling using a Gaussian copula framework enhances both the precision of marginal effect estimates and the understanding of comorbidity patterns. These findings support the design of integrated health interventions that address the interconnected nature of childhood illnesses in high-burden settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007387"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119913","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":"Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition.","authors":"Juaneta Luiz, Lesley J Workman, Cynthia B Baard, Yekiwe Hlombe, Margaretha Prins, Nomlindo Makubalo, Devan Jaganath, Adithya Cattamanchi, Mark P Nicol, Heather J Zar","doi":"10.1371/journal.pgph.0007271","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007271","url":null,"abstract":"<p><p>Microbiological diagnosis of childhood pulmonary tuberculosis can be challenging. We investigated the accuracy of Xpert MTB/RIF Ultra on the induced sputum, focused on high-risk groups (infants, malnourished children, and those living with HIV), where data is limited. Children (under 15 years) investigated for pulmonary tuberculosis at Dora Nginza Hospital, South Africa, were prospectively enrolled between January 2018 and January 2024, and followed up for 12 months. Induced sputa were tested with liquid culture and Xpert MTB/RIF Ultra (Ultra). Children were categorized with confirmed, unconfirmed, or unlikely tuberculosis, according to NIH consensus definitions. Ultra diagnostic accuracy was calculated against culture, with analysis by high-risk subgroups. Of 636 children (median age, 27.4 (IQR 11.8-61.6) months), 173 (27.2%) were classified with confirmed TB, 384 (60.4%) with unconfirmed TB, and 79 (12.4%) with unlikely TB. There were 223 (37.8%) children underweight-for-age, 168 (26.5%) living with HIV, and 163 (25.6%) infants. Of 557 children with TB, 145 (26.0%) were confirmed on induced sputa; with 137/557 (24.6%) confirmed on Ultra (46.0%; 63/137, of which were \"trace positive\"), and 88/557 (15.8%), on culture. Of those confirmed, 57/145 (39.3%) were Ultra positive, culture negative - contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores < -3. Overall, Ultra sensitivity was 90.9% (95%CI 82.9-96.0) and specificity, 89.6% (95%CI 86.7-92.0), with high accuracy across high-risk groups. Mortality amongst children treated for PTB was 4.9% (27/557) with aRR highest for stunted children (7.3; 95% CI, 2.2-24.2), followed by children with HIV (3.5; 95% CI, 1.6-7.5), and infants (3.3; 95% CI, 1.6-6.7). Ultra on induced sputum was feasible, with high yield and diagnostic accuracy for high-risk children.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007271"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119668","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}