BMJ Global Health最新文献

{"title":"Perceptions of body size and non-communicable disease risk among people with HIV in Nairobi, Kenya: an explanatory mixed-methods study.","authors":"Kara Suvada, Erica L Kocher, Michael H Chung, Christine Kundu, Helen Moraa, Nancy Ngumbau, Catherine Maina, Ludivine Brunissen, Mohammed K Ali, John Kinuthia, Emily W Kamau, Leslie C M Johnson","doi":"10.1136/bmjgh-2024-016546","DOIUrl":"10.1136/bmjgh-2024-016546","url":null,"abstract":"<p><strong>Introduction: </strong>Burden of non-communicable diseases (NCDs) continues to rise in low- and middle-income countries like Kenya. People with HIV (PWH) may be at greater risk for obesity and NCDs. National health policies recommend integrated approaches to manage these conditions, but have not been widely implemented. To inform implementation, we characterised PWH's knowledge, attitudes and practices related to NCDs, perceptions of body size and NCD risk, and experiences of weight-related stigma and discrimination.</p><p><strong>Methods: </strong>We conducted a cross-sectional, sequential explanatory, mixed-methods study among PWH attending the Comprehensive Care Centre of Kenyatta National Hospital in Nairobi, Kenya. We surveyed 101 patients and interviewed 24 based on body mass index, NCD status and sex. We conducted descriptive statistics and Student's t-tests with the survey data and employed a rapid qualitative analysis approach to the interview data. We triangulated quantitative and qualitative results using joint displays.</p><p><strong>Results: </strong>Participants had high levels of awareness and concern about NCDs. Women reported greater worry about NCDs than men; this difference was significant for cancer and hypertension (p<0.05). Participants were aware that higher weight can increase NCD risk, though often did not think of themselves as at risk. Additionally, 50% of participants underestimated their actual body size, and most (74%) tried gaining or losing weight within the last year. Weight-related discrimination and stigma were low overall, though underweight individuals expressed these concerns most. Some participants expressed a desire for integrated HIV-NCD care.</p><p><strong>Conclusion: </strong>Our results provide context for future weight management and HIV-NCD service integration initiatives in Kenya. NCDs are a major health concern for PWH. Many participants did not think of themselves as at risk, perhaps because half underestimated their actual body size. Future work should focus on understanding motivations for weight management to improve efforts to address HIV and NCDs in clinics and health systems.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic scoping review of the noma evidence landscape: current knowledge and gaps.","authors":"Brittany J Maguire, Rujan Shrestha, Prabin Dahal, Roland Ngu, Lionel Nizigama, Sumayyah Rashan, Poojan Shrestha, Elinor Harriss, Paul Newton, Yuka Makino, Benoit Varenne, Philippe J Guerin","doi":"10.1136/bmjgh-2024-018023","DOIUrl":"10.1136/bmjgh-2024-018023","url":null,"abstract":"<p><strong>Background: </strong>Noma (cancrum oris) is a severe gangrenous disease of the mouth and oro-facial structures. Noma often affects young children living in extreme poverty, malnutrition and poor sanitation. Gaps remain in understanding its aetiology, pathogenesis, prevention and treatment.</p><p><strong>Methods and findings: </strong>We systematically searched databases for all primary research studies (clinical trials, cohort studies, case-control, cross-sectional, other observational studies, case studies/series) reporting noma patients of any age up to 7 December 2022. The 366 publications (published between 1839 and 2022) included in our scoping review describe 15 082 patients. Although 53 cohort and 29 cross-sectional studies were identified, enrolling 13 489 patients, interventional research remains extremely limited, with only six studies identified (101 patients, range: 7-26) and only one in the past decade, highlighting a critical gap in treatment evaluation. A total of 380 different treatment modalities were described, which underscores lack of a standardised practice. Disease aetiology remains unclear, with 117 microorganisms reported across 113 studies, yet none more consistently linked to noma development. Since 2000, 91.2% of cases have been reported in Sub-Saharan Africa, though occurrences outside the 'noma belt' and into Asia and the Americas suggest a broader risk. The 212 potential risk factors identified in 269 (73.5%) publications reflect substantial heterogeneity, complicating efforts to determine definitive causative factors. Additionally, the inconsistent definition and reporting of noma staging significantly hinder comparability across studies, with wide adoption of the WHO staging classification needed.</p><p><strong>Conclusion: </strong>This comprehensive review of the literature underscores the urgent need for robust, policy-driven research to address the vast knowledge gaps in the physiopathology of noma and the limited evidence currently available to guide therapeutic and preventive policies. Collective action and increased research investment are crucial, especially now that noma is officially recognised as a neglected tropical disease by the WHO.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of depression with glycaemic control in people living with diabetes in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Kim A Nguyen, Mercian Daniel, Yang Zhao, Derrick Sekgala, Sudha Kallakuri, Jillian Hill, Rohina Joshi, Andre Pascal Kengne, Nasheeta Peer","doi":"10.1136/bmjgh-2025-018939","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-018939","url":null,"abstract":"<p><strong>Background: </strong>Depression has been found to be associated with poor diabetes control, which contributes to diabetes complications. However, the association between depression and glycaemic control remains understudied in low- and middle-income countries (LMICs) where the greatest burden of uncontrolled diabetes and diabetes complications exists. This meta-analysis examined the association of depression with glycaemic control in adults with diabetes mellitus in LMICs.</p><p><strong>Methods: </strong>We performed comprehensive searches in PubMed-Medline, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to identify studies that examined the association of depression with glycaemic control. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled effect estimates were expressed as ORs and mean differences (MDs) using random effects meta-analysis. Heterogeneity of effects was tested using Cochran's Q test.</p><p><strong>Results: </strong>A total of 39 studies comprising 22 456 adults with diabetes, of whom 21% had depression, were included in the meta-analysis. Depression was associated with poor glycaemic control (OR: 2.01, 95% CIs 1.41 to 2.86; I²: 90.8%; p<0.001; AOR: 1.52; 1.20 to 1.92; I²: 93%; p<0.001; MD: 0.56; 0.27 to 0.84; I²: 82%; p<0.001), with difference in effect sizes by depression diagnostic criteria (p<0.001). Age, diabetes duration, marital status and publication year had no effect on the association (all p≥0.096); while inconsistent effects on the association were observed for body mass index, male gender, sample size and region where studies were conducted. Observed publication bias (all p≤0.007 for the Egger's test) was likely spurious.</p><p><strong>Conclusion: </strong>This meta-analysis found a positive association of depression with poor glycaemic control in adults with diabetes in LMICs. The findings emphasise the importance of incorporating mental healthcare in diabetes management in low-resource settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of women's empowerment with childhood immunisation coverage in South and Southeast Asia: meta-analysis of Demographic and Health Surveys data from 11 countries.","authors":"Abdul Ghani Khatir, Negina Rahman, Tolulope Ariyo, Tingshuai Ge, Muhammad Usman Saleem, Quanbao Jiang","doi":"10.1136/bmjgh-2024-018306","DOIUrl":"10.1136/bmjgh-2024-018306","url":null,"abstract":"<p><strong>Background: </strong>Child health and gender inequalities are significant global public health issues that demand immediate action, particularly in South and Southeast Asian (SSEA) countries where both challenges are prevalent. This study examines the association between women's empowerment and child vaccination coverage in 11 SSEA low- and middle-income countries.</p><p><strong>Methods: </strong>Using population-level cross-sectional data from Demographic and Health Surveys across 11 SSEA countries, we developed an Individual-Level Women's Empowerment Index (ILWEI) based on three dimensions of women's empowerment: decision-making autonomy, attitude towards intimate partner violence and social independence. A three-stage mixed-effect individual participant data meta-analysis was employed to assess the association between ILWEI and childhood immunisation coverage.</p><p><strong>Results: </strong>In India, 81.28% of women reported participation in three to four decision-making areas, followed by 62.07% in Bangladesh. Full immunisation coverage ranged from 32.43% in Afghanistan to 63.30% in Bangladesh. The association between women's empowerment and vaccination coverage varied across South and Southeast Asia, with the strongest positive associations observed in Pakistan. However, mixed or negative associations were found in countries such as India and Timor-Leste.</p><p><strong>Conclusion: </strong>Our findings indicate that in several SSEA countries, including Pakistan, Cambodia, the Philippines and Afghanistan, higher levels of individual women's empowerment are positively associated with an increased likelihood of childhood immunisation coverage. However, in countries such as India, Myanmar and Timor-Leste, higher women's empowerment was associated with lower odds of childhood immunisation, highlighting potential contextual or systemic barriers that may hinder vaccination uptake. This underscores the critical role of women's empowerment in enhancing childhood vaccination intake while also emphasising the need for targeted interventions to address country-specific challenges. Coordinated, multifaceted strategies are essential to empower women and thereby support the immunisation of children across regions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic events exposure in men who have sex with men with and without experience of displacement in Ukraine.","authors":"Nicholas King, Jonanne Talebloo, Pavlo Smyrnov, Tetyana I Vasylyeva","doi":"10.1136/bmjgh-2024-017953","DOIUrl":"10.1136/bmjgh-2024-017953","url":null,"abstract":"<p><p>The Russian invasion of Ukraine has displaced millions, potentially exposing them to traumatic events in the process. Potentially traumatic events (PTEs) have been linked to negative health outcomes, including depression, substance abuse and risky sexual behaviours. Men who have sex with men (MSM) are especially vulnerable to the effects of displacement, given widespread MSM stigma in Ukraine. A cross-sectional survey of MSM was conducted as part of a peer-driven intervention between August 2023 and January 2024 across eight cities in Ukraine via respondent-driven sampling. Lifetime PTE exposure responses were grouped into three binary variables: accidental/injury, victimisation and death threat. The relationship between displacement and exposure to PTEs was modelled using multivariate covariance generalized linear models with a logistic link, extending logistic regression to all three PTE responses. n=3617 (mean age 29.8, SD 8.1; 93% of the 3886 surveyed) were analysed. Controlling for sampling structure, participation in military operations, adverse experience of unstable housing in the last 2 years and age, internal displacement was significantly associated (p<0.001) with all three types of PTEs: adjusted ORs for accidental/injury, victimisation and death threat were 2.04, 1.57 and 2.05, respectively. As the war continues, our results highlight the need for trauma-informed care for internally displaced MSM in Ukraine, as many of them have been exposed to various types of PTEs. Those with adverse experiences of unstable housing conditions or participating in military operations particularly need to be considered.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial protection and universal health coverage in Georgia: an analysis of impoverishing healthcare costs using household income and expenditure surveys .","authors":"Tsotne Gorgodze, Akaki Zoidze, Jolly Mae Catalan, George Gotsadze","doi":"10.1136/bmjgh-2025-019150","DOIUrl":"10.1136/bmjgh-2025-019150","url":null,"abstract":"<p><strong>Background: </strong>Financial protection, an important objective of universal health coverage, ensures that individuals can access necessary healthcare without financial hardship. It is typically assessed through two indicators: catastrophic out-of-pocket (OOP) health spending and impoverishing health spending. Despite the introduction of Georgia's Universal Health Coverage Programme (UHCP) in 2013, which covers nearly 90% of the population, the incidence of impoverishing and catastrophic health spending remains high compared with other European countries and has not changed much over the past decade.</p><p><strong>Objective: </strong>This study aims to identify the factors associated with impoverishing health expenditures among Georgian households to inform financing policy decisions and prevent individuals from being driven into or deeper into poverty due to healthcare costs.</p><p><strong>Methods: </strong>We used data from the Georgian Household Income and Expenditure Surveys, spanning 2009-2023 (n=198 292 households). A survey-weighted logistic regression accounted for complex design elements such as stratification, clustering and unequal selection probabilities. The outcome variable was impoverishing health spending, defined using the relative poverty line. Andersen's behavioural model of healthcare utilisation guided explanatory variable selection.</p><p><strong>Results: </strong>OOP spending on drugs was the strongest determinant of impoverishment (OR 43.3, 95% CI 39.3 to 47.7, p<0.001). The poorest quintile was especially burdened (OR 44.5, 95% CI 22.1 to 89.7, p<0.001), with the second quintile also at elevated risk. The odds of impoverishment declined from 2009 to 2013-when benefits were targeted to the poor-but rose slightly afterwards. From 2014 to 2023, the average probability of impoverishment was around 0.34, compared with 0.28 in 2013.</p><p><strong>Discussion: </strong>The findings suggest that targeted benefits before UHCP may have offered stronger protection than the broader, less targeted approach post-2013. Enhanced coverage for outpatient drug costs-especially for the poorest-through increased public investment and progressive benefit expansion could improve financial protection.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving social determinants of health significantly reduces AIDS incidence: a modelling study of 1.17 million individuals in Brazil.","authors":"Rodrigo Volmir Rezende Anderle, Felipe Alves Rubio, Priscila Scaff, Ana Paula Santin Bertoni, José Alejandro Ordoñez, Iracema Lua, Gonzalo Barreix, Megan Naidoo, James Macinko, Luis Eugenio de Souza, Maria Ines Costa Dourado, Davide Rasella","doi":"10.1136/bmjgh-2024-017726","DOIUrl":"10.1136/bmjgh-2024-017726","url":null,"abstract":"<p><p>Despite progress in addressing HIV/AIDS, the burden remains uneven, especially in low- and middle-income countries (LMICs). Social determinants of health (SDH) significantly influence HIV/AIDS. We studied the impact of SDH inequalities on AIDS incidence in Brazil, a large and diverse LMIC. We used an agent-based model (ABM) to introduce the SDH inequalities of income, education, sex and race in an HIV/AIDS model of 1 172 721 residents in 10 Brazilian state capitals. We simulated the poorest half of the population using the Cadastro Único database and calibrated our baseline models for each city with AIDS incidence from 2012 to 2019. We compared them with an alternative scenario where the effect of inequalities in SDH was removed. The difference between scenarios and subpopulations was measured in terms of cumulative rate ratios (RR) and avoidable cases over the study period. If there were no inequality in income, education, sex and race, there would be 38.8% lower AIDS incidence (95% CI 33% to 44.4%) compared with the baseline scenario. Furthermore, AIDS incidence was lower among individuals with low income (44.9%, 95% CI 34.7% to 61%), lower education (39.8%, 95% CI 34.6% to 46.5%) and people of Brown or Black race (39.3%, 95% CI 33.5% to 47.3%), in the alternative scenario compared with the baseline scenario. Furthermore, addressing inequality in the selected SDH had a positive spillover effect in reducing AIDS incidence in high income (31%, 95% CI 23.3% to 48.8%), highly educated (13.7%, 95% CI 8.4% to 27.8%) and white or Asian (35.4%, 95% CI 27.5% to 46.6%) populations, indicating a strong benefit to the whole of society. Our results suggest that addressing social inequalities in key SDH could reduce the number of AIDS cases among Brazil's poorest population by at least a third from 2012 to 2019. This effect is particularly significant in subpopulations with higher vulnerabilities. Implementing social protection policies to tackle these inequalities has the potential to help control the HIV/AIDS epidemic and advance the AIDS-related Social Development Goals.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying and assessing the capacity and experience of trial sites in low- and middle-income countries for high-quality randomised drug trials in maternal and perinatal health.","authors":"Maureen Makama, Annie Ra McDougall, Anna Shalit, Ben Sanderson, Tahlia Guneratne, Kate Mills, Jenny Cao, Shivaprasad S Goudar, Pisake Lumbiganon, Anne Ammerdorffer, Jennifer A Scott, Lindsay Keir, Ahmet Metin Gülmezoglu, Joshua Peter Vogel","doi":"10.1136/bmjgh-2024-018063","DOIUrl":"10.1136/bmjgh-2024-018063","url":null,"abstract":"<p><p>Existing international consortia for drug trials in maternal and perinatal health have focused largely on pragmatic trials using off-label medicines. This study aimed to identify and assess the capacity and experience of sites in low- and middle-income countries (LMICs) for conducting trials for regulatory approval of medicines for pregnancy-related conditions. We systematically reviewed site assessment checklists across any disease area to develop a maternal trial site assessment checklist. The checklist was pretested, revised and used to collect data from trial sites in LMICs. Sites were systematically identified from a scoping review of maternal trials conducted in LMICs, known networks and snowball searching. Data reported by sites were verified against publicly accessible sources (clinical trial registries and published articles). We contacted 106 sites in 30 countries, of which 49 (46.2%) sites in 21 countries completed the checklist. Sites were from five regions-Sub-Saharan Africa (37), South Asia (6), Latin America and the Caribbean (4), Middle East and North Africa (1) and East Asia and the Pacific (1). More than 70% of responding sites had the requisite physical infrastructure, clinical and research staff, ethics, participant recruitment and data management services to conduct randomised trials. Respondents collectively identified 52 completed, ongoing or planned maternal trials across their sites. Of these 52 trials, 16 (30.8%) were Good Clinical Practice-compliant, 22 (42.3%) were phase III and one was a regulatory trial. 14 trials were conducted by a collaborative group established mostly for a specific trial or a small group of related trials. Only two of these groups were pre-established trial networks. While there is some capacity to conduct high-quality maternal drug trials in LMICs, effective research collaborations are needed to further strengthen and expand this capacity. Establishing a sustainable LMIC-based trial network will accelerate the development and testing of novel drugs to improve maternal and newborn health outcomes in these regions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the quality of antimalarial drugs in Equatorial Guinea: a follow-up study.","authors":"Harparkash Kaur, Laura Paris, Jeremías N Mba Eyono, Restituto Mba Nguema Avue, Wonder P Phiri, Jordan M Smith, Carlos A Guerra, Matilde Riloha Rivas, Guillermo A García","doi":"10.1136/bmjgh-2024-018597","DOIUrl":"10.1136/bmjgh-2024-018597","url":null,"abstract":"<p><strong>Introduction: </strong>Poor-quality antimalarial medications, including falsified and substandard formulations, pose significant public health risks, contributing to ineffective treatment and potential drug resistance. Our research conducted in 2013 on Bioko Island, Equatorial Guinea (EG), found 9.6% (n=61) of the artemisinin-containing antimalarials (ACAs) purchased were of poor quality. This study aimed to update the quality of all sold antimalarials and extend to include regions on the mainland.</p><p><strong>Methods: </strong>A total of 637 samples, 564 ACAs and 73 non-ACAs, were purchased from 424 outlets on Bioko Island and mainland EG using a mystery client sampling approach. Samples were analysed for content using high-performance liquid chromatography with diode-array detection and classified as acceptable, substandard or falsified based on pharmacopoeia tolerance limits. Additionally, bioavailability was assessed through dissolution testing for a select number of samples.</p><p><strong>Results: </strong>Overall, 40.5% of the samples were of acceptable quality, 31.2% were substandard and 28.3% were falsified. Regional differences showed a higher prevalence of falsified samples in Bata, Mangomo, Evinayong and Ebebiyín cities on the mainland (30.9%) compared with Bioko Island (25.6%). Artemether/lumefantrine, the first-line treatment for malaria in EG, showed 25.7% were of acceptable quality, 48.2% substandard and 26.1% falsified. Artemisinin monotherapy tablets had the highest rate of falsification (56.8%). For non-ACAs, 13.3% of sulfadoxine/pyrimethamine tablets were of acceptable quality, 48.9% substandard and 37.8% falsified. All quinine syrups were falsified, and most quinine tablets (87.5%) and injections (75.0%) were substandard.</p><p><strong>Conclusion: </strong>The prevalence of substandard and falsified antimalarials in EG has alarmingly increased from 9% in 2013 to 59.5% in 2018, highlighting the urgent need for enhanced regulatory measures. Immediate actions should include strengthening drug quality surveillance, particularly in private sector pharmacies, and implementing low-cost medicine screening methods for early detection of poor-quality medications. Ensuring the quality of antimalarials is critical to maintaining the efficacy of malaria control programmes and preventing the development of drug resistance.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is rotavirus aetiology in young children with acute diarrhoea associated with sociodemographic and clinical factors, including rotavirus vaccination status? A secondary cross-sectional analysis of the ABCD trial.","authors":"Sarah Somji, Christopher R Sudfeld, Christopher Duggan, Karim Manji, Tahmeed Ahmed, Mohammod Jobayer Chisti, Usha Dhingra, Sunil Sazawal, Benson Singa, Judd L Walson, Patricia B Pavlinac, Naor Bar-Zeev, Eric Houpt, Queen Dube, Karen L Kotloff, Samba O Sow, Mohammad Tahir Yousafzai, Farah Naz Qamar, Rajiv Bahl, Ayesha De Costa, Jonathon L Simon, Per Ashorn","doi":"10.1136/bmjgh-2024-018337","DOIUrl":"10.1136/bmjgh-2024-018337","url":null,"abstract":"<p><strong>Introduction: </strong>One of the leading causes of global child mortality continues to be diarrhoea where rotavirus contributed to about 24% of deaths among all diarrhoeal deaths, mostly in low-income and middle-income countries. Rotavirus vaccination programmes have contributed to the reduction of mortality from 24% to 19% in rotavirus infections among hospitalised children, but the burden of rotaviral diarrhoea remains high, especially in settings with undernutrition. We aimed to determine the association of rotaviral diarrhoea aetiology with prior vaccination, socioeconomic status and clinical factors in children to see their utility in clinical settings.</p><p><strong>Methods: </strong>We analysed secondary data from a multicentre clinical trial on antibiotic impact in children with diarrhoea and increased risk of mortality. We used stored stool samples of 6697 children aged 2-23 months old, presenting to a health facility with diarrhoea and increased risk of mortality. We determined rotavirus aetiology prevalence using quantitative PCR (qPCR) and looked at its association with the patient's rotaviral vaccination status, clinical symptoms and sociodemographic characteristics. Prevalence ratios (PR) were calculated with log-binomial regression models; if they did not converge, log-Poisson models were used.</p><p><strong>Results: </strong>Rotavirus prevalence of 21.1% was observed. There was a weak and statistically non-significant inverse association between rotavirus vaccination and rotaviral diarrhoea aetiology (adjusted PR: 0.71, 95% CI 0.49 to 1.03). Of the five tested clinical symptoms, shorter diarrhoea duration was associated with rotaviral aetiology (PR: 2.65; 95% CI: 1.29 to 5.45). Of the seven tested socioeconomic characteristics, only maternal and paternal secondary education compared with no formal education were associated with rotaviral aetiology (PR: 0.86; 95% CI: 0.74 to 1.00, PR: 0.87, 95% CI: 0.75 to 1.00 respectively).</p><p><strong>Conclusion: </strong>Rotaviral diarrhoea aetiology cannot accurately be determined with prior receipt of rotavirus vaccination among children presenting to facilities with diarrhoea and increased risk of mortality. Short diarrhoea duration and parental secondary education were associated with increased prevalence of rotaviral aetiology; however, their utility in clinical care remains unclear.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}