BMJ Global Health最新文献

{"title":"ASEAN and the COVID-19 pandemic: a scoping review on the role and response of a regional organisation in a global health emergency.","authors":"Afifah Rahman-Shepherd, Jeffery Cutter, Soawapak Hinjoy, Zheng Jie Marc Ho, Joyce Chee Huimin, Irvin Miranda, Mohammad Arshil Moideen, Tikki Pang, Ahmed Razavi, Vincent Rollet, Li Yang Hsu","doi":"10.1136/bmjgh-2024-018342","DOIUrl":"10.1136/bmjgh-2024-018342","url":null,"abstract":"<p><p>The Association of Southeast Asian Nations (ASEAN) is a state-based membership organisation that facilitates cooperation in Southeast Asia. Over the past two decades, ASEAN has strengthened its cooperation efforts in health, particularly in managing infectious diseases. This scoping review explores the role and response of ASEAN in the COVID-19 pandemic, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched five databases using terminology related to 'ASEAN', 'COVID-19' and 'health emergencies', and extracted data on the role of ASEAN, its response efforts, critiques of either its role or response efforts, and any recommendations. We conducted a thematic synthesis of the evidence. From 17 studies, we characterised a normative, functional and diplomatic role that ASEAN played in managing the pandemic, and identified a total of 46 discrete mechanisms that ASEAN leveraged during. We synthesised both positive and negative critique of ASEAN's role and response efforts, and identified six themes of recommendations for ASEAN moving forward. Our review reveals the need for further research to understand where Member States' interests in managing health emergencies converge; and to define and measure the effectiveness of regional organisations to better establish their role and responsibilities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173566","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":"Wherever there is poverty - active and passive case finding to address neglect of noma in Mozambique.","authors":"Marta Ribes, Abdala Atumane, Fernando Padama, Filipe Abrigio, Milagre Andurage, Yosney Arbolaez, Eldo Elobolobo, Claire Jeantet, Gemma Moncunill, Tairo Sumine, Luis Transval, Marta Mapengo, Carlos Chaccour","doi":"10.1136/bmjgh-2025-020859","DOIUrl":"10.1136/bmjgh-2025-020859","url":null,"abstract":"<p><strong>Introduction: </strong>Noma is a rapidly progressing, disfiguring orofacial necrotising infection that primarily affects children living in poverty. To date, there are no primary data reporting noma in Mozambique. Our aim was to collect empirical evidence on the ongoing presence of noma in Zambezia Province, Mozambique, for the first time.</p><p><strong>Methods: </strong>We used a passive case search approach at the maxillofacial and paediatric wards of the reference hospital to identify acute noma cases. To find noma survivors, we conducted a community-based active case search, showing posters of noma sequelae to crowds of potential informants. We visited 12 of the 22 districts in the province and administered a questionnaire to each confirmed noma case.</p><p><strong>Results: </strong>Over a 5-week period, two acute noma cases and 21 survivors having had noma between 1971 and 2015 were identified. Using a cohort-estimated healthcare-seeking proportion of 18.75% and assuming a survival rate of 10%, the annual incidence in rural areas of Zambezia was estimated at 13.7 per 100 000 children under the age of nine years, suggesting that at least 213 noma cases occur yearly in the region.</p><p><strong>Conclusion: </strong>The total lack of data does not mean noma is non-existent in Mozambique. This study provides a simple methodology to rapidly identify noma cases in high-risk areas and populations. Noma is likely present wherever there is poverty. Increased awareness, reporting and public health interventions are urgently needed worldwide to stop the consequences of this preventable and treatable disease.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173582","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":"Differences in mental health between younger and older adults in complex humanitarian settings in low-income and middle-income countries: retrospective analysis from Médecins Sans Frontières-supported mental health services, 2019-2024.","authors":"Elburg van Boetzelaer, Raghda Sleit, Erickmar Rodriguez, Germando Kagomba Barathi, Favila Escobio, Joyce L Browne, Umberto Pellecchia, Judith van de Kamp, Martins Dada, Marion Staunton, Agirdo David Akaso, Nicole Wasara, Oscar Franco, Nadia Fredj, Grazia Caleo, Patrick Keating","doi":"10.1136/bmjgh-2025-019822","DOIUrl":"10.1136/bmjgh-2025-019822","url":null,"abstract":"<p><strong>Background: </strong>Humanitarian emergencies increase the risk of development or exacerbation of mental health conditions. This study documents how mental health differs between younger and older adults to inform adapted mental health services in humanitarian settings.</p><p><strong>Methods: </strong>This multicountry study includes adults who accessed Médecins Sans Frontières-supported mental health services in humanitarian settings across 20 low-income and middle-income countries between July 2019 and July 2024. Mental health symptoms and precipitating events were compared between younger (20-49 years old) and older adults (50 years or older) adjusting for sex and displacement status using logistic regression analyses.</p><p><strong>Findings: </strong>Data of 177 228 adults were included. Adults most frequently presented at mental health services with anxiety-related (44%; 70 496/158 665) and mood-related symptoms (26%; 41 732/158 665). Older adults had higher odds of reporting symptoms related to ageing (adjusted Odds Ratio (aOR)=4.44; 95% CI 3.84 to 5.14), physical complaints (aOR=2.74; 95% CI 2.65 to 2.83), social functioning (aOR=1.12; 95% CI 1.03 to 1.23) and neuro-psychiatry (aOR=1.09; 95% CI 1.02 to 1.17), and lower odds of reporting symptoms related to anxiety (aOR=0.68; 95% CI 0.66 to 0.70), mood (aOR=0.64; 95% CI 0.62 to 0.67) and behaviour (aOR=0.57; 95% CI 0.52 to 0.61), with variation by sex and displacement status. Compared with younger women, older women had higher odds of reporting violence, socioeconomic functioning and displacement, with variation by displacement status. Compared with younger men, older men had higher odds of reporting medical illness.</p><p><strong>Interpretation: </strong>Significant differences in mental health symptoms were identified between younger and older adults, with variations by sex and displacement status. Older adults were more likely than younger adults to present symptoms related to ageing. Compared with their younger counterparts, older women were more likely to report experiences of violence, and older men were more likely to report medical illness. These findings underscore the need for age-sensitive and sex-sensitive mental health services in humanitarian settings, including staff training on age-related mental health presentations.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173620","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":"Safety and efficacy of the ShangRing for early infant male circumcision in the routine clinical setting.","authors":"Lina Posada Calderon, Spyridon P Basourakos, Karla V Ballman, Kaylee Ho, Mark A Barone, Quentin Awori, Daniel Ouma, Jairus Oketch, Alice Christensen, Augustino Hellar, Maende Makokha, Alphonce Isangu, Robert Salim, Jackson Lija, Ronald Gray, Stephen Kiboneka, Aggrey Anok, Godfrey Kigozi, Regina Nakabuye, Charles Ddamulira, Silas Odiya, Marc Goldstein, Philip S Li, Richard K Lee","doi":"10.1136/bmjgh-2024-017903","DOIUrl":"10.1136/bmjgh-2024-017903","url":null,"abstract":"<p><strong>Introduction: </strong>Male circumcision (MC) has been shown to decrease transmission of HIV and is a critical strategy to decrease its incidence in countries with high rates of heterosexually transmitted HIV. Early infant MC (EIMC), with single-use MC devices, could increase rates of MC in Sub-Saharan Africa. Our objective was to determine the safety, efficacy and satisfaction of ShangRing EIMC in resource-constrained environments.</p><p><strong>Methods: </strong>Healthy male infants aged 1-60 days underwent ShangRing EIMC performed by non-physician clinicians in 14 sites in Kenya, Tanzania and Uganda. The primary outcomes were the safety and efficacy of ShangRing EIMC. Secondary outcomes were pain related to the procedure, wound healing and parental satisfaction. Male infants were assessed at discharge and on postoperative days 7 and 28 for wound healing and complications. This trial is registered with Clinical.</p><p><strong>Trials: </strong>gov, NCT03338699, and is complete.</p><p><strong>Results: </strong>From the 1697 participants enrolled from February to November 2020, 1691 (99.6%) underwent ShangRing EIMC. Median duration of the procedure was 10 min (IQR 6-13). The mean Neonatal Infant Pain Scale 20 min postprocedure was 0.3 (SD 0.8), indicating no pain. At the time of discharge, 1679 (99.0%) participants had a normal-appearing wound and 1574 (93.1%) demonstrated complete wound healing at 28 days. A total of 17 (1.0%) AEs were reported, most related to bleeding. A total of 1635 (99.1%) of parents were satisfied with the appearance of the circumcised penis at 28 days.</p><p><strong>Conclusion: </strong>ShangRing EIMC is a simple and successful MC method that non-physician clinicians can perform safely, with low AE rate, satisfactory wound healing and high satisfaction rate among parents. This indicates that the ShangRing EIMC can be considered a long-term strategic approach to accelerate the scale-up of MC in Sub-Saharan Africa.</p><p><strong>Trial registration number: </strong>NCT03338699.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147872","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":"It is not just about the training: rethinking strategies to strengthen the global emergency response workforce.","authors":"Mays Shamout, Adela Hoffman, Sonya Panjwani, Mariama Tejan, Cassandra Boutelle, Claire Corkish, Tasha Stehling-Ariza, Hannah Lofgren, Coralie Giese, Dante Bugli, Ashley Lauren Greiner","doi":"10.1136/bmjgh-2024-017454","DOIUrl":"10.1136/bmjgh-2024-017454","url":null,"abstract":"<p><strong>Introduction: </strong>Public health rapid response teams (RRTs) are critical to timely and effective emergency response. The US Centers for Disease Control and Prevention (CDC) has trained country-level public health emergency managers on RRT programme design, management and operations. However, countries continue to face challenges in RRT programming, requiring further elucidation of the supportive and challenging factors.</p><p><strong>Methods: </strong>In April 2021, 86 CDC-trained participants on RRT programme management were sent an anonymous online survey with questions regarding their country's RRT programme capacity (fully functional (FF-RRT) vs partially functional (PF-RRT)) and factors that affected programme implementation. Descriptive analyses were conducted; factors were stratified by respondent-reported RRT programme capacity and gross national income (low-lower middle (L-LM) and upper middle-high (UM-H) using a χ² test.</p><p><strong>Results: </strong>55 (64%) participants from 24 countries responded, most from the African region (75%) and 46% from L-LM countries. Most participants (82%) reported an RRT programme in their country, 65% PF-RRT and 35% FF-RRT. The greatest supportive factors for RRT programme implementation included a dedicated RRT management team (65%) and leadership understanding (65%). The major challenge was lack of funding (68%). L-LM countries cited greater challenges with funding (74% vs 38%; p=0.04) and equipment (46% vs 0%; p=0.01), while UM-H countries cited poor standard operating procedure development (50% vs 11%; p=0.04) and leadership understanding (50% vs 11%; p=0.01). Available funding was a more supportive factor for PF-RRTs than for FF-RRTs (48% vs 19%; p=0.004). More FF-RRTs (100% vs 62%; p=0.005) cited the lack of RRT surge staff as a challenging factor.</p><p><strong>Conclusion: </strong>Training RRTs is not enough. Addressing foundational factors such as sustainable funding and leadership support is essential for the long-term success of RRT programmes. With the challenges elucidated here, future global health initiatives can consider tailoring support based on RRT country capacity status and income level to ensure effective emergency response capacity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147896","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":"The landscape of violence against left-behind women in rural China: prevalence estimates and associated factors.","authors":"Leying Hou, Shiyi Shan, Zeyu Luo, Wenhan Xiao, Jiayao Ying, Jing Wu, Wen Liu, Peige Song","doi":"10.1136/bmjgh-2025-020501","DOIUrl":"10.1136/bmjgh-2025-020501","url":null,"abstract":"<p><strong>Background and objectives: </strong>Violence against women (VAW) is a critical public health issue, yet the experiences among left-behind women in rural China-resulting from rapid urbanisation-are largely overlooked. This study aimed to uncover the prevalence of VAW within this specific population and identify associated factors.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in Henan Province, China, in July 2023. A multistage stratified random sampling method was used to recruit rural left-behind women. Data on VAW were collected through validated questionnaires. To establish the full landscape of violence they might experience, VAW was assessed as intimate partner violence (IPV) and non-partner violence (NPV). As a new form of IPV, remote-IPV was also assessed. Prevalence estimates for various forms, types and specific items of violence were presented as frequencies with corresponding percentages. Random forest combined logistic regression was used to explore the associated factors of VAW.</p><p><strong>Results: </strong>Among 1516 eligible rural left-behind women, the median age was 52.0 years (IQR: 43.0-57.0). Overall, 31.1% reported experiencing VAW in their lifetime, of which 28.2% reported IPV, 5.4% reported remote-IPV and 7% reported NPV. In their past life, physical abuse (19.9%) was the most commonly reported IPV type, social abuse (3.3%) was the most commonly reported remote-IPV type and emotional abuse (5.9%) was the most commonly reported NPV type. VAW was significantly associated with advanced age (OR: 1.04, 95% CI: 1.02 to 1.06, p<0.001), marital dissatisfaction (OR: 3.42, 95% CI: 2.00 to 6.05, p<0.001) and husband's high-risk lifestyle behaviours (ORs varying from 1.37 to 2.59), including playing card, fighting and quarrelling history.</p><p><strong>Conclusions: </strong>VAW is highly prevalent and remains a significant serious public health problem for rural left-behind women in China. Depicting the landscape of VAW forms and types is beneficial to deeply understand the magnitude of the violence and to monitor the progress in addressing VAW.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147877","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":"Associations between digital financial services and health campaign workers' perceived satisfaction, motivation and performance in Nigeria.","authors":"Folashayo Peter Adeniji, David Adewole, Segun Bello, Juliet Aweko, Elizabeth Ekirapa Kiracho, Peter Waiswa, Fredrick Makumbi, Olufunmilayo Fawole","doi":"10.1136/bmjgh-2024-018384","DOIUrl":"10.1136/bmjgh-2024-018384","url":null,"abstract":"<p><strong>Background: </strong>Understanding the association between digital payment services and health worker outcomes is critical to improving public health outcomes and optimising health workforce efficiency. This study examined the link between digital payment systems and health campaign workers' perceived satisfaction, motivation and performance in Nigeria.</p><p><strong>Methods: </strong>A national survey was conducted among 821 polio immunisation workers who participated in campaigns. A structured electronic questionnaire which had sections on sociodemographic characteristics and digital payments was used to elicit information from participants. Campaign workers' self-reported satisfaction, motivation and performance were assessed using standardised tools for examining these outcomes. Linear mixed model regression analysis was used to examine the factors associated with health worker's motivation, satisfaction and performance. Predictors of these outcomes during periods of cash and digital payment methods were assessed, with statistical significance set at the 5% level.</p><p><strong>Results: </strong>This cross-sectional study included 821 health campaign workers in Nigeria, with a mean age of 37.13 years (SD=11.06). Regarding digitised payments, mean scores across all constructs were generally high: general motivation (16.34±2.58; maximum=20), job satisfaction (20.33±3.16; max=25), intrinsic job satisfaction (12.87±1.62; max=15), organisational commitment (16.99±1.96; max=20), conscientiousness (15.68±1.71; max=20), timeliness and attendance (13.35±1.55; max=15) and perceived performance (20.54±2.97; max=25). Overall, the combined motivation, satisfaction and performance score was higher among workers paid via digital methods compared with those paid in cash (104.14±9.34 vs 68.43±50.75). In multivariable linear regression, being female (β=1.83; 95% CI=0.28 to 3.38) and the ability to use the internet (β=1.87; 95% CI=0.02 to 3.72) were significant independent predictors of higher overall scores.</p><p><strong>Conclusion: </strong>Digital payment methods were associated with higher health workers' perceived job satisfaction, motivation and performance. Public health stakeholders need to promote the use of digital payments to maximise their positive influence on health workers.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130012","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":"What silence reveals: the quiet abandonment of free health care in North Korea.","authors":"Joon Hee Han, Shin Ha, Minjae Choi, Hanul Park, Eun Hae Lee, Sujeong Yu, Yo Han Lee","doi":"10.1136/bmjgh-2025-021019","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-021019","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124071","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":"Time to address the drawbacks in estimation and reporting of malaria cases in India and beyond.","authors":"Nimita Deora, Richa Singhal, Abhinav Sinha","doi":"10.1136/bmjgh-2025-019170","DOIUrl":"https://doi.org/10.1136/bmjgh-2025-019170","url":null,"abstract":"<p><p>India is committed to eliminate malaria by 2030. However, there has been a continuous debate between National Malaria Control Programmes (NMCPs) and World Health rganization (WHO) on the differential perception of malaria burden. The evident gap between the reported cases by NMCPs and WHO estimations, particularly for India, has never been unbiasedly addressed. This work provides a critical understanding of gaps between estimated and reported cases (ERR) of malaria and the possible reasons thereof.We calculated the ratio between estimated and reported cases, called ERR thereof, for highlighting this gap from 2010 to 2022. We also dissected some of the assumptions/adjustments used by WHO to compensate for data inadequacy while estimating malaria cases. The contribution of private sector in reporting malaria cases and contemporary research data on malaria burden in India were correlated with ERR.ERR remained consistently high (WHO-South-East Asia Region >6; India >10) from 2010 to 2022. Certain assumptions/adjustment factors used by WHO for estimation were unclear. Malaria case reporting from private sector in India was virtually non-existent contributing to consistently high ERR. Data from contemporary research in India also reveal a high burden gap with microscopy-positivity being 3 to 55 times higher than that reported by the NMCP.There still remain a few areas where more detailed clarification is needed both from the WHO and the NMCPs reporting malaria burden specifically regarding malaria case reporting from the private health sectors. If these issues are addressed and resolved, the gap between ERR can be narrowed down or even zeroed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129841","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":"Should neighbours of tuberculosis (TB) cases be prioritised for active case finding in high TB-burden settings? A prospective molecular epidemiological study.","authors":"Raspati C Koesoemadinata, Susan McAllister, Chuan-Chin Huang, Sri Hartati, Hanif Djunaedy, Nury Fitri Dewi, Lidya Chaidir, Bony Wiem Lestari, Panji Fortuna Hadisoemarto, Reinout Van Crevel, Megan B Murray, Bachti Alisjahbana, Philip C Hill","doi":"10.1136/bmjgh-2025-019137","DOIUrl":"10.1136/bmjgh-2025-019137","url":null,"abstract":"<p><strong>Introduction: </strong>In high tuberculosis (TB)-burden countries, considerable transmission of <i>Mycobacterium tuberculosis</i> (<i>M. tb</i>) likely occurs outside of households. We aimed to estimate the TB prevalence and incidence in households and neighbourhoods around known TB cases and to understand transmission patterns.</p><p><strong>Methods: </strong>Household and neighbourhood contacts of pulmonary TB index cases from contiguous areas in Bandung, Indonesia, were screened and followed up for 12 months. Sputum samples underwent smear microscopy, <i>M. tb</i> culture, Xpert MTB/RIF, DNA isolation and whole-genome sequencing (WGS). Pairwise single-nucleotide polymorphism (SNP) distance ≤12 defined transmission for pairs with known epidemiological links, or SNP≤3 for pairs without epidemiological link. An SNP=12 cut-off was used to characterise transmission clusters.</p><p><strong>Results: </strong>From 213 index cases, 514 household and 4141 neighbourhood contacts underwent TB screening: 19 household (3.70%, 95% CI 2.24 to 5.71) and 45 neighbourhood (1.09%, 95% CI 0.79 to 1.45) contacts were identified with TB, of whom 18 (3.50%, 95% CI 2.20 to 5.48) and 38 (0.92%, 95% CI 0.65 to 1.13) respectively, were bacteriologically confirmed. During follow-up, 11 household and 13 neighbourhood contacts were identified with TB (incidence per 100 000 person-years: 2286 (95% CI 1286 to 4148) and 350 (95% CI 190 to 563)), of whom 6 and 8, respectively, were bacteriologically confirmed (incidence per 100 000 person-years: 1247 (95% CI 560 to 2776) and 201 (95% CI 101 to 402)). A total of 223 patient <i>M. tb</i> isolates underwent WGS. Of 15 intra-household pairs, 8 (53.3%) were transmission pairs. Of 24 neighbour to index case pairs, 1 (4.2%) was a transmission pair. 11 of 19 transmission pairs shared no epidemiological link. We identified 25 <i>M</i>. <i>tb</i> genetic clusters from 205 mono-TB isolates overall.</p><p><strong>Conclusion: </strong>Neighbours have lower prevalence and incidence of TB than household contacts, but twice as many cases. Very few received <i>M. tb</i> from their index case, suggesting uncontrolled community-wide transmission. Whole population active case finding may be necessary in high TB-burden settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129788","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}