Tropical Medicine and Infectious Disease

Antimicrobial resistance (AMR) surveillance plays a critical role in tracking emerging trends and informing evidence-based policies. This study assessed bacterial contamination and resistance profiles of Escherichia coli and Pseudomonas aeruginosa in 1886 drinking water samples from 12 regions of Ghana between April 2024 and April 2025. Findings were compared to a baseline study from the Greater Accra region (2022). Water samples analysed included sachet, bottled, tap, borehole, well, and surface water. Isolates were tested for antibiotic susceptibility using the Kirby–Bauer disk diffusion method. The majority of treated and packaged water samples were free from bacterial contamination. E. coli was frequently detected in untreated surface water (68%) and well water (63%). E. coli isolates from untreated water samples exhibited high resistance to cefuroxime (74%) and amoxicillin-clavulanate (50%); resistance to gentamicin increased from 3% in 2022 to 35% in 2025, while ertapenem resistance rose from 6% to 18%. Multidrug-resistant (MDR) E. coli isolates were found in samples from eight regions, and MDR P. aeruginosa in three, mostly from borehole water. These findings highlight the urgency to integrate AMR surveillance into national water quality initiatives, along with coordinated public health interventions, to educate communities on household water treatment practices and the health risks posed by AMR. Full article

Leptospirosis is a zoonotic disease caused by pathogenic Leptospira, prevalent in tropical/sub-tropical regions. This study aimed to clarify the prevailing leptospiral species, clinical features, and risk factors of leptospirosis in north-central Bangladesh in 2024. Venous blood and urine samples were collected from 117 patients with clinically suspected leptospirosis. Among these cases, 75 (64%) tested positive for Leptospira infection by IgM ELISA test and/or PCR. By phylogenetic analysis of the 16S rRNA gene, all the samples tested were classified into L. wolffii (pathogenic group P2), showing high sequence identity to those of the type strain Khorat-H2 (97–99%) and L. wolffii reported in Bangladesh previously. Confirmed leptospirosis patients were mostly male (93%), aged 15–60 years (93%), living in rural areas in low socioeconomic conditions. Variable symptoms were presented by patients, with jaundice (84%), nausea/vomiting (84%), and myalgia (67%) being common. Some patients showed severe symptoms involving the nervous system (disorientation and neck stiffness) and the respiratory tract (cough, shortness of breath, and hemoptysis). Major risk factors for leptospirosis were exposures to mud/wet soil, sanding water, heavy rain, working in a paddy field, and cattle. In conclusion, L. wolffii was revealed to be circulating endemically in north-central Bangladesh, since its first detection in 2018, associated with variable and severe clinical symptoms in humans. Full article

Background: Tularemia is a zoonotic infection caused by Francisella tularensis, transmitted to humans through direct contact with infected animals, arthropod bites, or by ingesting contaminated water. It commonly presents with fever, lymphadenopathy, and oropharyngeal symptoms. In Turkey, where waterborne outbreaks are frequent, tularemia remains a significant public health concern. This study aimed to compare the clinical, epidemiological, and laboratory characteristics of patients diagnosed with tularemia and those with similar clinical features but seronegative results, with the goal of identifying parameters that may assist in differential diagnosis. Methods: This retrospective study included adults (≥18 years) who presented to the Infectious Diseases Outpatient Clinic between 2016 and 2024 with suspected tularemia and were tested using a microagglutination test (MAT). Patients with a positive MAT (≥1:160) or a fourfold titre increase were classified as tularemia cases, while seronegative patients were defined as tularemia-like cases. Demographic data, clinical symptoms, epidemiological risk factors, and laboratory findings were compared between the two groups. Results: A total of 105 patients were included, 54 (51.4%) of whom were diagnosed with tularemia. The duration from symptom onset to healthcare presentation was significantly longer in tularemia cases (20.3 ± 5.7 vs. 15.7 ± 6.2 days; p < 0.001). Sore throat (66.7% vs. 43.1%; p = 0.026) and tonsillitis/pharyngitis (55.6% vs. 21.6%; p = 0.001) were significantly more prevalent in the tularemia group. Epidemiological risk factors, including rural residence (92.6%), animal husbandry (74.1%), agricultural activity (72.2%), and contact with lake or stream water, were significantly more prevalent among tularemia cases (all p < 0.001). Alanine aminotransaminase (p = 0.019) and C-reactive protein levels (p = 0.027) were significantly lower in the tularemia group. Conclusions: Tularemia cases are associated with particular epidemiological risk factors and oropharyngeal symptoms. A thorough epidemiological evaluation is crucial for diagnosis, and enhancing awareness among healthcare providers and the public may facilitate earlier recognition and management. Full article

We evaluated the effectiveness of three locally available disinfectants in reducing Escherichia coli (E. coli) contamination of wastewater-irrigated lettuce while preserving structural integrity. We conducted a quasi-experimental study using lettuce from two farms (Accra and Tamale) in Ghana. Disinfectants tested included (i) salt combined with vinegar, (ii) sequential salt and potassium permanganate, and (iii) sequential vinegar and potassium permanganate. Structural integrity (stem crispness and leaf mushiness) was assessed at 5, 10, and 15 min. E. coli counts and antibiotic resistance were determined pre- and post-disinfection. All three disinfectants preserved structural integrity of lettuce at 5 and 10 min. At 15 min, sequential disinfectants preserved 100% structural integrity, while the salt–vinegar mix caused mushiness in 16%. Pre-disinfection E. coli counts were 9720 cfu/g for Accra (Inter Quartile range, IQR: 3915–14,175) and 72 cfu/g (IQR: 36–189) for Tamale. All disinfectants eliminated E. coli after 15 min. Multi-drug-resistant isolates were common (45% in Accra and 30% in Tamale), particularly against “Watch, restricted use” antibiotics. A 15 min exposure of lettuce to locally available disinfectants, particularly when used sequentially, can eliminate E. coli contamination while preserving structural quality. This practical, low-cost intervention can empower households, vendors, and farmers to limit lettuce-borne diarrheal diseases and antimicrobial resistance transmission. Full article

Background: Crimean–Congo hemorrhagic fever (CCHF) is a severe zoonotic viral infection with high mortality rates. This study aimed to examine the prognostic value of new-generation inflammatory markers—CRP/albumin ratio (CAR), D-dimer/albumin ratio (DAR), D-dimer/fibrinogen ratio (DFR), and triglyceride-glucose index (TGI)—in predicting mortality among patients diagnosed with CCHF. Methods: This prospective study involved 76 patients with a positive polymerase chain reaction test for CCHF and 38 age- and sex-matched healthy controls between 15 April 2023 and 15 October 2024. Participants’ demographic, clinical, and laboratory data at presentation were recorded. Results: CAR, DAR, DFR, and TGI levels were significantly higher in the patient group compared to the control group (all p < 0.001). Furthermore, when mortal cases were compared with survivors, all of these markers were found to be significantly higher in the mortal group (p = 0.005, p = 0.004, p = 0.001, and p = 0.003, respectively). In Kaplan–Meier analysis, survival time was significantly shorter in patients with higher levels of these parameters (p < 0.001 for all). In the Receiver Operating Characteristic analysis conducted to differentiate mortal cases from survivors, DFR and TGI were identified as the markers with the highest predictive power (area under the curve: 0.938 and 0.899, respectively). Conclusions: Inflammatory markers CAR, DAR, DFR and TGI may serve as significant prognostic tools to predict mortality in CCHF. Full article

Background: Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. Methods: A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. Results: Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. Conclusions: Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region. Full article

Background: An epidemiological survey of Onchocerca volvulus infection and onchocerciasis in Igbo-Eze North Local Government Area, Enugu State, Nigeria, was undertaken to assess its distribution and risks among individuals in the area. Methods: A total of 201 residents who have lived in the study area for at least one year were recruited. At recruitment, they were examined using a rapid assessment method. Their demographic information and risk factors were obtained using a structured questionnaire. Results: The overall prevalence for onchocerciasis was 3.5% (7/201). The prevalence of onchocerciasis was observed to be non-significantly (p = 0.689) different among the studied communities. The sex and age-related prevalence differences were non-significant (p > 0.05); however, onchocerciasis was more prevalent among males and those between 30 and 39 years of age. The prevalence of onchocerciasis was higher (p = 0.001) among farmers/fishermen. The significant risk associated with onchocerciasis is the proximity of the water body to houses (p = 0.034). Conclusions: The onchocerciasis prevalence was low and not dependent on sex or age but rather occupation. Risks to onchocerciasis are environmental and occupational, with chances of scaled up prevalence and burden overtime if unchecked. There is a need for awareness campaigning to enable proper education of the people about onchocerciasis in the area and neighboring communities. Full article

Controlling Rhipicephalus microplus is currently one of the main challenges in livestock farming due to the significant economic losses it causes. Traditionally, managing this parasite has been based on the use of synthetic ixodicides, among which fipronil has proven to be highly effective. However, its low water solubility and the limitations of commercially available formulations can affect the bioavailability of this compound, favoring the emergence of resistance in tick populations. In this context, fipronil-loaded nanoparticles were developed using the Eudragit^® E PO polymer (NP_F) (Helm, Naucalpan, Mexico, Mexico), which were physicochemically characterized and evaluated against fipronil-susceptible R. microplus larvae. NP_F had an average size of 143.43 ± 1.88 nm, a polydispersity index (PDI) of 0.162 ± 0.01, a ζ (P ζ) of 21.16 ± 0.54, an encapsulation percentage (%E) of 7.36 ± 0.30, and an encapsulation efficiency percentage (%EE) of 66.28 ± 3.5%. Free fipronil showed an LC₅₀ of 0.582 µg/mL and an LC₉₀ of 2.503 µg/mL against R. microplus. The NP_F formulation showed an LC₅₀ of 0.427 µg/mL and an LC₉₀ of 2.092 µg/mL. These results suggest that incorporating fipronil into nanoparticles improves its ixodicide efficacy, positioning it as an innovative and promising alternative for the development of effective tick control formulations. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Rational use of medicines, particularly antimicrobials, is critical for reducing antimicrobial resistance. In 2021, a study conducted at the outpatient department (OPD) of a district hospital in Ghana, identified high antibiotic prescribing and suboptimal adherence to World Health Organization (WHO) prescribing indicators. Based on those findings, antimicrobial stewardship (AMS) intervention was extended to the OPD. This before-and-after study was used to compare WHO prescribing indicators and patterns of antibiotic use, using WHO AWaRe (Access, Watch and Reserve) categorization of the years 2021 and 2023. A total of 65,157 patients visited the OPD in 2023 with 171,517 patient encounters and 247,313 prescriptions. Encounters resulting in antibiotic prescriptions halved from 36% to 18%. The average number of medicines prescribed per encounter reduced from three to two. Prescriptions using generic names increased from 76% to 80% and injection use reduced from 7% to 6%. However, prescriptions from the Ghana essential medicines list reduced from 90% to 79%. Access antibiotics use remained unchanged while Watch and Reserve categories increased by 5% and 2%, respectively. The AMS interventions potentially improved three of five WHO indicators. Continued efforts are needed to achieve complete compliance with all indicators and increase access antibiotic use to above 70%. Full article

Knowledge gaps exist regarding foodborne zoonotic diseases in migrant populations. We assessed the seroprevalence of Campylobacter, Salmonella, Yersinia, Brucella, hepatitis E virus (HEV), and Trichinella, and identified potential exposure risks in populations with and without migration backgrounds. In a cross-sectional study (2014–2016), adults with Turkish, Russian, Vietnamese, or German backgrounds residing in Berlin, Germany, were recruited via convenience sampling. Sera were screened for anti-IgG antibodies, and risk factors were assessed via a structured questionnaire. Logistic regression was used for analysis. We included 1180 participants: 497 Germans and 215, 273, and 195 individuals with Russian, Turkish, and Vietnamese backgrounds, respectively. Salmonella seroprevalence was highest among Vietnamese (47–50%) and lowest among Turks (18–20%). Campylobacter seroprevalence ranged from 17% to 23%. Yersinia seroprevalence was highest among Germans (64–70%) and associated with raw pork consumption. HEV seropositivity was highest among Vietnamese (27–28%) and lowest among Russians (5%). No samples were positive for Brucella; two were positive for Trichinella. High seroprevalence of Campylobacter, Salmonella, Yersinia, and HEV suggests substantial exposure and frequent asymptomatic or mild infections. While Yersinia seropositivity was associated with raw pork consumption, high seroprevalence in Turks—who rarely consume pork—suggests other food sources or transmission routes. Full article

AmpC β-lactamases are class C enzymes that hydrolyze penicillins, cephalosporins, and monobactams. The WHO recently classified third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales as critical pathogens. We conducted a systematic review and meta-analysis to evaluate AmpC prevalence in hospital isolates across South America. We searched PubMed/MEDLINE, SciELO, and Google Scholar. We included 69 observational studies that phenotypically or genotypically identified AmpC producers. A random-effects generalized linear mixed model with logit transformation estimated pooled prevalence; heterogeneity and moderators were explored through subgroup analyses and meta-regression. Seventy studies, including 48,801 isolates, were eligible. AmpC β-lactamases were detected in 11.7% of isolates (95% CI 11.4–12.0), with extreme heterogeneity (I² ≈ 97%). Enterobacter species showed the highest prevalence (~46%), whereas Escherichia spp. had the lowest (~4.5%) prevalence of AmpC positivity within each genus. Meta-regression indicated that studies focusing on a single genus reported higher prevalence and that including pediatric patients was associated with a lower prevalence of AmpC-positive microorganisms among isolates. Quality of evidence was rated low due to inconsistency, moderate risk of bias, and indirectness of data. AmpC producers are entrenched in South American hospitals, and species-aware surveillance and harmonized detection are critical to guide empiric therapy and antimicrobial stewardship. Full article

Human T-cell leukemia virus type 1 (HTLV-1), the first identified human retrovirus, is associated with adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The lack of effective antiviral therapies or vaccines highlights the critical importance of early diagnosis in managing HTLV-1-associated diseases. However, current commercial immunoassays, including enzyme immunoassays, line immunoassays, particle agglutination tests, and Western blots, are often limited by the need for specialized equipment and high costs, which restrict their accessibility in resource-poor regions. To address these challenges, we developed a novel dot-blot immunoassay using HTLV-1 P19 and GP46 synthetic peptides in combination with a precipitating tetramethylbenzidine (TMB) substrate. This innovative approach enables instrument-free visual detection through the formation of distinct blue-brown precipitates. Validation of this immunoassay with 179 clinical serum samples demonstrated 100% specificity and 91% sensitivity. Our assay offers a simple, cost-effective, and field-applicable diagnostic solution for HTLV-1 screening in resource-limited settings, potentially enhancing global surveillance of this neglected pathogen. Full article

Chikungunya fever (CHIKF), which is caused by the Chikungunya virus (CHIKV), has rapidly spread across the globe in recent years, leading to its listing as a public health concern by the World Health Organization. In 2019, the first local outbreak of Asian-type CHIKF was reported in Xishuangbanna, Yunnan Province, China, with 88 CHIKV nucleic acid-positive cases detected from clinical specimens. To further investigate the biological characteristics of the virus strain responsible for this outbreak, we reconstructed the 625D6h strain using reverse genetics and tested its growth kinetics in different cell lines. The results showed a strong replication capacity in the Aedes albopictus C6/36 insect cell line but a weaker one in mammalian cell lines. The virus’s high replication capacity in mosquito cells is an interesting phenotype that warrants further study to determine if it influences vector adaptation and transmission dynamics in endemic settings. The study also found that two DHODH inhibitors, ML390 and vidofludimus, could effectively inhibit CHIKV replication in vitro. The infectious clone created in this study provides a useful tool for studying the recently prevalent Asian-type strain in China, supporting the subsequent development of prevention and treatment methods. Full article

The Flaviviruses Dengue virus (DENV), West Nile virus (WNV), Zika virus (ZIKV), and Yellow Fever virus (YFV), are mosquito-borne viruses that represent a persistent challenge to global health due to the emergence and re-emergence of outbreaks of significant magnitudes. Their positive-sense RNA genome, about 11,000 nucleotides long, encodes structural and nonstructural proteins. These viruses evolve rapidly through mutations and genetic recombination, which can lead to more virulent and transmissible strains. Although whole-genome sequencing is ideal for studying their evolution and geographic spread, its cost is a limitation. We investigated the genetic variability of DENV, ZIKV, WNV, and YFV to identify genomic regions that accurately reflect the phylogeny of the complete coding sequence and evaluated the utility of these regions in reconstructing the geographic dispersal patterns of viral genotypes and lineages. Publicly available sequences from GenBank were examined to assess variability, reconstruct phylogenies, and identify the most informative genomic regions. Once representative regions were identified, they were used to infer the global phylogeographic structure of each virus. The virus depicted distinct variation patterns, but conserved regions of high and low variability were common to all. Highly variable regions of ~2700 nt offered greater resolution in phylogenetic trees, improving the definition of internal branches and statistical support for nodes. In some cases, combined multiple highly variable regions enhanced phylogenetic accuracy. Phylogeographic reconstruction consistently grouped sequences by genotype and geographic origin, with temporal structuring revealing evolutionarily distinct clusters that diverged over decades. These findings highlight the value of targeting genomic regions for phylogenetic and phylogeographic analysis, providing an efficient alternative for genomic surveillance. Full article

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis and is associated with high morbidity and mortality, especially in resource-limited settings. In Mozambique, where both tuberculosis and HIV are highly prevalent, TBM poses significant diagnostic and therapeutic challenges. This study aimed to describe the clinical characteristics and to identify predictors of TBM mortality among persons living with HIV (PLWH) in a rural hospital in Mozambique. Methods: We conducted a retrospective cohort study at Carmelo Hospital of Chokwe (CHC) between 2015 and 2020. We included 372 PLWH diagnosed with TBM (PTBM); data on demographics, clinical presentation, and laboratory findings were extracted from patient records. TBM diagnosis was considered for confirmed cases based on a hospital-adapted algorithm incorporating clinical features, cerebrospinal fluid (CSF) analysis, TB-LAM, and Xpert MTB/RIF testing. Cox proportional hazard models were used to identify independent predictors of mortality, and Kaplan–Meier survival curves with log-rank tests were used to assess survival differences across clinical subgroups. Significance was considered at a p value ≤ 0.05 with an adjusted hazard ratio (AHR) 95% CI in the multivariate analysis. Results: Overall, 372 PTBM contributed to a total of 3720 person-months (PM) of treatment follow-up, corresponding to a mortality incidence of 3.76 deaths per 100 person-months. Factors independently associated with increased mortality included male sex (adjusted hazard ratio [aHR]: 1.80; 95% CI: 1.21–2.68; p = 0.004), BMI < 18.5 kg/m² (aHR: 2.84; 95% CI: 1.46–5.55; p = 0.002), Immunovirological failure to ART (aHR: 2.86; 95% CI: 1.56–5.23; p = 0.001), CSF opening pressure >40 cmH₂O (aHR: 2.67; 95% CI: 1.46–4.86; p = 0.001), and TBM severity grading III (aHR: 4.59; 95% CI: 1.79–11.76; p = 0.001). TBM involving other organs also significantly worsened survival (aHR: 2.03; 95% CI: 1.27–3.25; p = 0.003). Conclusions: TBM mortality in PLWH was driven by ART failure, high CSF pressure, and malnutrition. Male sex and severe neurology also increased risk. Urgent interventions are proposed: optimize ART, manage intracranial pressure, provide nutritional support, and use corticosteroids. An integrated care approach is essential to improving survival in resource-limited settings. Full article

Leptospirosis is a zoonotic disease caused by Leptospira spp., with over 250 serovars classified into 24 serogroups. Control measures depend on understanding serovar-specific epidemiology, yet the microscopic agglutination test (MAT) is only serogroup specific, and classification is complicated by cross-reactivity. While MAT is the reference standard for leptospirosis serodiagnosis and seroepidemiological studies, factors influencing serogroup cross-reactivity remain poorly characterized. We investigated the relationship between age, antibody titer, and serogroup diversity among seropositive individuals in a population-based serosurvey in the Dominican Republic. Between June and October 2021, we conducted a multistage national serosurvey, enrolling 6683 participants across 134 clusters. MAT was performed on sera from 2091 participants in two provinces using a 20-serovar panel. MAT positivity was defined as titers ≥ 1:100. Generalized Additive Models were used to assess associations between age, maximum titer, and serogroup diversity. Of 2091 tested samples, 237 (11.3%) were seropositive. Older individuals and those with higher titers reacted to a greater number of serogroups (p = 0.005 and p < 0.0001, respectively). However, mean maximum titer decreased with age, suggesting that broader serogroup reactivity in older individuals reflects cumulative exposure rather than higher titers. Maximum titer was the strongest predictor of serogroup breadth, while gender, study region, and urban/rural setting were not significant. Overall, our findings demonstrate that serogroup cross-reactivity in MAT was significantly influenced by antibody titer and prior exposure, with older individuals displaying broader serogroup reactivity despite lower titers. These findings highlight key considerations for interpreting MAT results in seroepidemiological studies and underscore the limitations of MAT in serogroup-level classification. Full article

Bangladesh is among the 23 WHO priority countries for leprosy, with a new case detection rate of 21 per million population including children among new cases indicating recent transmission. We aimed to compare active versus passive case detection using geospatial tools. A cluster-randomized study was conducted across seven intervention and seven control districts. In the intervention arm, GPS coordinates of new cases were recorded, and contacts within a 75-m buffer were screened. Spatial cluster analysis using Kulldorff’s scan statistics was performed to identify hotspots. The main objective was to achieve early case detection in intervention areas, reflected in a lower proportion of new patients with grade 2 disabilities (G2Ds). A total of 347/382 (90%) index cases were enrolled in the intervention arm, compared to 380/462 (82%) in the control arm. Among household contacts, 7/1482 (5‰) new cases were found in the intervention area and 12/1565 (7.7‰) in the control area. Additionally, 18/25,720 (0.7‰) new cases were detected among neighbor contacts in the intervention arm. G2D proportions were not lower in the intervention arm (15%) than in the comparator arm (11%, p = 0.043). Comparable household contact cases were observed in both arms, with more cases emerging among neighbors in intervention districts. Eight spatial clusters were identified, including 288/844 (34%) index cases, with three significant clusters from 2022 to 2023. Screening within a 75-m buffer detected additional leprosy cases, though fewer than expected due to COVID-19 limitations. Targeting clusters for case detection and prophylaxis could strengthen transmission control efforts. Full article

In developing countries, adolescent girls and young women (AGYW) continue to experience high rates of unintended pregnancy and sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV). Several healthcare services are available at the primary level of healthcare to address the sexual and reproductive needs of adolescents in South Africa. Healthcare providers often face challenges such as limited resources, inadequate funds, and inadequate training, which hinder their ability to provide integrated care. Furthermore, cultural stigma and a lack of privacy prevent adolescents from seeking care. In response to increasing international calls for developing and implementing integrated person-centered care, which addresses both quality and access to care, this paper aims to develop and validate an integrated HIV/STI, and pregnancy prevention program for adolescent girls and young women in the Vhembe District of Limpopo. Multiphase mixed methods were employed in this study. This study consisted of three interconnected phases. As part of phase 1 of this study, a comprehensive literature review was conducted. In phase 2, an empirical study conducted using a concurrent triangulation strategy to collect and analyze both qualitative and quantitative data as a form of confirmation, dis-confirmation, cross-validation or corroboration of the findings. Consequently, a conceptual framework was developed using qualitative and quantitative analysis by merging, comparing, and interpreting the results. The findings of phase 2 interface were analyzed using the Political, Environmental, Social, and Technological (PEST) and Strength, Weakness, Opportunity, and Threat (SWOT) analyses. Additionally, the outcomes of the Logical Framework Analyses (LFA) informed the development of an integrated programme aimed at preventing HIV, STIs, and teenage pregnancy. Several stakeholders and experts (n = 35) were consulted as part of the Reduce the Risk (RTR) Coalition to validate the proposed integrated programme with an average of 94.3% on acceptability, feasibility, and appropriateness. In the Vhembe District of Limpopo province, there has been no published study that has developed an integrated HIV, STIs, and pregnancy prevention programme to improve the sexual health outcomes of adolescent girls and young women. Full article