Disability training for healthcare workers in Uganda: qualitative findings from the pilot test.

BACKGROUND: People with disabilities experience barriers to healthcare, resulting in poorer health outcomes. There is limited disability training for healthcare workers globally. A disability training was co-developed with people with disabilities and healthcare workers and pilot-tested in Uganda. OBJECTIVE: To use qualitative methods to understand co-learning experiences, identify strengths and areas for improvement, and to explore a disability training's effect on practices in Uganda. METHODS: We conducted a two-day Train-the-Trainer programme in September 2023 with ten trainers (5 people with disabilities, 5 healthcare workers). The trainers then delivered two one-day disability training programmes to 27 healthcare workers. Data on the perceptions and experience of the trainings were collected through focus group discussions with trainers and in-depth interviews with trainers and participants. We used an inductive approach for analysis and Kirkpatrick's Four-Level Training Evaluation Model to assess reactions, learning, behaviour changes, and results. RESULTS: The trainers valued the emphasis on practical application and the collaborative approach used during the sessions. Trainers with disabilities expressed increased confidence and ability to advocate for inclusive healthcare practices. Healthcare workers reported that the training was engaging and relevant to their roles. Three months post-training, healthcare workers reported improved attitudes and skills toward providing care for people with disabilities. Challenges in applying new practices included limitations in facility accommodations and accessibility. Further support and training were requested. CONCLUSION: The co-designed disability training programme can enhance healthcare workers' skills and interactions with patients with disabilities. Policy support is important for the implementation of disability training at scale

Reply to Adzemovic et al.

To the Editor—We thank Adzemovic and colleagues for their correspondence and interest in our article. The points raised make for interesting discussion

Detection of Haemophilus ducreyi from environmental and animal samples in Cameroon.

BACKGROUND: Children in parts of Africa, the South Pacific, and Southeast Asia frequently develop cutaneous ulcers caused by two bacteria: Haemophilus ducreyi (HD) and Treponema pallidum subspecies pertenue (causative agent of yaws). The World Health Organization (WHO) aims to eradicate yaws using mass administration of azithromycin. This also leads to a temporary decrease in ulcers caused by HD followed by a rebound suggesting an ongoing reservoir of infection. The aim of this study was to investigate whether HD could spread through the environment or animals. METHODS: Alongside detection of human cases of cutaneous ulcers from villages in Cameroon, we additionally collected samples from animals (dogs, cats, flies), fomites (bedsheets, clothing, benches, doors), and water sources (marigots and lakes). DNA was extracted and tested for HD and T. pallidum using two specific qPCR assays. RESULTS: HD was not detected in any of the environmental samples but it was on both clothing (13.3%) and in flies (27%). Flies also tested positive for T. pallidum, but at a lower rate (2.6%). CONCLUSIONS: These results suggest that flies and some fomites may contribute to the transmission of HD. Future research should focus on determining whether either of these are capable of carrying live bacteria that can cause onward transmission

Helminth driven gut inflammation and microbial translocation associate with altered vaccine responses in rural Uganda.

Vaccine responses are sometimes impaired in rural, low-income settings. Helminth-associated gut barrier dysfunction and microbial translocation (MT) may be implicated. We used samples from a trial of praziquantel treatment-effects on vaccine responses in Schistosoma mansoni (Sm)-endemic Ugandan islands, measuring intestinal fatty acid-binding protein 2 (I-FABP2), lipopolysaccharide-binding protein, anti-endotoxin core antibodies (EndoCab), soluble CD14 (sCD14) in plasma, and faecal lipocalin-2, occult blood (FOB), and calprotectin (fCAL), and evaluating their associations with baseline helminth infection, praziquantel treatment, and responses to BCG, yellow fever, typhoid, HPV, and tetanus-diphtheria vaccines. Sm associated positively with fCAL and FOB, hookworm with I-FABP2, and any helminth with EndoCab IgM, fCAL and FOB. Sm associated inversely with sCD14. Praziquantel treatment reduced all marker concentrations, significantly fCAL and FOB, implying that Sm-associated gut inflammation and MT is reversible. Associations of assessed markers with vaccine-specific responses were predominantly inverse. Interventions to improve gut barrier function may enhance vaccine responsiveness

YouTube as a Source for Arabic-Speaking Parent Education on the Oral Hygiene of Children: A Social Media Content Analysis.

INTRODUCTION: Much primary prevention in public health dentistry depends on parents' having accurate knowledge about pediatric oral health. In areas with minimal education levels and few oral health professionals, information on this topic is available from the widespread use of the social medial resource YouTube. This study assessed the quality and viewer engagement of YouTube Arabic videos on pediatric oral health practices. METHODS: Using standard procedures to search YouTube, we identified Arabic-language pediatric oral health videos. A social media content analysis was conducted and videos analyzed for viewer engagement metrics, country of origin, and creator occupation. The DISCERN instrument was used to evaluate video quality, reliability, and information quality; statistical correlations were examined between these parameters and video statistics. RESULTS: A majority of the 47 videos that were identified originated from Egypt and were created by pediatric dentists, attracting an average of 13,328.7 views and 218.7 likes. Quality assessment found 61.7% of videos with moderate quality; 63.8% had only medium levels of reliability (63.8%) and 63.8% medium information quality (63.8%); only a minor segment achieving high reliability and information quality. Correlation analysis revealed a positive but weak association between DISCERN scores and viewer engagement metrics (e.g., likes, comments, views), suggesting that while better quality videos tend to engage more viewers, other factors also contribute to engagement. Additionally, a stronger correlation was noted between the overall quality of videos and both information quality and reliability, indicating that videos with higher-quality content were perceived as more reliable and informative by viewers. CONCLUSION: While a significant volume of pediatric oral health content is available online, variability in quality highlights the need for stringent evidence-based standards to ensure the provision of reliable, quality educational materials

Association of sitting time with cardiovascular events among manual and non-manual workers: a prospective cohort study (PURE-China).

BACKGROUND: Prolonged sitting time is associated with an increased risk of cardiovascular disease (CVD) in the general population. However, it is unclear how these risks differ across occupational groups. This study aimed to investigate the association between sitting time and CVD in manual and non-manual workers among Chinese adults. METHODS: This population-based cohort study recruited 47,931 participants aged 35 to 70 years from 115 communities across 12 provinces in China between 2005 and 2009. Daily sitting time was measured using the International Physical Activity Questionnaire (IPAQ). The main outcome was a major CVD event (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Information on each participant's occupation was collected using standardized questionnaires and categorized into manual and non-manual occupations according to the Italian National Institute of Statistics 2001 (ISTAT-2001) occupational classification standard. Cox frailty models were used to examine the associations. RESULTS: Of 43,256 in the final sample (excluding those with CVD at baseline and missing data), 25,252 (58.4%) were women, and the mean (± SD, Standard Deviation) age was 50.6 ± 9.5 years. During a median follow-up of 11.9 (IQR, Interquartile Range: 9.5-12.6) years, 3,408 major CVD events (899 myocardial infarctions, 2,400 strokes, 240 incident heart failure, and 764 cardiovascular deaths) were documented. Compared with the reference group (< 4 h per day of sitting), the risk of major CVD events was positively associated with increasing sitting time among manual workers (HR, 1.20; 95% CI, 1.05-1.37 for 6-8 h per day; HR, 1.43; 95% CI, 1.12-1.82 for ≥ 8 h per day), while the risk among non-manual workers was greater for those reporting daily sitting times of more than 8 h (HR, 1.86; 95% CI, 1.18-2.95). Similar trends were observed when CVD mortality and incidence were analysed separately. CONCLUSIONS: Longer daily sitting time was associated with an increased risk of major CVD in both manual and non-manual occupational groups, and the risk was especially high among non-manual workers. Our findings highlight the importance of including measures to reduce sedentary behaviour within a comprehensive strategy to reduce the burden of cardiovascular disease in China

Does enhanced HIV prevention, diagnosis, and linkage to care reduce hospitalisation in high HIV-burden communities in Zambia and South Africa? findings from the HPTN 071 (PopART) randomised trial.

ClinicalTrials.gov NCT01900977

The first BILGENSA Research Network workshop in Zambia: identifying research priorities, challenges and needs in genital bilharzia in Southern Africa [version 2; peer review: 3 approved, 1 approved with reservations]

Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium.Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to lack of awareness of both diseases and absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS

Intermittent suppressive posaconazole therapy is ineffective at mitigating cardiac and digestive tract pathologies in an experimental model of chronic Chagas disease.

Infections with Trypanosoma cruzi cause Chagas disease, a chronic condition that can give rise to debilitating cardiac and/or gastrointestinal damage. However, it is unclear why only ~30% of individuals progress to symptomatic pathology, why this can take decades to become apparent, and why there is such a wide range of disease outcomes. Disease pathology is a long-term cumulative process resulting from collateral damage caused by inflammatory immune responses that continually eliminate transient parasite infections in the heart and/or gastrointestinal tract. The guiding principle behind anti-parasitic drug development is that a sterile cure is required to prevent progression to symptomatic pathology. Evidence suggests that the cumulative damage required to reach the symptomatic threshold is determined by a number of factors, including host and parasite genetics, which govern the intensity and location(s) of infection. Therefore, an alternative therapeutic strategy could involve long-term intermittent treatment, which may not confer sterile cure but is able to suppress the parasite burden to a level where the disease does not become symptomatic within the lifetime of the infected individual. To test this hypothesis, we used an experimental murine model that displays both cardiac and digestive tract pathologies. Mice were given intermittent treatment with posaconazole under conditions that initially reduced the parasite burden by >99% but did not confer sterile clearance. Our results show that this did not provide long-term protection against the key cardiac or gastrointestinal manifestations of Chagas disease, and that sterile cure should remain the single goal of the drug development community

The triple impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy: a focus on people living with HIV/AIDS in Maiduguri, Nigeria

Background: The multifaceted impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy (ART) among people living with HIV/AIDS (PLHIV) in Maiduguri, Nigeria is highlighted by this article. While ART has transformed HIV from a fatal condition to a manageable chronic illness, achieving consistent access in regions facing socioeconomic and environmental challenges such as Maiduguri remains a critical issue. Factors such as inflation, poverty, and high transportation costs hinder PLHIV’s ability to obtain treatment and related medical services. Although antiretroviral drugs are subsidised in Nigeria, associated costs, including transport-fare and laboratory fees, place a significant burden on patients. This financial strain disrupts adherence to treatment, risking clinical failures and drug resistance. Insecurity due to the Boko Haram insurgency exacerbates these challenges. Methods: A comprehensive literature search was conducted using keywords such as ART, economic hardship, Maiduguri, flooding, and insecurity to identify relevant articles from Scopus, PubMed, and Google Scholar. Boolean operators "AND" and "OR" were applied to construct precise search strings, ensuring broad yet targeted retrieval of relevant studies. A total of 27 articles were included based on their relevance, methodological quality, and contribution to the study's aim. Eligible publications encompassed original research, systematic and narrative reviews, meta-analyses, perspectives, and grey literature, with priority given to studies published in English within the last ten years. A snowballing bibliometric approach was also employed to identify additional relevant literature. Full-text articles were critically analyzed and narratively synthesized under appropriate subheadings. Conclusion: There is an urgent need for comprehensive strategies that address these interlinked issues. Bolstering healthcare infrastructure, developing climate-resilient HIV prevention strategies, and enhancing policy frameworks for emergency health response, strengthening government coordination and securing both local and international support are vital for sustaining ART access. These could assist to improving health outcomes for vulnerable populations such as PLHIV in conflict and disaster-affected areas like Maiduguri