Knowledge and acceptability of male HPV vaccination among young people and community stakeholders in northwest Tanzania: social sciences in the Add-Vacc trial.

INTRODUCTION: Human papillomavirus (HPV) and related diseases are global health concerns affecting both males and females. Tanzania introduced two-dose HPV vaccination for 14-year old girls in 2018. The Add-Vacc trial in rural northwest Tanzania is evaluating the impact of adding one-time, single-dose HPV vaccination for 14-18-year-old boys to the national programme for girls on HPV population prevalence. As this is the first time HPV vaccination has been offered to adolescent males in Tanzania, acceptability of boys' HPV vaccination among adolescents and community stakeholders was assessed. METHODS: Qualitative data were collected between July 2023-May 2024 through: 1) rapid ethnography; 2) rumours tracking using an electronic tool piloted during the study; 3) in-depth interviews with in- and out-of-school boys who accepted or declined vaccination; 4) key informant interviews with vaccination stakeholders including parents, teachers, health workers, and community leaders; and 5) focus group discussions with stakeholders and vaccination-age boys and girls. Data were coded using Nvivo12 and analysed thematically. RESULTS: Messaging on HPV-related complications beyond cervical cancer motivated parental and adolescent support for vaccinating both boys and girls. Framing male HPV vaccination as a gender equity issue and highlighting the economic burden of illness emerged as important themes. Participants emphasised the need for trusted, locally recognised messengers to convey information. Parents and peers were key influencers for adolescents, while health workers and religious/community leaders influenced parents. Some parents and adolescents who initially declined vaccination reported they later accepted it after having time to reflect and seeing vaccinated boys experienced no adverse effects. CONCLUSIONS: Single-dose HPV vaccination of males was generally acceptable across all study groups. Ongoing, dynamic community engagement and open dialogue about the full spectrum of HPV-related sequalae and HPV vaccination for both genders are essential to building trust and improving understanding and acceptability of HPV vaccination targeting boys and girls in this Tanzanian context

Towards cleaner air: PM2.5 exposure and disparities around childcare providers in England

Air pollution poses a significant health risk for young children, particularly in urban and deprived areas. Exposure to fine particulate matter (PM2.5) during early life may contribute to long-term adverse health out-comes. This study examined changes in PM2.5 concentrations around Early Years Providers (EYPs; childcare providers) in England from 2018 to 2022. We assessed associations between small-area socio-demographic characteristics and exposure levels exceeding the World Health Organisation (WHO) 2021 annual air quality guideline (>5 μg/m3). We integrated data on EYPs locations from Ordnance Survey with annual PM2.5 estimates from DEFRA using Geographic Information Systems and socio-demographic indicators — deprivation, urbanicity, and ethnic composition. A Bayesian spatial regression model with random effects was used to estimate adjusted associations between PM2.5 levels and local population characteristics. The number of EYPs ranged from 15,780 in 2018 to 18,427 in 2019. Mean PM2.5 levels around EYPs changed by 17.8 % over the study period (from 9.4 μg/m3 [SD = 1.8] in 2018 to 7.8 μg/m3 [SD = 1.5] in 2022). However, PM2.5 levels at over 96 % of EYPs remained above the WHO, 2021 annual guideline throughout. Higher PM2.5 concentrations were observed in EYPs located in more deprived, urban, and predominantly non-white communities. Despite recent improvements, PM2.5 levels around most EYPs in England remain above recommended thresholds. Targeted interventions in deprived urban areas are needed to reduce young children’s exposure and address environmental health inequalities

The mechanisms by which a whole-school intervention might improve sexual health: qualitative realist research nested in a trial in English secondary schools.

Whole-school interventions go beyond classroom education, promoting health by modifying school environments. These can be effective in delaying sexual debut and increasing contraception use but mechanisms are poorly understood. Qualitative research within realist evaluation can explore mechanisms via building 'context-mechanism-outcome configurations', describing how interventions trigger mechanisms that interact with context to generate outcomes. We explored these for the Positive Choices whole-school sexual health intervention within the intervention arm of a randomised trial conducted 2021-2025. Using 'dimensional analysis', we analysed 52 interviews with teachers and 40 focus-groups involving 266 students from 22 English secondary schools. Our results suggest seven mechanisms through which whole-school interventions might 'work': improving knowledge using diverse pedagogies; improving confidence and ability to talk by normalising talk about sexual health; changing gender attitudes through challenging stereotypes and providing insights and empathy with others' perspectives; promoting access to sexual health and other services via helping students understand their needs and entitlements; building school engagement by providing new student roles on decision-making groups; increasing inclusion of sexual-minority students by normalising consideration of non-heterosexual identities and practices; and reducing sexual harassment and abuse by helping students understand consent and when to intervene in harassment. Contextual contingencies included: high initial student needs; teacher skills and commitment; and school commitment and capacity. Our research suggests novel mechanisms via which whole-school interventions might promote sexual health. Quantitative analyses will now be conducted to examine these mechanisms and contingencies

Epidemiology of Schistosoma haematobium infection and microhaematuria among schoolchildren in a setting of sustained mass drug administration in Banfora, Burkina Faso

Background: Limited evidence exists regarding the current epidemiology of Schistosoma (S.) haematobium infection following decades of mass drug administration implementation in many areas of Burkina Faso, including the Cascades region, which is predominantly a riverine community with a high risk of schistosomiasis. This study aimed to determine the prevalence and correlates of S. haematobium infection and microhaematuria among schoolchildren in the municipality of Banfora, southwestern Burkina Faso. Methods: An analytical cross-sectional study was conducted in November 2024 among schoolchildren aged 5–15 years in the Banfora municipality. Sociodemographic and water contact data were collected using a pre-tested structured questionnaire. Each consenting child provided a freshly voided urine sample, which was examined for the presence of S. haematobium eggs and microhaematuria using the urine filtration technique and urine multistix reagent test strips, respectively. Correlates of S. haematobium infection and microhaematuria were determined using multivariable logistic regression. Results: The mean age of the children was 8.79 ± 2.22 years. Of the 300 school children tested, 11 (3.67 %) were found to be infected with S. haematobium eggs. The geometric mean intensity of S. haematobium infection was 14.94 eggs/10 mL of urine (95 % CI: 4.96–44.98), and 27.27 % of the infected participants (3/11) had a heavy infection. The prevalence of microhaematuria was 13.33 % (40/300). Being a boy was the main risk factor for S. haematobium infection (adjusted OR: 11.0, 95 % CI: 2.5–48.2), while having a urinary tract infection was significantly associated with S. haematobium infection (adjusted OR: 59.6, 95 % CI: 6.9–515.7). Risk factors for microhaematuria included living in rural areas (adjusted OR: 8.3, 95 % CI: 2.4–28.6) and S. haematobium infection (adjusted OR: 31.3, 95 % CI: 5.9–165.8). Conclusions: Our findings show that S. haematobium infection is hypoendemic in the Banfora municipality. However, the high prevalence of heavy infections is a particular concern, and targeted treatment strategies and complementary measures, including health education, should prioritize school-aged children living in rural areas

Consumption and expenditure on fidaxomicin and oral vancomycin for Clostridioides difficile infection: A 12-year longitudinal study of 43 countries and regions.

BACKGROUND: Current treatment guidelines recommend fidaxomicin and oral vancomycin as first-line treatments for Clostridioides difficile infection (CDI). Disparities in the prevalence of CDI and the availability of novel treatments necessitate understanding the contemporary trends in their consumption at the global level. METHODS: This longitudinal study used global pharmaceutical sales from IQVIA-MIDAS for fidaxomicin and oral vancomycin in 43 countries from 2012 to 2023. We measured defined daily doses per 100,000 inhabitants per year (DDD/100K) and manufacture-level prices, calculating changes using compound annual growth rates (CAGR). We conducted interrupted time-series analyses to assess the impact of guideline updates by Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America (IDSA/SHEA) on quarterly consumption. RESULTS: Overall fidaxomicin consumption increased from 21.68 DDD/100K in 2012 to 126.86 DDD/100K in 2023 (CAGR = 17.42%) and similar increases in expenditure (0.07-0.34 USD/capita; CAGR = 14.96%). Oral vancomycin consumption increased from 71.61 to 120.82 DDD/100K (CAGR = 4.87%), although with a decreasing trend in expenditure (0.20-0.03 USD/capita; CAGR = -15.16%). The earliest adoption of fidaxomicin in middle-income economies occurred five years later than in high-income economies. Despite higher CAGRs, consumption of fidaxomicin and oral vancomycin in middle-income economies was only 1.9% and 2.3%, respectively, of that in high-income economies in 2023. Following the IDSA/SHEA guideline updates, fidaxomicin consumption in Northern America increased immediately. CONCLUSION: Consumption of fidaxomicin and oral vancomycin continues to increase globally; however, significant economic and geographical disparities in utilization highlight inequitable access to first-line CDI treatments

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

The role of puppetry in mental health promotion: A scoping review of its efficacy and applications

Puppetry-based interventions have gained recognition as a potential tool in therapeutic, educational, and social contexts, offering unique benefits in emotional expression, anxiety reduction, and social skills development, thereby contributing to mental health promotion. This review aims to bridge the gap between practice and theory, providing a comprehensive understanding of the role of puppetry in therapeutic and educational settings for promoting mental health. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, examining studies across 16 databases up to August 2024. This review evaluated 30 studies to assess the effectiveness of puppetry-based interventions across diverse populations, including children, adolescents, and vulnerable groups such as refugees and the elderly. The findings demonstrate significant improvements in emotional regulation, anxiety management, and social interaction, particularly in pediatric and educational settings. However, the review also identifies critical gaps in the literature, including the limited use of large-scale randomized controlled trials, a scarcity of longitudinal studies, and inconsistent application of theoretical frameworks. These gaps highlight the need for more rigorous and theoretically grounded research to fully optimize the benefits of puppetry-based interventions. This review consolidates existing evidence and offers a roadmap for future research, emphasizing the importance of standardized protocols and long-term outcome evaluations. The findings contribute to the growing recognition of puppetry as a valuable tool in therapeutic and educational practices, offering insights into how these interventions can be effectively tailored to meet the needs of diverse populations

Harnessing artificial intelligence for predictive modeling in combating antimicrobial resistance: a call for integration and innovation

Antimicrobial resistance (AMR) represents a critical global health challenge with profound socioeconomic and public health implications. The rise of resistant microorganisms undermines the effectiveness of antibiotics, antivirals, antifungals, and other antimicrobial agents, leading to increased mortality, prolonged illnesses, and escalating medical costs. This study underscores the urgent need for innovative solutions, focusing on the integration of artificial intelligence (AI) to combat AMR. AI, with its rapid data processing, predictive modeling capabilities, and cost-effectiveness, emerges as a transformative tool in mitigating this global crisis. AI-driven predictive models have demonstrated remarkable accuracy in identifying AMR patterns by analyzing vast datasets encompassing patient demographics, antibiotic usage, and environmental factors. These models enhance the precision of antibiotic therapy, guide antimicrobial stewardship programs, and provide early warnings for resistance outbreaks. Furthermore, AI facilitates the development of novel antimicrobial agents, accelerates drug discovery, and supports precision medicine by tailoring treatments to individual patients' profiles. The effective application of AI in addressing AMR necessitates interdisciplinary collaboration among healthcare professionals, microbiologists, policymakers, and AI specialists. This paper calls for robust policy frameworks, dedicated funding, and global partnerships to integrate AI into healthcare systems for AMR surveillance, prevention, and control. Embracing AI innovation is pivotal to safeguarding global public health and ensuring a sustainable future free from the threat of antimicrobial resistance

Projected uptake of sulfadoxine-pyrimethamine for perennial malaria chemoprevention in children under 2 years of age in nine sub-Saharan African countries: an epidemiologically-based 5-year forecast analysis.

BACKGROUND: Perennial malaria chemoprevention (PMC) with sulfadoxine-pyrimethamine (SP) is recommended for children under 2 years of age living in areas of perennial malaria transmission. Initially delivered through the Expanded Programme of Immunization (EPI), recent pilot studies explored PMC delivery via the vitamin A supplementation programme or community health workers (CHWs). Understanding SP demand across the various delivery channels is key to implementing PMC. METHODS: A 5-year epidemiologically-based forecasting model was developed to estimate SP volumes required for nine sub-Saharan countries based on seven different scenarios considering the EPI, vitamin A or CHWs delivery channels, alone or in combination. Model inputs were secondary data sources, enhanced with information from a field survey conducted among 40 national decision-makers and 176 healthcare providers. Projected SP volumes were estimated based on expected coverage and uptake within the eligible population. The efficiency of meeting the need versus demand was calculated for each scenario. A sensitivity analysis was performed for base, low and high estimates of the coverage and uptake rates. The forecasting period was 2023 to 2027. RESULTS: The eligible population in the study countries was estimated at 21 million children in 2023. Estimated demand in 2027 ranged from 17.8 million SP doses for EPI to 49.6 million when combining all delivery channels. These results were highly dependent on the coverage and uptake rate of each delivery channel. The sensitivity analysis showed that uncertainty around the estimates ranged from twofold (Vitamin A), to 3.4-fold (CHWs). EPI was the most efficient channel overall (53%), but the efficiency of each scenario varied by country depending on local contexts. CONCLUSIONS: The model provides a tool to anticipate SP needs and demand for PMC under various scenarios, aiding manufacturers, donors, partners, governments, and procurement organizations in effective planning for PMC implementation