Mass Deworming for Soil-Transmitted Helminths and Schistosomiasis among Pregnant Women: A Systematic Review and Individual Participant Data Meta-Analysis

Background: Soil transmitted helminthiasis (STH) and schistosomiasis during pregnancy can cause active and debilitating disease with adverse birth outcomes. A recent estimation suggests that approximately 688 million girls and women of reproductive age (WRA) are at risk of helminth infections; including 140 million pregnant and lactating women and another 108 million adolescent girls. Mass deworming is regarded as the most effective means of controlling morbidity and mortality with STH and schistosomiasis; however there are various factors that could potentially modify its effectiveness including baseline nutritional status, worm burden and concomitant interventions. Currently, it is difficult to establish whether mass deworming during pregnancy has beneficial effects under certain conditions and limited effects under others. Objectives: 1. To conduct a systematic review and meta-analysis on the impact of deworming during pregnancy. 2. To conduct a systematic review and meta-analysis on the impact of interventions other than deworming; including water, sanitation and hygiene (WASH) interventions. 3. To conduct an individual participants data (IPD) meta-analysis to identify the factors that explain variation in the effect estimates of mass deworming. 4. To discuss the current guidelines on mass deworming, the challenges and the economic perspective of mass deworming for WRA. Methods: To achieve the aforementioned objectives, following methodology was adopted: 1. A systematic review and meta-analysis evaluating the effectiveness of mass deworming during pregnancy. 2. A systematic review and meta-analysis evaluating the effectiveness of WASH interventions during pregnancy. 3. An IPD meta-analysis to explore whether the effect of mass deworming during pregnancy varies with individual characteristics, intensity of infection, socioeconomic status, sanitation environment and co-interventions. Results: 1. Findings from the systematic review assessing mass deworming during pregnancy suggest that it does not have any impact on maternal anaemia; however it significantly reduced the prevalence of STH and schistosomiasis. There was no impact of mass deworming during pregnancy on haemoglobin, birth weight, low birth weight (LBW), preterm birth, perinatal mortality, stillbirths, neonatal mortality and congenital abnormalities. 2. Findings from the systematic review on interventions other than mass deworming among pregnant women and WRA suggest that the data are too scarce and of low quality to inform best practice. 3. The IPD component of the thesis captured majority of the existing data (70% of the total potential participant population). 4. Findings from the IPD analysis suggest that mass deworming during pregnancy is associated with reducing anaemia with no apparent impact on infection intensity, LBW and preterm birth. These analyses were limited by the availability of data for the impact by subgroups and effect modification. Further studies accounting for maternal baseline worm intensities, concomitant iron/folic acid supplementation and antenatal care coverage could change these findings. Conclusion Mass deworming remains the recommended strategy to prevent and treat STH and schistosomiasis; however deworming alone is insufficient to achieve improvements in all maternal and newborn health outcomes. It is essential to address other factors such as poor sanitation, food insecurity and malnutrition. There is a need to support and promote open data policy for future IPDs to test new hypothesis.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201

Evaluation of Nutrition Surveys in Flood-affected Areas of Pakistan: Seeing the Unseen!

In 2010 Pakistan experienced the worst floods recorded in its history; millions of people were affected and thousands lost their lives. Nutrition assessment surveys led by UNICEF were conducted in flood?affected areas of Punjab and Sindh provinces to assess the nutrition status of children between 6–59 months while Aga Khan University (AKU) undertook a parallel assessment including micronutrient status in their project areas within Balochistan, Sindh and Punjab. Standardised Monitoring and Assessment of Relief and Transition (SMART) methodology was used. 881 children from Sindh, 1,143 from Punjab and 817 from AKU project areas were measured for anthropometry and their households were interviewed. The findings indicated that while immediate life?saving interventions were essential, there was also an urgent need to address chronic malnutrition. Through high?level dissemination of the survey results, treatment and prevention of malnutrition has become a priority for the provincial and federal government in Pakistan and for donors

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination : A systematic review and meta-analysis

Research Funding National Health and Medical Research Council. Grant Number: APP1194679 World Health Organization Article Funding Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.Peer reviewedPublisher PD

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination:A systematic review and meta-analysis

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.</p

Efficacy of typhoid vaccines against culture-confirmed salmonella typhi in typhoid endemic countries: A systematic review and meta-analysis

Background: Typhoid is a serious public health threat in many low-income and middle-income countries. Several vaccines for typhoid have been recommended by WHO for typhoid prevention in endemic countries. This study aimed to review the efficacy of typhoid vaccines against culture-confirmed Salmonella enterica serovar Typhi.Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for studies published in English between Jan 1, 1986 and Nov 2, 2023. We included randomised controlled trials (RCTs) comparing typhoid vaccines with a placebo or another vaccine. This meta-analysis evaluated the efficacy and safety of several typhoid vaccines, including live attenuated oral Ty21a vaccine, Vi capsular polysaccharide (Vi-PS), Vi polysaccharide conjugated to recombinant Pseudomonas aeruginosa exotoxin A vaccine (Vi-rEPA), and Vi-tetanus toxoid conjugate vaccine (TCV). The certainty of evidence for key outcomes was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. The outcome of interest was typhoid fever confirmed by the isolation of Salmonella enterica serovar Typhi in blood and adverse events following immunisation. This study is registered with PROSPERO (CRD42021241043).Findings: We included 14 RCTs assessing four different vaccines (Ty21a: four trials; Vi-PS: five trials; Vi-rEPA: one trial; TCV: four trials) involving 585 253 participants. All trials were conducted in typhoid endemic countries and the age of participants ranged from 6 months to 50 years. The pooled efficacy against typhoid fever was 45% (95% CI 33-55%; four trials; 247 649 participants; I2 59%; moderate certainty) for Ty21a and 58% (44-69%; five trials; 214 456 participants; I2 34%; moderate certainty) for polysaccharide Vi-PS. The cumulative efficacy of two doses of Vi-rEPA vaccine at 2 years was 91% (88-96%; one trial; 12 008 participants; moderate certainty). The pooled efficacy of a single shot of TCV at 2 years post-immunisation was 83% (77-87%; four trials; 111 130 participants; I2 0%; moderate certainty). All vaccines were safe, with no serious adverse effects reported in the trials.Interpretation: The existing data from included trials provide promising results regarding the efficacy and safety of the four recommended typhoid vaccines. TCV and Vi-rEPA were found to have the highest efficacy at 2 years post-immunisation. However, follow-up data for Vi-rEPA are scarce and only TCV is pre-qualified by WHO. Therefore, roll-out of TCV into routine immunisation programmes in typhoid endemic settings is highly recommended

<b>Supplementary File of "Exploring Preconception Health in Adolescents and Young Adults: Identifying Risk Factors and Interventions to Prevent Adverse Maternal, Perinatal, and Child Health Outcomes – A Scoping Review"</b>

This is a link to supporting documents for the scoping review being published in PLOS One journal. The scoping review aimed to investigate the preconception risk factors and interventions among adolescents and young adults and its impact on adverse maternal, perinatal and child health outcomes.</p

Evaluation of Nutrition Surveys in Flood-affected Areas of Pakistan: Seeing the Unseen!

In 2010 Pakistan experienced the worst floods recorded in its history; millions of people were affected and thousands lost their lives. Nutrition assessment surveys led by UNICEF were conducted in flood?affected areas of Punjab and Sindh provinces to assess the nutrition status of children between 6–59 months while Aga Khan University (AKU) undertook a parallel assessment including micronutrient status in their project areas within Balochistan, Sindh and Punjab. Standardised Monitoring and Assessment of Relief and Transition (SMART) methodology was used. 881 children from Sindh, 1,143 from Punjab and 817 from AKU project areas were measured for anthropometry and their households were interviewed. The findings indicated that while immediate life?saving interventions were essential, there was also an urgent need to address chronic malnutrition. Through high?level dissemination of the survey results, treatment and prevention of malnutrition has become a priority for the provincial and federal government in Pakistan and for donors