A quality improvement approach in co-developing a primary healthcare package for raising awareness and managing female genital schistosomiasis in Nigeria and Liberia

Background: Girls and women living in endemic areas for urogenital schistosomiasis may have lifelong vulnerability to female genital schistosomiasis (FGS). For >2 decades, the importance of FGS has been increasing in sub-Saharan Africa, but without established policies for case detection and treatment. This research aimed to understand the level of FGS knowledge of frontline health workers and health professionals working in endemic areas and to identify health system needs for the effective management of FGS cases and prevention of further complications due to ongoing infections. Methods: Workshops were conducted with health workers and stakeholders using participatory methods. These workshops were part of a quality improvement approach to develop the intervention. Results: Health workers’ and system stakeholders’ knowledge regarding FGS was low. Participants identified key steps to be taken to improve the diagnosis and treatment of FGS in schistosomiasis-endemic settings, which focused mainly on awareness creation, supply of praziquantel, development of FGS syndromic management and mass administration of praziquantel to all eligible ages. The FGS intervention component varies across countries and depends on the health system structure, existing facilities, services provided and the cadre of personnel available. Conclusion: Our study found that co-developing a new service for FGS that responds to contextual variations is feasible, promotes ownership and embeds learning across health sectors, including healthcare providers, NTD policymakers and implementers, health professionals and community health workers

Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria

Background: Detection and management of female genital schistosomiasis (FGS) within primary healthcare is crucial for achieving schistosomiasis elimination, however, current technical strategies are not feasible in many settings. In Nigeria, there are currently no established standard operating procedures to support front-line health workers. This article presents an evaluation of piloting an FGS care package in two LGAs of Ogun State, Nigeria. Methods: We used quantitative and qualitative analysis, including 46 interviews with patients, health workers and the quality improvement team; observations of training, learning sessions and supervision across 23 heath facilities; and records of patients detected and managed. Results: Of 79 women and girls who were screened, 66 were treated and followed up. Health workers assimilated knowledge of FGS and effectively diagnosed and managed patients, demonstrating the feasibility of using symptomatic screening and treatment tools to diagnose and care for women or girls with suspected FGS. Challenges included establishing a referral pathway to tertiary care for patients with complications, insecurity, gender norms that limited uptake and sensitization, the limited capacity of the workforce, conflicting priorities and praziquantel acquisition. Conclusions: Simple tools can be used in primary healthcare settings to detect and manage women and girls with FGS. Contextual challenges must be addressed. Sustainability will require political and financial commitments

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA. © 2022, The Author(s).Funding text 1: S Afzal acknowledges support of the Pakistan Society of Medical Infectious Diseases and King Edward Medical University to access the relevant data of HIV from various sources. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia (FCT), I.P., in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences - UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy - i4HB; FCT/MCTES (Ministério da Ciência, Tecnologia e Ensino Superior) through the project UIDB/50006/2020. K Deribe acknowledges support by the Wellcome Trust [grant number 201900/Z/16/Z] as part of his International Intermediate Fellowship. C Herteliu and A Pana are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu is partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. Y J Kim acknowledges support by the Research Management Centre, Xiamen University Malaysia [No. XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support by the Manipal Academy of Higher Education. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. M Kumar would like to acknowledge NIH/FIC K43 TW010716-04. I Landires is a member of the Sistema Nacional de Investigación (SNI), supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panama. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya was supported by the Fogarty International Center of the National Institutes of Health under the Award Number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Z Quazi Syed acknowledges support from JNMC, Datta Meghe Institute of Medical Sciences. A I Ribeiro was supported by National Funds through FCT, under the ‘Stimulus of Scientific Employment – Individual Support’ program within the contract CEECIND/02386/2018. A M Samy acknowledges the support from a fellowship of the Egyptian Fulbright Mission program and Ain Shams University. R Shrestha acknowledges support from NIDA K01 Award: K01DA051346. N Taveira acknowledges support from FCT and Aga Khan Development Network (AKDN) - Portugal Collaborative Research Network in Portuguese speaking countries in Africa (project reference: 332821690), and by the European & Developing Countries Clinical Trials Partnership (EDCTP), UE (project reference: RIA2016MC-1615). B Unnikrishnan acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. ; Funding text 2: LBD sub-Saharan Africa HIV Prevalence Collaborators S Afzal acknowledges support of the Pakistan Society of Medical Infectious Diseases and King Edward Medical University to access the relevant data of HIV from various sources. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia (FCT), I.P., in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences - UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy - i4HB; FCT/MCTES (Ministério da Ciência, Tecnologia e Ensino Superior) through the project UIDB/50006/2020. K Deribe acknowledges support by the Wellcome Trust [grant number 201900/Z/16/Z] as part of his International Intermediate Fellowship. C Herteliu and A Pana are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu is partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. Y J Kim acknowledges support by the Research Management Centre, Xiamen University Malaysia [No. XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support by the Manipal Academy of Higher Education. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. M Kumar would like to acknowledge NIH/FIC K43 TW010716-04. I Landires is a member of the Sistema Nacional de Investigación (SNI), supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panama. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya was supported by the Fogarty International Center of the National Institutes of Health under the Award Number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Z Quazi Syed acknowledges support from JNMC, Datta Meghe Institute of Medical Sciences. A I Ribeiro was supported by National Funds through FCT, under the ‘Stimulus of Scientific Employment – Individual Support’ program within the contract CEECIND/02386/2018. A M Samy acknowledges the support from a fellowship of the Egyptian Fulbright Mission program and Ain Shams University. R Shrestha acknowledges support from NIDA K01 Award: K01DA051346. N Taveira acknowledges support from FCT and Aga Khan Development Network (AKDN) - Portugal Collaborative Research Network in Portuguese speaking countries in Africa (project reference: 332821690), and by the European & Developing Countries Clinical Trials Partnership (EDCTP), UE (project reference: RIA2016MC-1615). B Unnikrishnan acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal.; Funding text 3: This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation. The funder of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or decision to publish. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. ; Funding text 4: S Afzal reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the Pakistan society of Community Medicine & Public Health, the Pakistan Association of Medical Editors, and the Pakistan Society of Medical Infectious Diseases, all outside the submitted work. R Ancuceanu reports 5 payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Avvie, Sandoz, and B Braun, all outside the submitted work. T W Bärnighausen reports research grants from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, UNAIDS, and WHO; consulting fees from KfW on the OSCAR initiative in Vietnam; participation on a Data Safety Monitoring Board or Advisory Board with the NIH-funded study “Healthy Options” (PIs: Smith Fawzi, Kaaya), Chair, Data Safety and Monitoring Board (DSMB), German National Committee on the “Future of Public Health Research and Education,” Chair of the scientific advisory board to the EDCTP Evaluation, Member of the UNAIDS Evaluation Expert Advisory Committee, National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH), US National Academies of Sciences, Engineering, and Medicine’s Committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President’s Emergency Plan for AIDS Relief (PEPFAR),” University of Pennsylvania (UPenn) Population Aging Research Center (PARC) External Advisory Board Member; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as co-chair of the Global Health Hub Germany (which was initiated by the German Ministry of Health); all outside the submitted work. J das Neves reports grants or contracts from Ref. 13605 – Programa GÉNESE, Gilead Portugal (PGG/002/2016 – Programa GÉNESE, Gilead Portugal) outside the submitted work. L Dwyer-Lindgren reports support for the present manuscript from the Bill & Melinda Gates Foundation through grant OPP1132415. I Filip reports other financial or non-financial interests from Avicenna Medical and Clinical Research Institute, outside the submitted work. E Haeuser reports support for the present manuscript from the Bill & Melinda Gates Foundation through grant OPP1132415. C Herteliu reports grants from Romanian Ministry of Research Innovation and Digitalization, MCID, for project number ID-585-CTR-42-PFE-2021 (Jan 2022-Jun 2023) “Enhancing institutional performance through development of infrastructure and transdisciplinary research ecosystem within socio-economic domain – PERFECTIS,” from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, for project number PN-III-P4-ID-PCCF-2016-0084 (Oct 2018-Sep 2022) “Understanding and modelling time-space patterns of psychology-related inequalities and polarization,” and project number PN-III-P2-2.1-SOL-2020-2-0351 (Jun 2020-Oct 2020) “Approaches within public health management in the context of COVID-19 pandemic,” and from the Ministry of Labour and Social Justice, Romania for project number “Agenda for skills Romania 2020-2025”; all outside the submitted work. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Teva, Amgen, Synexus, Boehringer Ingelheim, Zentiva, and Sanofi as personal fees, all outside the submitted work. J Khubchandani reports other financial interests from Teva Pharmaceuticals, all outside the submitted work. K Krishnan reports other non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. H J Larson reports grants or contracts from the MacArthur Foundation and Merck to London School of Hygeine and Tropical Medicine, and from the Vaccine Confidence Fund to the University of Washington; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Center for Strategic and International Studies as payment to LSHTM for co-chairing HighLevel Panel and from GSK as personal payment for developing training sessions and lectures; leadership or fiduciary role in other board, society, committee or advocacy group, pair, with the ApiJect Advisory Board; all outside the submitted work. O O Odukoya reports support for the present manuscript from the Fogarty International Center of the National Institutes of Health under the Award Number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A Pans reports grants from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, for project number PN-III-P4-ID-PCCF-2016-0084 (Oct 2018-Sep 2022) “Understanding and modelling time-space patterns of psychology-related inequalities and polarization,” and project number PN-III-P2-2.1-SOL-2020-2-0351 (Jun 2020-Oct 2020) “Approaches within public health management in the context of COVID-19 pandemic,” outside the submitted work. S R Pandi-Perumal reports royalties from Springer for editing services; stock or stock options in Somnogen Canada Inc as the President and Chief Executive Officer; all outside the submitted work. A Radfar reports other financial or non-financial interests from Avicenna Medical and Clinical Research Institute, outside the submitted work. A I Ribeiro reports grants or contracts from National Funds through FCT, under the ‘Stimulus of Scientific Employment – Individual Support’ program within the contract CEECIND/02386/2018, outside the submitted work. J M Ross reports support for the present manuscript from the Bill & Melinda Gates Foundation through grant OPP1132415; grants or contracts from National Institutes of Health and Firland Foundation as payments to their institution; consulting fees from United States Agency for International Development as personal payments, and from KNCV Tuberculosis Foundation as payments to their institution; all outside the submitted work. E Rubagotti reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Greenwich China Office and Unviersity Prince Mohammad VI, Morocco, all outside the submitted work. B Sartorius reports grants or contracts from DHSC – GRAM Project; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of the GBD Scientific Council and a Member of WHO RGHS; all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science LLC, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for participating in the speakers bureau for Simply Speaking; support for attending meetings and/or travel from the steering committee of OMERACT, to attend their meeting every 2 years; participation on a Data Safety Monitoring Board or Advisory Board as an unpaid member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, with the Veterans Affairs Rheumatology Field Advisory Committee as Chair, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc, Series Therapeutics, Tonix Pharmaceuticals, and Charlotte’s Web Holdings Inc. and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; all outside the submitted work. N Taveira reports grants or contracts from FCT and Aga Khan Development Network (AKDN) – Portugal Collaborative Research Network in Portuguese speaking countries in Africa (Project reference: 332821690) and from European & Developing Countries Clinical Trials Partnership (EDCTP), UE (Project reference: RIA2016MC-1615), as payments made to their institution, all outside the submitted work

The overlapping burden of the three leading causes of disability and death in sub-Saharan African children

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival. © 2022, The Author(s).Funding text 1: This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation. ; Funding text 2: This study was funded by the Bill & Melinda Gates Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The non-consortium authors have no competing interests . Competing interests for consortium authors is as follows: Robert Ancuceanu reports receiving consultancy or speaker feeds from UCB, Sandoz, Abbvie, Zentiva, Teva, Laropharm, CEGEDIM, Angelini, Biessen Pharma, Hofigal, AstraZeneca, and Stada. Jacek Jerzy Jozwiak reports personal fees from Amgen, ALAB Laboratories, Teva, Synexus, Boehringer Ingelheim, and Zentiva, all outside the submitted work. Kewal Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. Walter Mendoza is a Program Analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, which does not necessarily endorse or support these findings. Maarten J Postma reports grants and personal fees from MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, BMS, Seqirus, Astra Zeneca, Sanofi, IQVIA, grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, Budi, personal fees from Novartis, Quintiles, Pharmerit, owning stock options in Health-Ecore and PAG Ltd, and being advisor to Asc Academics, all outside the submitted work. Jasviner A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, the National Institutes of Health, the American College of Rheumatology, and Simply Speaking, owning stock options in Amarin, Viking, Moderna, Vaxart pharmaceuticals and Charlotte’s Web Holdings, being a member of FDA Arthritis Advisory Committee, the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, and the Veterans Affairs Rheumatology Field Advisory Committee, and acting as Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, all outside the submitted work. Era Upadhyay has a patent A system and method of reusable filters for anti-pollution mask pending, and a patent A system and method for electricity generation through crop stubble by using microbial fuel cells pending

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe