Explore the vast range of titles available.

IntroductionThis systematic review investigates the burden, clinical outcomes and risk factors of neglected tropical diseases (NTDs) and malaria in the Middle East and North African region, highlighting the urgency and scope of these health challenges.MethodsWe searched six databases for peer-reviewed literature and additional sources to capture grey literature in any language from 2000 to 28 August 2024. Studies were included if they provided primary data on outcomes in migrants. Primary outcomes were prevalence, incidence and mortality. Peer-reviewed articles were critically appraised using Joanna Briggs Institute tools, while the AACODS (Authority, Accuracy, Coverage, Objectivity, Date and Significance) checklist was used for grey literature. Estimates were pooled using random-effects meta-analysis where possible or synthesised narratively.ResultsWe included 39 studies with 81 678 migrants across 11 countries for NTDs and 16 studies encompassing 12 823 migrants across five countries for malaria. The pooled prevalence of specific NTDs among migrants was 4.7% for hookworm (95% CI 0.9% to 11.3%, I²=99%), 1.8% for Trichuris trichiura (95% CI 0.3% to 4.3%, I²=98%), 1.75% for Ascaris lumbricoides (95% CI 0.6% to 3.5%, I²=96%) and 1.8% for taeniasis (95% CI 0.3% to 4.4%, I²=98%). Compared with non-migrants, migrants exhibited higher prevalence rates for hookworm (1.8% vs 0.03%), Ascaris lumbricoides (0.3% vs 0%), Trichuris trichiura (0.5% vs 0%), dengue (26% vs 3.5%) and chikungunya (4.2% vs 0.5%). Migrants had a higher proportion of confirmed cases of schistosomiasis (0.21–20.3% vs 0–0.013%), cystic echinococcosis (7.4% vs 3.5%) and dengue (57.2% vs 56.4%) among suspected cases compared with non-migrants. Case fatality rates were 3.1% for dengue and 0.2–1.5% for malaria. Malaria incidence was only reported in Sudan (internally displaced persons: 6.8/1000; refugees: 2.72/1000; refugees <5 years old: 7.3/1000). While hospitalisation and intensive care unit rates for malaria were 25.8% and 1.3%, respectively, severe malaria was higher in non-migrants compared with migrants in Qatar (50% vs 5.2%, respectively).ConclusionsDespite a wide range of diseases reported in 55 studies, there were gaps in the evidence, primarily related to risk factors, clinical outcomes and the subregion of North Africa. We generally found that migrants were disproportionately affected by both NTDs and malaria, especially in the Middle East. PROSPERO registration number CRD42023407748

IntroductionThe Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise and synthesise the available evidence on the burden and health outcomes, policies and access (barriers and facilitators) related to these mobile populations in the region.MethodsSeven systematic reviews will cover three questions to explore the: (1) burden and health outcomes, (2) policies and (3) healthcare barriers and facilitators for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000–2023), reference-check relevant publications and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data by disease outcome if they are of sufficient volume and similarity. Where meta-analysis is not possible and where data are on policy or access, we will narratively synthesise the evidence using summary tables, figures and text.DisseminationWe anticipate disseminating the findings through peer-reviewed publications, conferences and other formats relevant to all stakeholders. We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and protocols will be registered on International Prospective Register of Systematic Reviews.

IntroductionThe Middle East and North Africa (MENA) region is characterised by major health disparities and complex migration flows. Yet, because of a lack of epidemiological data, there is an urgent need to strengthen routine data collection around migrant health and to define key indicators towards migrant health monitoring. To address this problem, we aim to design and pilot test the Migrant Health Country Profile tool (MHCP-t) which can collate country-level data collection around migration health data, policies and healthcare provision.Methods and analysisThe MHCP-t development is a stepwise process that will integrate a process evaluation model with active involvement and engagement of multilevel stakeholders. First, towards the generation of indicators, qualitative field activities will be conducted in different regions in Morocco, Tunisia and Egypt with migrants (n=50 per region), migrant community leaders (n=20 per region) and professionals working with them (n=20 per region). Deductive–inductive thematic analysis will be applied to the data collected. Results from the national qualitative studies and a series of systematic reviews in the MENA region will conclude with a first draft of tool indicators which will be reviewed by national and international experts using the Nominal Group Technique. The revised indicators will be entered into an electronic data capture system and the tool will be pilot-tested by applying a mixed-methods process evaluation to examine its relevance, comprehensiveness, comprehensibility and other practical issues, such as completion time and ease of responding. Mechanisms of change will be assessed on how the participative interactions towards the tool development can trigger change at national and regional levels.Ethics and disseminationThe study protocol has been approved by the institutional review boards at the Hospital Clinic in Barcelona, Spain, the University of Sousse in Sousse, Tunisia, the University Hospital of Tanger, Morocco and Badr University of Cairo in Egypt. Findings will be disseminated in peer-reviewed journals and communications to national and regional congresses.

IntroductionMorocco’s position at the crossroads of Africa and Europe has made it a major transit and destination country for migrants. While migrants are entitled to free emergency and primary healthcare services, some challenges persist. This study aimed to explore the experiences of migrants in accessing healthcare services and to identify recommendations for improvement.MethodsThis multisite qualitative study was conducted across five cities in Morocco between May 2023 and January 2024. Data were collected through semi-structured interviews and focus group discussions with 34 migrants, 17 migrant community leaders, 5 representatives of civil society organisations (CSOs), and 8 healthcare professionals. Migrants were recruited with the support of a Moroccan CSO, and primary healthcare professionals were recruited in health centres. Data were analysed using a hybrid thematic analysis approach, guided by Levesque’s Patient-Centered Access to Care framework.ResultsWe found that fear of costs, negative perceptions about the healthcare system, misconceptions about entitlement to services, cultural norms and health beliefs influenced participants’ health-seeking behaviours. Most reported free and easy access to primary healthcare, but administrative barriers, language challenges and medication costs persisted despite entitlement. Some migrant participants showed limited understanding of care pathways, leading to delays in care-seeking and fear of service denial—especially in the absence of peer accompaniment. Financial and administrative barriers were greatest at higher levels of care, posing challenges for uninsured migrants who formed the majority of participants. CSOs provided important support services but faced limits due to inconsistent funding and heavy centralisation.ConclusionMorocco has become a global and regional champion in migrant health, through major policy and programmatic efforts. Yet, economic and sociocultural barriers still limit full service utilisation. Ongoing national reforms offer a chance to leapfrog towards universal health coverage through innovative migrant-inclusive health insurance schemes and empowered community actors.

A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D’Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

The ChAdOx1 nCoV-19 (AZD1222) vaccine has been approved for emergency use by the UK regulatory authority, Medicines and Healthcare products Regulatory Agency, with a regimen of two standard doses given with an interval of 4–12 weeks. The planned roll-out in the UK will involve vaccinating people in high-risk categories with their first dose immediately, and delivering the second dose 12 weeks later. Here, we provide both a further prespecified pooled analysis of trials of ChAdOx1 nCoV-19 and exploratory analyses of the impact on immunogenicity and efficacy of extending the interval between priming and booster doses. In addition, we show the immunogenicity and protection afforded by the first dose, before a booster dose has been offered. We present data from three single-blind randomised controlled trials—one phase 1/2 study in the UK (COV001), one phase 2/3 study in the UK (COV002), and a phase 3 study in Brazil (COV003)—and one double-blind phase 1/2 study in South Africa (COV005). As previously described, individuals 18 years and older were randomly assigned 1:1 to receive two standard doses of ChAdOx1 nCoV-19 (5 × 1010 viral particles) or a control vaccine or saline placebo. In the UK trial, a subset of participants received a lower dose (2·2 × 1010 viral particles) of the ChAdOx1 nCoV-19 for the first dose. The primary outcome was virologically confirmed symptomatic COVID-19 disease, defined as a nucleic acid amplification test (NAAT)-positive swab combined with at least one qualifying symptom (fever ≥37·8°C, cough, shortness of breath, or anosmia or ageusia) more than 14 days after the second dose. Secondary efficacy analyses included cases occuring at least 22 days after the first dose. Antibody responses measured by immunoassay and by pseudovirus neutralisation were exploratory outcomes. All cases of COVID-19 with a NAAT-positive swab were adjudicated for inclusion in the analysis by a masked independent endpoint review committee. The primary analysis included all participants who were SARS-CoV-2 N protein seronegative at baseline, had had at least 14 days of follow-up after the second dose, and had no evidence of previous SARS-CoV-2 infection from NAAT swabs. Safety was assessed in all participants who received at least one dose. The four trials are registered at ISRCTN89951424 (COV003) and ClinicalTrials.gov, NCT04324606 (COV001), NCT04400838 (COV002), and NCT04444674 (COV005). Between April 23 and Dec 6, 2020, 24 422 participants were recruited and vaccinated across the four studies, of whom 17 178 were included in the primary analysis (8597 receiving ChAdOx1 nCoV-19 and 8581 receiving control vaccine). The data cutoff for these analyses was Dec 7, 2020. 332 NAAT-positive infections met the primary endpoint of symptomatic infection more than 14 days after the second dose. Overall vaccine efficacy more than 14 days after the second dose was 66·7% (95% CI 57·4–74·0), with 84 (1·0%) cases in the 8597 participants in the ChAdOx1 nCoV-19 group and 248 (2·9%) in the 8581 participants in the control group. There were no hospital admissions for COVID-19 in the ChAdOx1 nCoV-19 group after the initial 21-day exclusion period, and 15 in the control group. 108 (0·9%) of 12 282 participants in the ChAdOx1 nCoV-19 group and 127 (1·1%) of 11 962 participants in the control group had serious adverse events. There were seven deaths considered unrelated to vaccination (two in the ChAdOx1 nCov-19 group and five in the control group), including one COVID-19-related death in one participant in the control group. Exploratory analyses showed that vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 after vaccination was 76·0% (59·3–85·9). Our modelling analysis indicated that protection did not wane during this initial 3-month period. Similarly, antibody levels were maintained during this period with minimal waning by day 90 (geometric mean ratio [GMR] 0·66 [95% CI 0·59–0·74]). In the participants who received two standard doses, after the second dose, efficacy was higher in those with a longer prime-boost interval (vaccine efficacy 81·3% [95% CI 60·3–91·2] at ≥12 weeks) than in those with a short interval (vaccine efficacy 55·1% [33·0–69·9] at <6 weeks). These observations are supported by immunogenicity data that showed binding antibody responses more than two-fold higher after an interval of 12 or more weeks compared with an interval of less than 6 weeks in those who were aged 18–55 years (GMR 2·32 [2·01–2·68]). The results of this primary analysis of two doses of ChAdOx1 nCoV-19 were consistent with those seen in the interim analysis of the trials and confirm that the vaccine is efficacious, with results varying by dose interval in exploratory analyses. A 3-month dose interval might have advantages over a programme with a short dose interval for roll-out of a pandemic vaccine to protect the largest number of individuals in the population as early as possible when supplies are scarce, while also improving protection after receiving a second dose. UK Research and Innovation, National Institutes of Health Research (NIHR), The Coalition for Epidemic Preparedness Innovations, the Bill & Melinda Gates Foundation, the Lemann Foundation, Rede D’Or, the Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Background and purposeA subset of ischaemic stroke patients with atrial fibrillation (AF) have ischaemic stroke despite anticoagulation. We sought to determine the association between prestroke anticoagulant therapy and recurrent ischaemic events and symptomatic intracranial haemorrhage (sICH).MethodsWe included consecutive patients with acute ischaemic stroke and AF from the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study from eight comprehensive stroke centres in the USA. We compared recurrent ischaemic events and delayed sICH risk using adjusted Cox regression analyses between patients who were prescribed anticoagulation (ACp) versus patients who were naïve to anticoagulation therapy prior to the ischaemic stroke (anticoagulation naïve).ResultsAmong 2084 patients in IAC, 1518 had prior anticoagulation status recorded and were followed for 90 days. In adjusted Cox hazard models, ACp was associated with some evidence of a higher risk higher risk of 90-day recurrent ischaemic events only in the fully adjusted model (adjusted HR 1.50, 95% CI 0.99 to 2.28, p=0.058) but not increased risk of 90-day sICH (adjusted HR 1.08, 95% CI 0.46 to 2.51, p=0.862). In addition, switching anticoagulation class was not associated with reduced risk of recurrent ischaemic events (adjusted HR 0.41, 95% CI 0.12 to 1.33, p=0.136) nor sICH (adjusted HR 1.47, 95% CI 0.29 to 7.50, p=0.641).ConclusionAF patients with ischaemic stroke despite anticoagulation may have higher recurrent ischaemic event risk compared with anticoagulation-naïve patients. This suggests differing underlying pathomechanisms requiring different stroke prevention measures and identifying these mechanisms may improve secondary prevention strategies.

Marble is currently a commonly used material in the building industry, and environmental degradation is an inevitable consequence of its use. Marble waste occurs during the exploitation of deposits using shooting technologies. The obtained elements most mainly often have an irregular geometry and small dimensions, which excludes their use in the stone industry. There is no systematic way of disposing of these massive mounds of waste, which results in the occurrence of landfills and environmental pollution. To mitigate this problem, an effort was made to incorporate waste marble powder into clay bricks. Different percentage proportions of marble powder were considered as a partial substitute for clay, i.e., 5–30%. A total of 105 samples were prepared in order to assess the performance of the prepared marble clay bricks, i.e., their water absorption, bulk density, apparent porosity, salt resistance, and compressive strength. The obtained bricks were 1.3–19.9% lighter than conventional bricks. The bricks with the addition of 5–20% of marble powder had an adequate compressive strength with regards to the values required by international standards. Their compressive strength and bulk density decreased, while their water absorption capacity and porosity improved with an increased content of marble powder. The obtained empirical equations showed good agreement with the experimental results. The use of waste marble powder in the construction industry not only lowers project costs, but also reduces the likelihood of soil erosion and water contamination. This can be seen to be a crucial factor for economic growth in agricultural production.

The Republic of South Sudan lacks adequate data to support decision-makers in planning. Therefore, a land use land cover (LULC) study was conducted in Jubek State for 17 years (2000–2017). It was divided into three time intervals, using remote sensing (RS), geographic information system (GIS), Landsat TM, Landsat ETM+, and Landsat 8 OLI approaches. A transition matrix for the total change was developed to generate spatiotemporal and quantitative indicators to analyze LULC spatiotemporal dynamics for better developmental decisions. Overall accuracy assessment results were 97.41% (kappa 0.96), 90.45% (kappa 0.85), and 91.5% (kappa 0.89) for years 2000, 2009, and 2017, respectively. Furthermore, quantitative and spatiotemporal results show that built up areas drastically increase, especially from 2009 to 2017. The most dominant class in the study area was grassland, 9929.9 km2 (54.22%), followed by forest, 5555 km2 (30.33%), barren land, 2497.3 km2 (13.64%), built up areas, 166.7 km2 (0.9%), farmland, 128.31 km2 (0.71%), and water bodies, 35.91 km2 (0.96%). The outcomes of the analysis show that since 1955 Jubek State (Juba) has been the preferable place for the local citizens’ settlement in South Sudan. Unfortunately, agricultural production was insufficient due to the limited cultivated area; on the other hand, the study area is rich in natural resources and could meet local people’s demand if a proper strategy such as LULC transformation is well implemented.

The reduction in severe and moderate acute malnutrition (SAM and MAM) rates in Pakistan has been sub-optimal compared to other low-and middle-income countries (LMICs). Specially-formulated products have been designed globally to manage SAM and MAM, such as ready-to-use therapeutic food (RUTF) and ready-to-use supplementary food (RUSF), with variable efficacies. RUTF is primarily produced and patented in industrialized countries, raising supply challenges in resource-constrained regions with a high burden of acute malnutrition. RUSF minimizes costs by using locally-available ingredients while providing similar nutritional value. In this study, we compared the efficacy, side effects, and compliance of two months of supplementation with either RUTF or RUSF. Children aged nine months in the rural district of Matiari, Pakistan, with a weight-for-height z-score (WHZ) <-2 received either RUTF (500 kcal sachet) for two months in 2015 or RUSF (520 kcal sachet) for two months in 2018. The RUSF group had a higher height gain and mid-upper arm circumferences (MUAC) score. Higher compliance was noted with lower side effects in the RUSF group. A higher compliance rate did correlate with the growth parameters in respective groups. Our study found that both RUTF and RUSF partially improve the anthropometric status of acutely malnourished children, with neither being superior to the other.