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To determine the prevalence and causes of blindness and vision impairment (VI) among adults aged ≥50 years in Western Uganda. A population-based cross-sectional survey was conducted in Western Uganda (July-August 2023) using RAAB7. Adults aged ≥50 years who had resided in the study districts for at least six months in the past year were eligible. Participants were identified through door-to-door household visits using a two-stage cluster sampling approach. Primary outcomes include prevalence of blindness and VI and its causes. Secondary outcomes include cataract surgical coverage (CSC), effective CSC (eCSC), refractive error coverage (REC), and effective REC (eREC). A total of 3,125 participants were examined (54.1% female). The adjusted prevalence of blindness (presenting visual acuity (PVA) <3/60) was 0.9% (95% CI: 0.5-1.3%). Severe, moderate, and mild VI were found in 0.9% (95% CI: 0.4-1.3%), 4.5% (95% CI: 3.3-5.8%), and 3.8% (95% CI: 3.0-4.6%), respectively. Untreated cataract was the leading cause of bilateral blindness (49.4%). The CSC and eCSC at the < 6/12 threshold were 19.7% and 7.3%, respectively. Only 19.4% of 108 operated eyes achieved good outcomes (PVA ≥ 6/12). The main barriers to cataract surgery included lack of awareness (32.8%), cost (23.9%), and perceived lack of need (20.9%). The adjusted prevalence of uncorrected refractive error as a cause of moderate VI was 1.6% (95% CI: 1.1-2.0%), and mild VI was 2.8% (95% CI: 2.2-3.5%). REC was 1.0%, while eREC was 0.6% (95% CI: 0.0-1.4%). Blindness and vision impairment remain major public health issues in Western Uganda, primarily due to untreated cataract and uncorrected refractive error. Poor post-operative outcomes highlight the urgent need to improve surgical quality. These findings may guide targeted interventions and policy to strengthen eye care services.

People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.

In July 2023, the World Health Organization (WHO) released the 23rd Model List of Essential Medicines (EML) for adults and the 9th Model List of EML for children. These lists serve as global references for essential medicines that should be universally available, accessible, and affordable. This editorial explores recent updates to the WHO EML lists, with a particular focus on medicines addressing neglected tropical diseases (NTDs). We discuss the persistent barriers to equitable access, including economic, regulatory, and logistical challenges; highlight global initiatives aimed at improving accessibility; and propose strategies to bridge the gap in essential medicine access. We emphasize the need for international collaboration, increased funding for research institutions, pharmaceutical companies, and global health initiatives to support the development of novel treatments for NTDs, and innovative distribution approaches to ensure these medications reach underserved populations.

Background: From early in its history, gold mining in South Africa involved recruiting hundreds of thousands of workers from Malawi and other neighbouring countries to work in an environment conducive to high rates of tuberculosis and silicosis. Official recruitment from Malawi ended in the 1990s, depriving large numbers of these migrant miners of their livelihood, with limited or no access to employment-linked social benefits and services. Objectives: To describe barriers faced by Malawian migrant ex-gold miners in accessing social benefits related to occupational lung disease and related health services and medical examinations, and to identify needed actions. Methods: This study, conducted in the Blantyre region of Malawi, draws from field observations and interviews with 14 ex-gold miners who had worked on South African gold mines, supplemented by five key informant interviews. Data were analysed using a phenomenological and thematic analysis approach. Findings: Ex-migrant miners described precarious livelihoods and difficulty accessing employment-linked benefit examinations and health services. They are largely uncertain about their entitlements related to their past work in South Africa and the means for pursuing such rights. The division of responsibility within South Africa and between the governments of South Africa and Malawi has resulted in confusion and misinformation. Within Malawi, scarcity of funding, administrative hurdles and limited occupational lung disease expertise are barriers to expanding current services for ex-migrant miners as well as ex-miners from Malawian mines. Conclusions: A number of actions are needed: coordination between the Malawian government and South African agencies; integration of occupational health services, including for migrant ex-gold miners, into Malawi’s public health system; education of ex-gold miners and their dependents about their rights and related processes and the provision of relief aid through local and external support. Financial involvement of the South African mining industry that profited from the services of migrant miners is required to alleviate the burden on publicly funded health systems.

Current control strategies for soil-transmitted helminths (STH) emphasize morbidity control through mass drug administration (MDA) targeting preschool- and school-age children, women of childbearing age and adults in certain high-risk occupations such as agricultural laborers or miners. This strategy is effective at reducing morbidity in those treated but, without massive economic development, it is unlikely it will interrupt transmission. MDA will therefore need to continue indefinitely to maintain benefit. Mathematical models suggest that transmission interruption may be achievable through MDA alone, provided that all age groups are targeted with high coverage. The DeWorm3 Project will test the feasibility of interrupting STH transmission using biannual MDA targeting all age groups. Study sites (population ≥80,000) have been identified in Benin, Malawi and India. Each site will be divided into 40 clusters, to be randomized 1:1 to three years of twice-annual community-wide MDA or standard-of-care MDA, typically annual school-based deworming. Community-wide MDA will be delivered door-to-door, while standard-of-care MDA will be delivered according to national guidelines. The primary outcome is transmission interruption of the STH species present at each site, defined as weighted cluster-level prevalence ≤2% by quantitative polymerase chain reaction (qPCR), 24 months after the final round of MDA. Secondary outcomes include the endline prevalence of STH, overall and by species, and the endline prevalence of STH among children under five as an indicator of incident infections. Secondary analyses will identify cluster-level factors associated with transmission interruption. Prevalence will be assessed using qPCR of stool samples collected from a random sample of cluster residents at baseline, six months after the final round of MDA and 24 months post-MDA. A smaller number of individuals in each cluster will be followed with annual sampling to monitor trends in prevalence and reinfection throughout the trial. ClinicalTrials.gov NCT03014167.

Schistosomiasis is endemic to Malawi, where preventive chemotherapy by mass drug administration (MDA) has been the foundational public health strategy for over a decade. Despite ongoing control, our understanding of the contemporary epidemiology of schistosomiasis in rural Malawi is limited to infrequent school-based surveys, typically lacking evidence from community-based surveys particularly within non-lakeshore upland communities who may be perceived to be at lower risk. Between July and August 2022, we conducted a cross-sectional parasitological survey amongst a community-representative sub-sample of boys aged 10-15 years who had been randomly selected and recruited to the DeWorm3 endline survey in Namwera, Mangochi District. A total of 306 participants from 38 communities were assessed for S. mansoni by duplicate Kato-Katz thick smears. Of these, 243 (79.4%) subsequently provided a urine sample to be assessed by filtration for S. haematobium and 238 (77.8%) responded to a risk-factor questionnaire. A parallel malacological survey of eight locally important water contact sites was conducted. The overall prevalence of egg-patent schistosomiasis was 50.6% (95% CI 44.2-57.1). The prevalence of S. haematobium was 47.7% (95% CI 41.3-54.2), of which 37.9% (n=44) were heavy intensity infections whereas the prevalence of S. mansoni was 6.5% (95% CI 4.0-9.9), with one moderate intensity infection (0.3%). There was strong evidence of a positive association between detected S. haematobium infection and reporting \"red urine\" (p<0.001) and 'bilharzia' (p=0.005). Biomphalaria spp. were found at two sites while Bulinus spp. were found at five sites. Despite multiple years of MDA at reportedly high coverage, we observed a high egg-patent prevalence with high prevalence of heavy intensity infections amongst boys aged 10-15 years. This evidences engrained and ongoing transmission requiring additional efforts to gain and sustain effective control. Our findings highlight the importance of epidemiological monitoring alongside a schistosomiasis control programme, particularly in areas historically perceived to be at lower risk.

  Corneal scarring and phthisis bulbi due to vitamin A deficiency, measles, and infection were the commonest causes of blindness in the early 1990s in much of Asia and Africa [6]-[8]. [...]corneal blindness was listed as the primary cause of blindness in children for planning for childhood blindness [8]. [...]as reported in annual UNICEF State of the World's Children reports, vitamin A-supplementation coverage has increased and blindness due to vitamin A deficiency has been virtually eliminated in many developing countries.

Mass drug administration (MDA) programmes with the macrolide antibiotic azithromycin to reduce childhood mortality are expanding in Africa; however, concerns remain about the long-term effects of these programmes on antimicrobial resistance (AMR). We aimed to evaluate the persistence and spread of Streptococcus pneumoniae AMR following a community-randomised MDA trial. This population-based, cross-sectional, pneumococcal carriage survey was conducted in Mangochi, Malawi, 3·5 years after the MORDOR trial, in which communities received twice-yearly azithromycin or placebo for 2 years. Eligible participants in this carriage survey were children aged 4–9 years who lived in an azithromycin-treated or placebo-treated cluster during the MORDOR trial, and children aged 1–3 years who were resident in a cluster but born after the MORDOR trial ended. Nasopharyngeal swabs were collected from participants and analysed by whole genome sequencing; pneumococcal genomes obtained from a distant site in Malawi, in which MDA had not been conducted, were used as reference genomes. The primary outcome was the prevalence of S pneumoniae macrolide resistance, comparing placebo-treated and azithromycin-treated clusters at baseline, 6 months post-MDA, and 3·5 years post-MDA. Between April 8 and May 14, 2021, 924 children aged 1–9 years were screened, of whom 19 were excluded and 905 were recruited to the follow-up carriage survey: 452 from azithromycin-treated clusters and 453 from placebo-treated clusters of the MORDOR trial. We assessed 426 isolates from these participants (190 from azithromycin-treated clusters and 236 from placebo-treated clusters), as well as samples from the baseline of the MORDOR trial (164 isolates; 83 from azithromycin-treated clusters and 81 from placebo-treated clusters) and from 6 months post-MDA (223 isolates; 119 from azithromycin-treated clusters and 104 from placebo-treated clusters). In azithromycin-treated clusters, macrolide resistance increased from 21·7% (95% CI 14·2–31·7; 18 of 83 isolates) at baseline to 31·9% (24·2–40·8; 38 of 119 isolates) 6 months post-MDA and to 32·1% (25·9–39·0; 61 of 190 isolates) 3·5 years post-MDA. In placebo-treated clusters, resistance increased from 21·0% (13·5–31·1; 17 of 81 isolates) at baseline to 25·0% (17·7–34·1; 26 of 104 isolates) 6 months post-MDA and to 30·9% (25·4–37·1; 73 of 236 isolates) 3·5 years post-MDA. No significant differences were observed in odds ratios between treatment groups across the survey timepoints: 0·97 (95% CI 0·36–2·55) at baseline, 1·46 (0·67–3·17) at 6 months post-MDA, and 1·12 (0·66–1·91) at 3·5 years post-MDA. Macrolide resistance in the non-MDA site remained stable: 16·9% (95% CI 12·8–21·8; 45 of 267 isolates) at baseline, 16·5% (13·3–20·3; 70 of 424 isolates) at 6 months, and 16·5% (12·5–21·4; 44 of 267 isolates) at 2·5 years. Among children born into azithromycin-treated clusters after MDA, macrolide resistance was 36·0% (27·7–45·1; 41 of 114 children). Multidrug resistance to at least three antibiotic classes was significantly higher in azithromycin-treated (p=0·0015) and placebo-treated (p<0·0001) clusters than in the comparator population at 3·5 years post-MDA and was associated with integrative conjugative elements. Azithromycin MDA is associated with macrolide resistance that persists and potentially spreads to untreated populations. The co-existence of multidrug resistance and transmissible resistance on integrative conjugative elements in these populations is a public health concern. Careful monitoring of AMR is essential in areas where MDA is implemented. The Gates Foundation, the National Institute for Health and Care Research, and the Wellcome Trust.

Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1–9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0–54%) and seroconversion rates (range: 0–15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69–75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination. Trachoma is targeted for global elimination as a public health problem by 2030. Here, the authors combine data from 14 African populations to show that IgG in children is a robust approach to monitor transmission as populations approach elimination.

Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem.