Explore the vast range of titles available.

IntroductionGroup B streptococcus (GBS) affects approximately 19.7 million pregnant women, causing about 58 300 (0.3%) infant deaths globally, with highest disease burden observed in Africa. Providing a Kenyan advisory board with evidence guiding maternal GBS priority interventions, we reviewed evidence and identified gaps on determining factors, vertical transmission rates (VTR), signs and symptoms, provision of care, burden, testing, comorbidities, sequelae, and management of maternal GBS colonisation and neonatal early-onset disease (EoD) in Africa.MethodsWe searched MEDLINE, EMBASE, Web of Science and Global Index Medicus, CINAHL and SCOPUS, CENTRAL, ClinicalTrials.gov and WHO Trials Register and MedRxiv. Two independent reviewers screened studies and extraction was conducted independently. We did not assess risk of bias or methodological rigour. Results were presented descriptively.ResultsOur search yielded 835 studies; we included 59. Most studies were cross-sectional (n=41, 69.5%). Studies were mainly from Eastern (n=29), Southern (n=15) and Western Africa (n=14). Participants totalled 31 544 women and 8244 neonates. Most studies (n=46, 77.9%) focused on maternal GBS colonisation, highlighting a myriad of determining factors like age below 25 years (OR 2.07). VTR ranged between 33.0% and 59.1%. Signs and symptoms included dyspareunia in pregnancy (23.3% of 279 women) and respiratory distress (OR 0.11) among neonates. Rectovaginal and/or vaginal colonisation and EoD prevalence among all neonates ranged from 1.8%–64.0% in pregnancy and 6.8%–65.1% in neonates. Nearly all studies (n=58) reported on testing criteria, mainly culture methods both in pregnancy (n=45 studies) and neonates (n=25 studies). HIV/AIDS was the most common comorbidity in women (OR range: 2.8 to 4.22). Meningitis was a common sequela in four studies, one reporting presence in 36.4% of participants. Ampicillin was the most common antibiotic reported in three studies. No evidence of maternal mortality was found.ConclusionsMost evidence concerns maternal colonisation, mainly testing and prevalence. Most research is from the Eastern, Southern and Western regions, with limited evidence from the Central and Northern regions. Main gaps are in EoD burden, maternal mortality, sequelae, comorbidity and management. Testing/reporting of GBS should be adapted. Systematic reviews on determinant factors and the effectiveness of management strategies will better inform the prioritisation of GBS interventions.

IntroductionIn March 2020, the WHO released a Global Research Roadmap in an effort to coordinate and accelerate the global research response to combat COVID-19 based on deliberations of 400 experts across the world. Three months on, the disease and our understanding have both evolved significantly. As we now tackle a pandemic in very different contexts and with increased knowledge, we sought to build on the work of the WHO to gain a more current and global perspective on these initial priorities.MethodsWe undertook a mixed methods study seeking the views of the global research community to (1) assess which of the early WHO roadmap priorities are still most pressing; (2) understand whether they are still valid in different settings, regions or countries; and (3) identify any new emerging priorities.ResultsThematic analysis of the significant body of combined data shows the WHO roadmap is globally relevant; however, new important priorities have emerged, in particular, pertinent to low and lower middle-income countries (less resourced countries), where health systems are under significant competing pressures. We also found a shift from prioritising vaccine and therapeutic development towards a focus on assessing the effectiveness, risks, benefits and trust in the variety of public health interventions and measures. Our findings also provide insight into temporal nature of these research priorities, highlighting the urgency of research that can only be undertaken within the period of virus transmission, as well as other important research questions but which can be answered outside the transmission period. Both types of studies are key to help combat this pandemic but also importantly to ensure we are better prepared for the future.ConclusionWe hope these findings will help guide decision-making across the broad research system including the multilateral partners, research funders, public health practitioners, clinicians and civil society.

Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was shown to be an efficacious first-line treatment with low toxicity in India. This was a 3-arm multicentre, open-label, randomized, controlled clinical trial to compare three treatment regimens for VL in East Africa: paromomycin sulphate (PM) at 15 mg/kg/day for 21 days versus sodium stibogluconate (SSG) at 20 mg/kg/day for 30 days; and the combination of both dose regimens for 17 days. The primary efficacy endpoint was cure based on parasite-free tissue aspirates taken 6 months after treatment. Overall, 135 patients per arm were enrolled at five centres in Sudan (2 sites), Kenya (1) and Ethiopia (2), when the PM arm had to be discontinued due to poor efficacy. The trial has continued with the higher dose of PM as well as the combination of PM and SSG arms. These results will be reported later. Baseline patient characteristics were similar among treatment arms. The overall cure with PM was significantly inferior to that with SSG (63.8% versus 92.2%; difference 28.5%, 95%CI 18.8% to 38.8%, p<0.001). The efficacy of PM varied among centres and was significantly lower in Sudan (14.3% and 46.7%) than in Kenya (80.0%) and Ethiopia (75.0% and 96.6%). No major safety issues with PM were identified. The efficacy of PM at 15 mg/kg/day for 21 days was inadequate, particularly in Sudan. The efficacy of higher doses and the combination treatment warrant further studies.