WHO Recommendations Research Articles

Road traffic crash data in Southwestern Nigeria: a qualitative analysis of sources, contents and management methods

Objective This study qualitatively examined road traffic crash (RTC) data collection and management in southwest Nigeria, with the goal of addressing the tenets of the UN Decade of Action Plan on Road Safety’s call for an effective data system. Methods Data on RTCs data collection in the study area was obtained through key informant interviews with five hospital accident emergency unit directors, three Federal Road Safety Commission (FRSC) Sector commanders, and three Nigeria Police Force (NPF) commissioners. Datasets were transcribed, categorized, and interpreted using content analysis, descriptive statistics, and WHO recommended minimal crash data element requirements. Results The study found disparate systems, a lack of synergy, and discrepancy in the various data sources in the country when compared with WHO recommendations on road traffic data collection systems, with 55% of agencies using non-standardized paper forms. The study also reveals that the minimum crash data elements recommended by WHO are not consistently captured in the NPF, FRSC, and hospital traffic crash data sources. Conclusions The study suggested the use of an upgraded National Road Traffic Crash Data Management System (NRTCDMS) Data Template to unify data gathering and linkage issues, but recommends a digital version of the template.

Economic Evaluation of Expanding HPV Vaccination Programs for Boys: A Systematic Review

Background: Human papillomavirus is responsible for almost all cases of cervical and non-cervical cancers. Various treatments have been carried out, but they have not been effective enough in reducing the burden. The U.S. Food and Drug Administration has approved three HPV vaccines for use. Since its recommendation in 2006, HPV infections have significantly decreased by 88% among teen girls and 81% among young adult women. Additionally, research has indicated that HPV vaccine is cost-effective in preventing both cervical and non-cervical cancers. The primary target group of HPV vaccination is girls aged 9-14, but some countries are starting to expand their programs according to the WHO recommendation for secondary targets: boys and adult women. This study gave updated information regarding the expansion of HPV vaccination programs for boys. Objective: To systematically review the health economic studies to evaluate the cost-effectiveness of expanding HPV vaccination program for including boys to prevent HPV-related cancer. Method: An electronic literature search was performed on two databases (Pubmed and ScienceDirect) to identify studies published from 2013 to 2023 in English and Indonesian. Three search strategies were used, including the terms «economic evaluation», «HPV», and «boys». The screening and selection of the literature was performed according to the PRISMA statement. Results: A total of 306 articles were identified. Only 26 of them were deemed relevant. This research compiled studies from countries with varying economic levels on the expansion of vaccination programs in boys to prevent or reduce cervical, anogenital, and HNC cancers. All the studies used a modeling approach to estimate the number of cases averted and the health care costs. Sixteen studies found that it was cost-effective to expand HPV vaccination programs to include boys. The ICER values were found to be sensitive to the vaccine price, duration of protection, and vaccination coverage. Conclusion: Expanding HPV vaccination to boys is considered a cost-effective solution for preventing HPV-related cancers, based on studies conducted in many countries. It is recommended to conduct an economic evaluation to estimate the cost-effectiveness of HPV vaccination as a prevention method for HPV-related cancers in low and middle-income countries like Indonesia. To begin the study, it is suggested to expand the HPV vaccination target to boys with a lower-priced vaccine and increased vaccination coverage.

Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data

Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear. This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC). Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations. This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.

Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis.

Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.

Simultaneous removal of malachite green and lead from water by consortium dry-biomasses of Bacillus licheniformis AG3 and Bacillus cereus M116

Synthetic textile dye malachite green (MG) and heavy metals present in industrial wastewater are hazardous to the ecosystem. Bioremediation of dyes and heavy metals using dry-biomasses has advantages over chemical methods. This study screened an acclimatized, heavy metal-resistant, and dye-degrading Gram positive Bacillus licheniformis AG3 strain from the textile wastewater near Kolkata, West Bengal. The EDXRF analysis of this colored wastewater effluent showed 36.33 mg/L lead, significantly higher than the WHO recommendation. Previously, Bag et al. showed bioremediation of synthetic dyes using dry-biomass of Bacillus cereus M116 from an aqueous solution (Bag et al. Arch Microbiol 203(7):3811–3823, 2021). Here, a consortium of dry-biomasses of B.licheniformis AG3 and B. cereus M116 strains (1:1 w/w ratio) was prepared for the simultaneous removal of lead and MG from wastewater. Statistical optimization determines that the pH, initial concentration of contaminants, and dry-biomass concentrations are critical for bioremediation under batch procedures. Further, optimization using the response surface methodology showed that 0.01% consortium dry-biomasses eliminated a maximum of 99.35% MG and 96.01% lead (II) within 6 h. SEM–EDS and FTIR confirmed a strong surface biosorption. Furthermore, a fixed-bed biofilter column of the consortium dry-biomasses was prepared, which was able to remove 98.1% MG and 98.5% lead at the 0.5–1 mL/min flow rate. Together, this study developed a biofilter with a consortium dry biomasses of B. licheniformis AG3 and B. cereus M116 for the simultaneous removal of MG and lead from wastewater.

Chemical speciation of methylmercury and mercury(II) cations in fish by new fluorogenic naphthalimide alkynyl gold complexes: The ultimate test for detecting fish contamination

The proof of concept of a new portable protocol for the detection and speciation of methylmercury and mercury(II) cations in fish samples is described. In this way, traces of methylmercury and/or mercury(II) cations in fish were quantitatively detected using an elaborated protocol and including a fluorescent sensor. In-the-field accurate results were obtained due to the selective behavior of the chemical sensor in the presence of both cations, working at very low concentrations of mercury species in fish under standard laboratory conditions, that are suitable for daily use in ordinary sampling by border companies importing fish or remote laboratories where large devices cannot be carried. The reported fish protocol is useful under real-life conditions for analyzing fish for the presence of methylmercury in contrast to total mercury analysis. The combination of the protocol and the fluorescent reporter constitutes the ultimate test for fish contamination by mercury(II) species in the workplace. The reported limits of detection of 0.72 nM for Hg2+ and 1.62 nM for CH3Hg+ and the closely related values of the two mercury(II) species in fish samples, obtained by ICP-MS analysis and fluorescent measurements, make the method suitable for daily control of methylmercury in fish under the EU legislation parameters and the WHO recommendations.

Reliability and validity of the German version of the Iowa infant feeding attitude scale (IIFAS-G) and relations to breastfeeding duration and feeding method

BackgroundPublic health initiatives (e.g., the Baby Friendly Hospital Initiative) have led to an increase in breastfeeding rates worldwide. However, as (exclusive) breastfeeding duration is still below WHO recommendations, it is crucial to understand the factors that influence decisions on breastfeeding practice. Modifiable psychological factors such as intention to breastfeed have therefore become targets of recent interventions. As the intention to breastfeed is among the strongest predictors of breastfeeding duration, reliable tools for measuring the intention to breastfeed are needed. The Iowa Infant Feeding Attitude Scale (IIFAS) measures attitudes towards infant feeding and is used in various languages and across different cultural contexts. However, there has been no German version of the IIFAS (IIFAS-G) so far. The aim of this study was to investigate reliability, validity, and associations of the IIFAS-G with feeding method and breastfeeding duration.MethodsBetween August and November 2022, a total of 353 mothers (Mage = 35 years, SDage = 4.2 years) of singleton infants (47.3% female (1 undetermined), Mage = 10.8 months, SDage = 4.7 months, age range: 3-547 days; 90.4% living in Switzerland) participated in an online survey. The IIFAS-G was administered as a part of a larger study on early child development and infant feeding method.ResultsThe translated IIFAS-G showed unsatisfactory model fit for the two factor 17-item solution. Four items showed low factor loadings. After item reduction, a 13-item two factor solution showed satisfactory model fit (CFI = 0.92, TLI = 0.90, RMSEA = 0.07) and high internal consistency (Cronbach’s α = 0.85). The IIFAS-G score was higher for mothers who exclusively breastfed their infants compared to mothers who additionally or exclusively fed infant formula. Moreover, mothers with higher IIFAS-G scores were less likely to stop breastfeeding their child over the course of 1.5years (HR = 0.87).ConclusionA shorter two-factor IIFAS-G is proposed to investigate attitudes towards breastfeeding and formula feeding in German-speaking mothers.

Patient-reported physical activity, pain, and fear of movement after cardiac surgery: a descriptive cross-sectional study

Objectives After cardiac surgery, there may be barriers to being physically active. Patients are encouraged to gradually increase physical activity, but limited knowledge exists regarding postoperative physical activity levels. This study aimed to assess patient-reported physical activity six months after cardiac surgery, determine adherence to WHO's physical activity recommendations, and explore potential relationships between pain, dyspnea, fear of movement, and activity levels. Methods The study design was a cross-sectional study at Örebro University Hospital, Sweden. Preoperative and surgical data were retrieved from medical records and questionnaires concerning physical activity (Frändin-Grimby Activity Scale, the Physical activity Likert-scale Haskell, Patient-Specific Functional Scale, and Exercise Self-efficacy Scale) were completed six months after surgery. Data were collected on pain, dyspnea, general health status and kinesiophobia i.e. fear of movement, using the Tampa Scale of Kinesiophobia Heart. Results In total, 71 patients (68 ± 11 years, males 82%) participated in this study. Most patients (76%) reported a light to moderate activity level (Frändin-Grimby levels 3-4) six months after cardiac surgery. In total, 42% of the patients adhered to the WHO’s physical activity recommendations (150 min/week). Pain and dyspnea were low. Patients with lower activity levels exhibited significantly higher levels of fear of movement (p =.025). Conclusions The majority of patients reported engaging in light to moderate activity levels six months after cardiac surgery. Despite this, less than half of the patients met the WHO's physical activity recommendations. Potential barriers to physical activity such as pain, dyspnea and fear of movement were reported to be low.

Navigating the Waves: A Comprehensive Analysis of India's COVID-19 Journey from 2019 to the Arrival of JN.1 Subvariant in 2023

COVID-19, caused by the SARS-CoV-2 virus, has emerged as a global threat. The journey of COVID-19, from its origins in Wuhan in 2019 to the emergence of various variants, including the recent JN.1 subvariant, is a complex narrative marked by global efforts to control the pandemic. The progression of the virus in India, as illustrated by data from 2020 to 2023, reflects both the challenges faced and the resilience exhibited by different states. The decline in cases in 2023, compared to the previous year, is attributed to factors such as extensive vaccination campaigns, the emergence of less severe variants, and changing immune responses. The inclusion of comprehensive WHO recommendations emphasizes the ongoing importance of preventive measures. The evolving scenario also highlights the need for continued vigilance, international collaboration, and public health initiatives to minimize the impact of the virus. The advent of JN.1 serves as a reminder of the virus's adaptability and the significance of remaining in advance of emerging variants as the globe struggles with COVID-19's unexpected nature.

Nutritional Status, Sugar Sweetened Beverage Consumption and Physical Activity Level in Male and Female College Students Living in Dormitory

Introduction: The global prevalence of obesity is on the rise, including in Indonesia. High energy intake from sugar is a growing concern worldwide due to its association with weight gain, tooth decay, and non-communicable diseases. A prior study revealed that 10.9% of Indonesian adults consumed energy from sweetened beverages in excess of the WHO recommendation. This study aimed to assess the consumption of sweetened beverages in male and female college students in Indonesia. Method: The study was conducted at Universitas Indonesia and involved 107 subjects aged 19-21 years who resided in student dormitories. Result: The result found the median BMI in female was higher than male. In female, 3 out of 10 students was overweight-obese, while 1 out of 10 in male. Interestingly, the median daily intake of sweetened beverages significantly higher in male than female; 387 (25–1580) vs 246 (0–762) ml/day (p=0.001). Added sugar content in beverages in males was higher than half of Indonesian recommendation (28.4 [1.9–134.4] vs 19.2 [0–61.1]) which contributed to energy as much as 170.9 (12.4–625.7) kcal/ day or about 8.9% of total energy intake than female (108.5 [0–394.4] kcal/day). Compared to Indonesian guideline, 12% of male subjects consumed added sugar higher than 50 g/day. Simultaneously, 7 out of 10 subjects consumed energy from sweetened beverages higher than 10% of their total energy intake (WHO recommendation). The BMI and prevalence of overweight-obese were higher in female, while the sweetened beverage was higher in male. It might be caused by the physical activity in male was higher than female. Although male had higher energy intake from SSB, their energy output through physical activity balanced with energy input. Conclusion: These finding alerted the university as educational institution should take an action to prevent this issue since the prevalence of overweight-obesity and sweetened beverage consumption has occurred in young age.

How Safe Are Nepal’s Roads? A Study of Road Safety Legislation and WHO Standards

Around the world, traffic accidents result in significant catastrophes. The consequences of traffic accidents go far beyond the immediate suffering of the individuals involved. This paper aims to examine the road safety legislation and WHO standards adopted in Nepal. The paper is based on secondary data and policy documents related to road safety and WHO standards in the context of Nepal. It presents Nepal’s road network, significant improvements in road safety indicators, and encouraging advancements in road safety. The study finds five major areas for improvement in road safety laws in Nepal: seat-belt regulations, helmet laws, speed laws, child restraint laws, and drinking and driving laws. The study also reveals that Nepal’s current regulatory framework needs to be improved by monitoring actual appropriate helmet fastening and standardization. There is a lack of precise BAC restrictions for drivers and insufficient speed limits under WHO recommendations. Nepal’s child restraint rules also need to be expanded to include seat belt usage in all cars and forbid children from sitting in the front seats. To close those regulatory gaps and protect Nepalese citizens’ safety on the roads, it ends by providing a strict set of recommendations, such as increased enforcement, public awareness campaigns, and changes to road design and concrete making plans. Policymakers, researchers, and stakeholders working to promote street safety measures in Nepal and abroad would find great assistance from this article, which offers a detailed examination and smart recommendations.

A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later

We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation. Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling. Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P= 0.0002; area under the receiver operating characteristic curve= 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF. This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.

Evaluation of drinking water quality and associated health risks in Adama City, Ethiopia

Drinking water deterioration causes to risk of public health which is essential to supply safe water to the public. This study assessed groundwater quality and health risks in Adama City by analyzing groundwater and chlorine samples. Ion photometry techniques detected anions and cations, ensuring accuracy with quality control protocols. Water Quality Index (WQI) and chlorine decay modeling via WaterGEMs assessed water quality. Hazard index (HI) calculations evaluated exposure risks; Pearson correlation analyzed physicochemical relationships. Findings highlighted water quality and hazards. Aquachem software analyzed Adama's groundwater, revealing high total alkalinity and potassium exceeding WHO limits. Other parameters (nitrate, nitrite, chloride, fluoride, and sulfate) met WHO standards. Sodium, calcium, magnesium, iron, manganese, and boron also complied. Multivariate analysis showed significant parameter associations. Water types included Ca–Na–HCO3 (27.27 %), Na–Ca–HCO3 (36.36 %), Na–Ca–Mg–HCO3, Na–HCO3 (9.09 % each), and Na–Mg–HCO3 (18.18 %). Drinking Water Quality Index rated boreholes as "Good." Health risk assessments found no significant fluoride, iron, or manganese risks across ages. Chlorine residual analysis indicated 74 % had levels below WHO recommendations, prompting chlorine dosing adjustments. Findings inform groundwater management in Adama City.

Yield of TB screening in prisons in Tajikistan.

The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan's prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan. A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test. A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001). The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.

How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

Prevalence of Strongyloides stercoralis and other helminths in four districts of Madagascar

BackgroundEstimation of prevalence of Strongyloides stercoralis infection is required in endemic areas, in order to identify areas in need of control programmes. Data on prevalence of strongyloidiasis in Madagascar are scant. Aim of this work was to estimate prevalence of S. stercoralis in four districts of Madagascar.MethodsFecal and serum samples collected in the context of a previous study on schistosomiasis were tested with S. stercoralis real-time PCR and serology, respectively. A multiplex real-time PCR for Ascaris lumbricoides, Ancylostoma duodenalis, Necator americanus, and Trichuris trichiura was done on fecal samples collected in the areas demonstrating higher prevalence of strongyloidiasis. Comparisons between proportions were made using Fisher exact test, with false discovery rate correction used for post-hoc comparisons. A multivariable Firth logistic regression model was used to assess potential risk factors for S. stercoralis infection.ResultsOverall, 1775 serum samples were tested, of which 102 of 487 (20.9%) and 104 of 296 (35.2%) were serological-positive in Marovoay and in Vatomandry districts (both coastal areas), respectively, compared to 28 of 496 (5.6%) and 30 of 496 (6.1%) in Tsiroanomandidy and in Ambositra districts (both highlands), respectively (adj. p < 0.001). PCR for S. stercoralis was positive in 15 of 210 (7.1%) and in 11 of 296 (3.7%) samples from Marovoay from Vatomandry, respectively, while was negative for all samples tested in the other two districts. High prevalence of A. lumbricoides (45.9%), hookworm (44.6%) and T. trichiura (32.1%) was found in Vatomandry. In the multivariable analysis, strongyloidiasis was associated with hookworm infection. Hookworm infection was also associated with male sex and lower education level.ConclusionsS. stercoralis prevalence proved higher in coastal areas compared to highlands. Different climatic conditions may explain this distribution, along with previous rounds of anthelminthics distributed in the country, which may have reduced the parasite load in the population. The high prevalence of the other soil-transmitted helminths (STH) in Vatomandry was unexpected, given the good coverage with benzimidazole in control campaigns. Further studies are needed to explore the risk factors for STH and S. stercoralis infections in Madagascar, in order to align with the WHO recommendations.

WHO recommendations on psychological interventions for mental disorders

WHO recommendations on psychological interventions for mental disorders

Was priority setting considered in COVID-19 response planning? A global comparative analysis

BackgroundThe COVID-19 pandemic forced governments across the world to consider how to prioritize resource allocation. Most countries produced pandemic preparedness plans that guide and coordinate healthcare, including how to allocate scarce resources such as ventilators, human resources, and therapeutics. The objective of this study was to compare and contrast the extent to which established parameters for effective priority setting (PS) were incorporated into COVID-19 pandemic response planning in several countries around the world. MethodsWe used the Kapriri and Martin framework for effective priority setting and performed a quantitative descriptive analysis to explore whether and how countries’ type of health system, political, and economic contexts impacted the inclusion of those parameters in their COVID-19 pandemic plans. We analyzed 86 country plans across six regions of the World Health Organization. ResultsThe countries sampled represent 40% of nations in AFRO, 54.5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to parameters of PS emerged by WHO region or country income levels. The parameters: evidence of political will, stakeholder participation, and use of scientific evidence/ adoption of WHO recommendations were each found in over 80% of plans. We identified a description of a specific PS process in 7% of the plans; explicit criteria for PS in 36.5%; inclusion of publicity strategies in 65%; mention of mechanisms for appealing decisions or implementing procedures to improve internal accountability and reduce corruption in 20%; explicit reference to public values in 15%; and a description of means for enhancing compliance with the decisions in 5%. ConclusionThe findings provide a basis for policymakers to reflect on their prioritization plans and identify areas that need to be strengthened. Overall, there is little consideration for explicit prioritization processes and tools and restricted attention to equity considerations; this may be a starting point for policymakers interested in improving future preparedness and response planning. Although the study focused on the COVID-19 pandemic, priority setting remains one of the policymakers’ most prominent challenges. Policymakers should consider integrating systematic priority setting in their routine decision-making processes.

Intake of Artificial Sweeteners through Soft Drinks in the Preschool- and School-Aged Population.

One of the main public health issues that has recently been observed in a greater number of children is being overweight. The cause certainly lies in the decreasing physical activity of children, but mostly in their eating habits. Soft drinks are recognized as the most significant contributor to body overweight due to high sugar content; thus, as a result of numerous campaigns, part of the sugar is replaced by artificial sweeteners (ASs). Despite their advantage due to their low caloric value, WHO recommends that they should not be used to achieve weight control or as prevention for reducing the risk of non-communicable diseases, as there is no evidence of their effectiveness. Apart from beverages, artificial sweetener combinations are also added to a variety of "low fat" and "high protein" food products, which are highly favored especially among the young population. Therefore, it is necessary to take care of the cumulative intake. The conducted study included a survey of 323 parents of children aged 1-14 years, as well as an analysis of the AS content in the products most often consumed by the respondents. The results of the survey show that a large part of children (40%) aged 3-14 often consume soft drinks. Different products (soft drinks, juices/nectars, syrups) were sampled based on the respondents' responses, and an analysis showed that 54% of them contained one or more ASs. In addition, the survey indicated parents' lack of information about the presence of AS in products, as 51% of parents declared that they do not read the declarations of the products they buy. It is necessary to persist in consumer education and changes in dietary preferences and habits, especially among children.

Prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia: a systematic review and meta-analysis.

Co-trimoxazole is used as a prophylaxis for human immunodeficiency virus (HIV) patients to prevent opportunistic infections. Its widespread use results in the emergence of co-trimoxazole resistance, which is a significant problem. This systematic review and meta-analysis determined the pooled prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to report this study. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the assigned number CRD42024532240. Article search was performed using electronic databases such as PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online. Data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of co-trimoxazole resistance across studies with a 95% confidence interval. The heterogeneity was checked using I2 statistic. The presence of publication bias was determined using a funnel plot and Egger's test with a p-value <0.05 evidence of statistically significant bias. Subgroup and sensitivity analyses were performed. Twenty-two studies with 5,788 HIV-infected individuals were included. The pooled prevalence of co-trimoxazole resistance was 61.73% (95% CI: 53.10-70.37%), with heterogeneity (I2 = 87.7%) and statistical significance (p < 0.001). A higher co-trimoxazole resistance was observed in HIV-infected individuals with urinary tract infection; 82.10% (95% CI: 75.03-89.17%). Among the bacterial spp., higher resistance to co-trimoxazole was observed in Escherichia coli; 70.86% (95% CI: 53.44-88.27%) followed by Salmonella spp.; 67.66% (95% CI: 41.51-93.81%) and Proteus spp.; 66.23% (95% CI: 34.65-97.82%). There is a higher prevalence of co-trimoxazole resistance in HIV-infected individuals in Ethiopia. This alarms WHO's recommendation of co-trimoxazole prophylaxis guidelines to review and update it. Additionally, a nationwide assessment of co-trimoxazole resistance in Ethiopia as a whole is required.Systematic review registration: identifier: CRD42024532240.