Search Results (140)

Background: Respiratory viral infections such as influenza, COVID-19, and respiratory syncytial virus (RSV) are considered as major public health threats in Africa. Despite global advancements in vaccine development, persistent inequities in access, delivery infrastructure, and public trust limit the continent’s capacity to control these diseases effectively. This review aimed at providing insights on challenges, efforts, impacts, and opportunities for the future related to vaccination against respiratory viral infections in Africa. Methods: This narrative review synthesizes the peer-reviewed literature and global health reports to examine vaccination efforts against respiratory viruses in Africa. The analysis focuses on disease burden, vaccine coverage, barriers to uptake, enabling factors, progress in local vaccine production, and strategies for integrating vaccines into national immunization programs (NIPs). Results: Respiratory vaccines have significantly reduced hospitalizations and mortality among high-risk groups in African countries. Nonetheless, key challenges, including limited cold chain capacity, vaccine hesitancy, donor-reliant supply chains, and under-resourced health systems, continue to undermine vaccine delivery. Successful interventions include community mobilization, use of mobile health technologies, and leveraging existing immunization platforms. Emerging initiatives in local vaccine manufacturing, including Rwanda’s modular mRNA facility and Senegal’s Institut Pasteur, signal a shift toward regional self-reliance. Conclusions: Maximizing the impact of respiratory vaccines in Africa requires a multifaceted strategy: integrating vaccines into NIPs, strengthening domestic production, expanding cold chain and digital infrastructure, and addressing sociocultural barriers through community-driven communication. These efforts are essential to achieving vaccine equity, health resilience, and pandemic preparedness across the continent. Full article

Background: Hansen’s disease or leprosy is one of the 21 neglected tropical diseases (NTDs). In Ecuador, leprosy is considered eliminated as a public health problem; however, new cases are reported annually. Additionally, Mycobacterium leprae infection was detected in nine-banded armadillos across the country, suggesting a potential zoonotic reservoir. This literature review aims to provide an updated overview of the epidemiological situation of leprosy in Ecuador, identify knowledge gaps, and outline research priorities to support the development of a comprehensive national strategy for achieving zero autochthonous cases. Methods: This article analyses the current situation of leprosy in Ecuador based on international and national publications. A retrospective literature search using five international, regional, and national publications on leprosy published between 1954 and 2024 (70 years) with no restriction on language or publication date, was performed. Findings: Our review identified 28 publications with the earliest article dating back to 1954. Of these, 14 were published in international journals, 15 (53.6%) were in Spanish. Four nationwide studies documented leprosy cases across Ecuador’s three continental regions (Coast, Andes, and Amazon) with a predominance in the tropical coast. No cases have been reported from the Galápagos Islands. From 1983, Ecuador started multi-drug therapy. Data from the Ministry of Public Health (MoH) system identified 1539 incident cases, showing a significant decline in new cases from 2000 to 2024, with no cases in children. New cases detection rate by 100,000 inhabitants was 0.51 in 2019 according to the World Health Organization (WHO). No study has genotyped the Mycobacterium spp. in human cases, other animal species, or environment. According to the MoH, multibacillary leprosy accounts for 78.95% of diagnosed cases, with confirmation based on Ziehl–Neelsen staining and histopathology. No survey has assessed disabilities, knowledge, attitudes, and practices (KAP) or stigma related to leprosy. Research is needed on transmission routes, Mycobacterium genotyping, genetic susceptibility, and antibiotic resistance. BCG vaccination coverage fell to 75.3% in 2021. Cases are currently diagnosed and treated on an outpatient basis in large hospitals. Conclusions: This comprehensive review highlights persistent gaps in leprosy research and critical information, despite seven decades of documented cases in Ecuador. The disease is still endemic across the country, particularly at subnational level in the subtropics and tropics of the Pacific coast and the Amazon. There is a need for nationwide epidemiological research on reservoirs and the environment applying the One Health concept. Increased laboratory facilities and readily available official data are required to improve our understanding of leprosy in Ecuador. Strengthening community-level efforts is essential for Ecuador to meet the targets of the “WHO’s Towards Zero Leprosy: Strategy 2021–2030.” Full article

Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of myelomeningocele (MMC; a severe form of NTD). This study sought to characterize the barriers influencing access to healthcare for children born with MMC in Zambia. Methods: Two cross-sectional surveys were administered to healthcare providers at referring public health facilities and mothers of infants born with MMC undergoing surgical closure. The survey among mothers was nested in a longitudinal study evaluating surgical closure in Lusaka, Zambia from 28 May 2024 to 21 January 2025. Results: Sixty-nine mother–MMC baby dyads and 123 providers from 21 facilities were enrolled in the study. The median age at presentation for MMC was 7.5 (range 0–244) days old. Most patients were referred from rural district hospitals (51%; n = 35) and travelled greater than 250 km to access care (80%; n = 55). Seventy-seven percent (n = 53) of mothers reported receiving at least one antenatal ultrasound, with 62% (n = 43) undergoing an ultrasound after 20 weeks estimated gestational age. Of these, only 3% (n = 2) received an MMC diagnosis prior to delivery. Referring patients with MMC for further care greater than six hours after birth was reported by 59% providers (n = 73). Hospitals further away from the tertiary center were more likely to report late referrals (p < 0.001). Conclusions: There is a delay in the diagnosis and referral of infants with MMC to specialized care in Zambia, which may be attributed to inadequate in utero diagnosis capabilities and distance from the tertiary facility. Improving the accuracy of prenatal diagnosis and strengthening referral pathways to facilitate access to care among infants with MMC in Zambia are important for improving incidence and outcomes. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

In recent decades, the River Ganges in India has been heavily contaminated with domestic waste and industrial toxins because of cultural activities, a lack of community awareness, an absence of sewage disposal facilities, and rapid population growth. Previous studies have focused separately on either the physical or social factors associated with River Ganges pollution but have not combined these elements in a single study. To fill this research gap, our study assesses the bio-physical and social vulnerability of the River Ganges by using a holistic approach. The following four sampling stations were selected: Rishikesh, Haridwar, Kanpur, and Varanasi. These locations were chosen to test the water quality in bio-physical aspects and to assess the social perceptions of river vulnerability among the residents and visitors. Perceptions of river water quality and likely sources of pollution were gathered via the distribution of over 1000 questionnaires. Data collection took place in the winter and summer of 2022 and 2023. The results showed that river water quality is not suitable for drinking purposes at any of the four cities without conventional treatment, and that the river is unsuitable for bathing at all locations, except upstream of Rishikesh. Nearly 50% of those questioned agreed that the river is polluted, whilst 74% agreed that pollution has increased in recent decades, particularly in the last 10 years. These compelling results are critical for policymakers and decision makers. They highlight the urgent need for novel strategies that address Ganges pollution while fostering community health education and environmental management. By dispelling myths surrounding river quality, this study strengthens the ongoing efforts to restore the Ganges, ensuring that it remains a vital lifeline for present and future generations. Full article

Background: The Baby-Friendly Hospital Initiative (BFHI) promotes, protects, and supports optimal breastfeeding through facility-based strategies. While prior studies have examined individual BFHI components in specific contexts, global evidence on its overall impact remains limited. This systematic review and meta-analysis aimed to evaluate the BFHI’s effectiveness in improving early initiation and exclusive breastfeeding practices worldwide. Methods: A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google for English-language studies. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-experimental designs assessing BFHI’s effect on breastfeeding outcomes. Random-effects meta-analysis models were used to estimate the pooled effects with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics and p-values. Study quality was appraised using the GRADE approach. Results: Thirty studies met the inclusion criteria. The BFHI was associated with increased early initiation of breastfeeding (pooled RR 1.43; 95% CI: 1.12–1.81; I² = 97.1%). Positive associations were also observed for exclusive breastfeeding at four months (RR 1.18, 95% CI: 1.08–1.29; I² = 61.7%) and at six months (RR 1.56, 95% CI: 1.14–2.14; I² = 82.8%). Substantial heterogeneity reflected variability in study design, BFHI implementation fidelity, and context. Conclusions: Our findings suggest that the BFHI is effective in improving breastfeeding practices globally. However, study variability and partial implementation may limit the generalizability of results. High-quality RCTs assessing full BFHI implementation are needed to strengthen evidence and guide global maternal–child health policy. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Background/Objectives: The COVID-19 pandemic presented unprecedented challenges to healthcare systems worldwide, significantly impacting individuals with chronic conditions who depend on continuous medical care. In Romania, the pandemic revealed systemic vulnerabilities, particularly in ensuring access to services for older adults and rural populations. This study aimed to assess perceived barriers to healthcare access and service quality among Romanian patients with chronic diseases and a confirmed history of COVID-19, within the framework of the country’s multi-tiered healthcare system. Methods: A cross-sectional study was conducted between January and March 2025, involving 16 adult participants diagnosed with at least one chronic illness. Data were collected using a 30-item questionnaire administered by the principal investigator after obtaining informed consent. The instrument explored access to services, challenges related to remote consultations, and satisfaction with nursing care. Descriptive and comparative analyses were carried out based on age group and area of residence. Due to the small sample size, the results are considered exploratory and context-specific. Results: Most participants reported disrupted access to healthcare services, especially within public sector facilities. Rural residents experienced longer delays in receiving care than those in urban areas. Digital health tools were perceived as barriers by 75% of respondents aged 60 and above, while younger participants adapted more easily. Overall satisfaction with nursing care was moderate to high (mean score: 3.56/5), with the highest ratings observed among patients aged 30–60 years. Conclusions: This study highlights significant barriers to healthcare access among Romanian patients with chronic illnesses and a confirmed COVID-19 diagnosis during the pandemic. The key challenges included digital exclusion and rural–urban disparities. The findings underscore the need for targeted strategies to enhance digital health literacy, adapt care delivery models, and strengthen healthcare system resilience in future public health emergencies. Full article

Biological invasions are one of the main causes of biodiversity loss globally, affecting the quality of ecosystem services, the economy, and public health. Research on the presence, distribution, impacts, and introduction pathways of invasive alien species is essential for understanding and tackling the invasion process. Continental, coastal, and marine aquatic ecosystems of the Yucatan Peninsula concentrate a high number of native species; however, the states that are in the region (Campeche, Yucatan, and Quintana Roo) also have the largest loss of natural capital at the national level. The presence of aquatic invasive species has contributed to this downward trend, mainly in protected areas. For this research, an analysis of the national biodiversity information system, the global biodiversity information facility, and the specialized scientific literature was carried out to determine the presence of aquatic invasive species within the protected areas of the Yucatan Peninsula and adjacent marine zone. The results indicated that there are 22 documented aquatic invasive species in 25 protected areas, which were classified into the following taxonomic groups: marine macroalgae (3 species), plants (2), inland and marine fish (11), crustaceans (2), mollusks (2), and hydrozoans (2). A total of 15 of these species had a very high invasiveness score, 6 had a high score, and 1 had a medium score. This research will be useful in strengthening regional public policy and guiding decision makers on the management of aquatic invasive species, mainly for those that are seriously affecting aquatic ecosystems, such as Pterygoplichthys disjunctivus and P. pardalis in freshwater protected areas and Pterois volitans in marine protected areas. Efficient management strategies will be a key element in the protection of biodiversity and ecosystem services, and for sustainable regional development. Full article

As individuals grow older, they experience notable shifts in their health conditions, social positions, and personal identity. Studies show that finding meaning in life correlates with healthier lifestyle choices and enhanced overall well-being. This sense of meaning functions as a protective factor against life’s challenges, strengthening resilience during later years. The research utilized thematic analysis within a qualitative methodology to investigate the subjective sources of meaning among elderly people living in Romanian institutional settings. The analysis revealed several interconnected themes. Religiosity and spirituality emerged as a fundamental anchor, with participants often mentioning God, Divinity, and Higher Power in their narratives. They typically conceptualized life as a sacred gift and emphasized the importance of religious practices such as prayer and church attendance as essential to their sense of purpose. The intergenerational transmission of values also proved significant, with elderly individuals finding meaning in passing down moral and spiritual principles to younger family members, viewing this as their enduring legacy. Interpersonal connections played a crucial role as well, with quality relationships with family and friends fostering a sense of belonging, while broken relationships or isolation negatively impacted well-being. Daily life objectives, including short-term goals like maintaining routines or anticipating family visits, along with preserving functional independence, provided structure and immediate purpose for many participants. The research distinguished between religiosity and spirituality as related but separate concepts: while formal religious rituals offered community-based meaning, those less engaged with organized religion discovered transcendence through personal spiritual experiences such as connecting with nature. This study highlights cultural specificities, particularly how Orthodox Christian traditions shape existential narratives among Romanian elderly, and proposes practical interventions for retirement facilities to incorporate activities focused on spiritual engagement, relationship building, and opportunities for elders to share their wisdom with younger generations. Full article

Residential green space (RGS), as a frequently visited green space by residents, is the main space for daily activities and interactions, and its quality directly affects residents’ physical and mental health. Although many studies have revealed the impact of green space characteristics on health, research on the relationship between its environmental elements and health is still insufficient. This study selected five types of residential area in the central urban area of Beijing for investigation, collecting people’s green space perception, usage, and self-rated health information, and, using stepwise regression analysis, exploring the impact of RGS environmental factors on residents’ self-rated health under different vegetation cover rates. The results suggest the following: (1) Residents’ perception and usage of RGS characteristics are closely related to their self-rated health status, but the impact of environmental factors varies depending on vegetation coverage. (2) Maximizing natural features and cultural symbols is crucial for residential areas with high greenery. In residential areas with moderate vegetation, priority should be given to enhancing path elements, maintenance and shelter. For residential areas with low greenery cover, efforts should focus on strengthening fitness facilities and improving shelter to promote people’s health. (3) The impact of activity duration on usage behavior is most significant. These findings contribute to a more comprehensive understanding of the significance of RGS quality in urban residential areas. They also provide a reference for the optimization and management of the living environment and support the sustainable development of community environments. Full article

The first 1000 days of life starts from conception to a child’s second birthday. Research suggests that the period is critical for cognitive, physical, and emotional development. Investments in maternal and child healthcare during this period have a profound impact on long-term health, educational attainment, and economic productivity. This study examined the impact of such investments on child health outcomes in Kenya, using data from the 2015/2016 Kenya Integrated Household Budget Survey (KIHBS). Key areas of focus included maternal healthcare, early antenatal care, skilled delivery, exclusive breastfeeding, proper weaning practices, immunization, and the timely treatment of childhood illnesses. Using the Cox regression hazard model, the study revealed that twins faced a higher risk of mortality compared to single births, while firstborns were less likely to die before their fifth birthday; larger household sizes were associated with reduced child mortality, and children in female-headed households had a lower likelihood of dying, likely due to better adherence to proper health and nutritional practices. Maternal health conditions, the place of delivery, and assistance during childbirth significantly influenced survival, with government health facility deliveries yielding better outcomes than homebirths. This study emphasizes the importance of educating pregnant women and mothers on health risks and public health protocols during this critical period. Strengthening healthcare systems and promoting equitable access to essential services during the first 1000 days could improve child survival rates and enhance long-term economic productivity. Full article

Biosecurity is essential in livestock farming to prevent the spread of diseases, ensure animal welfare, and maintain farm sustainability. In Portugal, small ruminant farms are predominantly extensive and small-scale, and most of them are familiar, especially in the northern and inland regions. Thus, biosecurity implementation on these farms is low due to factors such as an aging livestock farmer population, poor training, limited veterinary support, and economic constraints. This study, the first to assess biosecurity on Portuguese small ruminant farms, evaluated compliance levels and the influence of sociodemographic factors. A cross-sectional study was conducted between July 2023 and April 2024, through structured interviews with 276 farmers. A 32-question checklist covering nine biosecurity categories was used to assess compliance. The results revealed poor implementation of key biosecurity measures, particularly cleaning and disinfection, quarantine protocols, and visitor control. Inadequate premises infrastructure, including the absence of quarantine areas, isolation facilities for sick animals, and farrowing rooms, further hampered disease prevention. Compliance was influenced by farmers’ age, education level, herd size, and production. Larger farms, particularly dairy farms, demonstrated better biosecurity practices, likely due to better management and infrastructure. This study highlights the challenges of implementing biosecurity measures on small-scale, extensive farms and argues that standardized plans are ineffective. Instead, region- and farm-specific strategies are needed, considering the socioeconomic realities of farmers. Improving farmers’ education and access to veterinary services is crucial. Furthermore, public policies should provide financial incentives and educational programs to improve biosecurity without compromising farm viability. Strengthening biosecurity on small ruminant farms is vital to protecting animal and public health and ensuring the long-term sustainability of rural communities in Portugal. Full article

Background/Objectives: The outpatient healthcare experiences of patients with chronic diseases significantly impact disease management and quality of life. Patient satisfaction with healthcare services serves as a critical indicator of the responsiveness of healthcare systems and the advancement of patient-centered care. This study aimed to identify key factors influencing patient satisfaction and propose strategies for improvement. Methods: Using secondary data from the 2023 Healthcare Service Experience Survey (HSES), we analyzed patient satisfaction and its associated factors among respondents aged 15 years and older from households nationwide. Through multiple regression analysis and statistical testing, we examined the impact of the healthcare facility type, sociodemographic characteristics, and healthcare service experiences on satisfaction levels. Results: Information provided by physicians and nurses, communication with healthcare providers, and shared decision-making processes had a significant impact on patient satisfaction. Satisfaction levels were highest in hospitals and lowest in clinics. Older patients and those who discontinued treatment due to the financial burden reported lower satisfaction. Notably, information provided by nurses had the most substantial positive influence on satisfaction. Conclusions: Delivering patient-centered outpatient healthcare services is essential in improving satisfaction and health outcomes. Enhancing the service quality, reducing financial burdens, and adopting digital platforms to promote patient engagement are critical measures. These approaches will strengthen chronic disease management systems and contribute to improving the overall quality of life of the population. The entire study focused on outpatient care. Full article

Managing special pathogens cases, also known as high consequence infectious diseases, presents unique challenges for healthcare systems. It requires thorough planning and comprehensive operational protocols, as well as an appreciation of how human and organizational factors influence readiness. Based on the outcomes from a full-scale Ebola Virus Disease exercise at New York City Health and Hospitals (NYC Health + Hospitals), this paper presents a checklist of considerations to promote healthcare facility preparedness for special pathogens and to minimize gaps between protocol design and real-world implementation. This approach not only strengthens compliance with the new Joint Commission requirements but also provides a replicable framework for enhancing special pathogens preparedness within other healthcare systems. Full article