Search Results (4,021)

Environmental enteric dysfunction (EED) may be associated with poor cognitive and overall early child development (ECD) independent of linear growth. This may serve as an opportunity to improve ECD with water, sanitation, and hygiene (WASH) interventions. This study aimed to measure the association between EED and ECD amongst 119 infants aged 11–24 months from five villages in rural Wonosobo, Indonesia. Data collection at baseline (September–October 2024) and follow-up (February–March 2025) involved a quantitative questionnaire, anthropometric measurements, measurement of three EED stool biomarkers, alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO), and assessment of ECD using the Caregiver Reported Early Development Instruments (CREDI) z-scores for the cognitive and overall category performed at follow-up. Linear regression modelled the association between EED biomarkers and CREDI cognitive and overall z-score. The associations between MPO and ECD were generally weak and insignificant. MPO above the 75th percentile at baseline was associated with lower cognitive z-score (β = −0.63, 95% CI = −0.99 to −0.26, p < 0.001) but, at follow-up, was associated with higher cognitive z-score (β = 0.41, 95% CI = 0.03 to 0.79, p < 0.05). Associations between AAT and NEO with cognitive and development z-scores were not statistically significant. These findings show that the relationships between EED and early child development are complex and weakly explained by these biomarkers. Full article

University-based animal welfare organizations are grassroots actors involved in managing free-roaming dog and cat populations, yet their role remains poorly characterized, particularly in low- and middle-income countries. This study aimed to identify and describe animal welfare organizations operating within universities in Ecuador and to analyze their potential contributions within a One Health framework. A cross-sectional survey of 63 universities was conducted using publicly available information from institutional websites and social media platforms, complemented by semi-structured interviews with representatives of identified organizations. Organizations with evidence of activity through 2026 and a focus on dogs or cats were included. A total of 14 animal welfare organizations from 12 universities were identified, representing 19.0% of the universities analyzed. Most organizations were located in public universities (75.0%), and 28.6% were associated with veterinary-related programs. Thematic analysis of interview data (12 out of 14 organizations interviewed) revealed four key dimensions of organizational functioning: capacity and governance, animal care and population management, public health and community engagement, and institutional integration. Reported activities included animal rescue, sterilization campaigns, adoption initiatives, and community outreach, aligning with internationally recommended strategies for humane population management. Several organizations have extended their reach beyond campus boundaries through free veterinary intervention campaigns in rural communities, partnerships with municipal authorities, and collaboration with civil society networks, reflecting a broader public health role consistent with One Health principles. Despite their potential, these organizations face structural challenges, including high volunteer turnover, the absence of direct institutional funding, and limited formal integration into governmental frameworks. Institutional support, where present, is predominantly material rather than financial, placing the burden of sustainability on self-management mechanisms. Nonetheless, their embeddedness within academic environments positions them as strategic platforms for interdisciplinary collaboration, experiential training, and community engagement. This study highlights the need to recognize and integrate university-based animal welfare organizations into broader animal population management and public health strategies. Strengthening partnerships between academia, government, and civil society could enhance both animal welfare outcomes and zoonotic disease surveillance efforts in Ecuador and other low- and middle-income countries. Full article

Antimicrobial resistance is a growing global crisis that threatens to return humanity to a pre-antibiotic era where common infections become deadly. This narrative review synthesizes evidence from 2000 to early 2026, including Global Research on Antimicrobial Resistance data and World Health Organization surveillance, to outline the problem’s scale, drivers, and solutions. In 2019, bacterial resistance directly caused 1.27 million deaths and was linked to 4.95 million more. Low- and middle-income countries bear the heaviest burden. ESKAPE pathogens, especially carbapenem-resistant Acinetobacter baumannii and NDM-producing Klebsiella pneumoniae, drive intensive care unit mortality near 50% and cause untreatable neonatal sepsis. One Health drivers include antibiotic overuse in humans, with 30% of prescriptions unnecessary in high-income settings; agriculture, consuming 70% of global antibiotics; and environmental pollution, with resistance genes found in 72% of rivers. Bacteria spread resistance through horizontal gene transfer and mutations such as gyrA S83L, creating pan-drug-resistant strains that make surgeries, transplants, and cancer treatment risky. Economic modeling studies suggest that unchecked antimicrobial resistance could reduce annual global GDP by 1.1–3.8%, with some scenarios projecting losses of up to approximately 5% by 2050, depending on assumptions about healthcare costs, labor productivity, and livestock production. Solutions require subscription-based payment models, enforceable agricultural regulations, integrated genomic surveillance, and equity-focused diagnostics for low- and middle-income countries. Without binding 2030 targets, the post-antibiotic era would become a clinical reality within a decade. Full article

Background: Adolescents and young adults in Jordan experience high levels of psychological distress amid persistent stigma, limited mental health literacy, and shortages of specialist services. Although task-shared interventions have expanded access, their dependence on in-person delivery and sustained human resources constrains scalability. Guided digital interventions may extend reach, but evidence regarding their system integration and sustainability in low- and middle-income countries remains limited. Purpose: This study explored how the WHO-developed Scalable Technology for Adolescents and youth to Reduce Stress (STARS), a non-generative, rule-based chatbot intervention supported by trained e-helpers, was experienced and implemented in Jordan. It also examined the system-level tensions shaping its potential for sustainable scale-up. Methods: We conducted a qualitative multiple-case study nested within a randomized controlled trial of STARS in Jordan. Semi-structured interviews were conducted with 21 individuals, including STARS completers and non-completers, trained non-specialist e-helpers, a clinical supervisor, and policy and implementation stakeholders. Data were analyzed using a hybrid approach combining inductive thematic analysis with deductive coding informed by a system-innovation perspective and the culture–structure–practice framework. Results: Participants described STARS as culturally resonant, accessible, and adaptable to everyday life. Four recurring system-level tensions emerged: individualized support versus standardized protocols; privacy and anonymity versus institutional and parental trust; non-specialist support versus expectations for professionally qualified providers; and innovation within research settings versus integration into routine service systems. These tensions reflected competing priorities shaping implementation and perceptions of sustainable scale-up. Conclusions: STARS shows promise as a scalable guided digital mental health intervention for young people in Jordan. However, scale-up will require navigating recurring tensions across cultural, structural, and practice domains rather than addressing implementation barriers in isolation. This will require policy alignment, sustained investment in digital infrastructure and supervision, and cross-sector collaboration. Full article

Transmission of water, vector, and foodborne diseases tends to increase with climate variability, disproportionately affecting vulnerable communities. Globally, this dynamic contributes to adverse health outcomes in low- and middle-income countries such as Mozambique. Nevertheless, the influence of climate variability on disease patterns remains unclear. We assessed the potential relationship between climate variables and diseases, including diarrheal diseases, malaria, and malnutrition, in four districts around the Revuè sub-basin. An ecological, longitudinal, retrospective study conducted from 2016 to 2024 used secondary weekly disease data and annual malnutrition records. We applied a Generalized Additive Model framework to evaluate non-linear associations between climate factors and disease case counts. Our main findings showed that while higher maximum temperature was associated with increased cumulative malaria case counts, cumulative and heavy rainfall (~100 mm/week) was associated with decreased diarrheal disease case counts. Higher prevalence of moderate acute malnutrition is associated with a decrease in annual mean total precipitation (p = 0.0062). In contrast, higher prevalence of severe acute malnutrition is associated with a decrease in annual mean temperature (p = 0.0312). This study contributes to understanding climate variables associated with water, vector, and foodborne diseases, enhancing our understanding of factors contributing to overall food insecurity and affecting public health. Full article

Airborne fungal contamination poses an occupational health risk in environments where engineering-controls are essential for maintaining indoor air quality. However, evidence integrating assessments of engineering-control readiness and airborne fungal contamination in forensic pathology facilities remains limited, particularly in low- and middle-income countries. This study assessed engineering-control readiness, indoor environmental conditions, and airborne fungal contamination in three public forensic pathology facilities in Gauteng Province, South Africa, and explored factors associated with airborne fungal contamination. A cross-sectional occupational hygiene study was conducted in three public forensic pathology facilities. Engineering-control readiness was assessed using structured walkthroughs and summarised using a study-specific Engineering Control Readiness Index (ECRI). Indoor temperature, relative humidity, carbon dioxide (CO₂), and airborne fungal concentrations were measured concurrently. Duplicate fungal air samples were collected at predefined locations over three consecutive sampling days. For the primary regression analysis, duplicate fungal measurements were averaged within each physical sampling location and sampling day, yielding 54 indoor location-day observations from 18 physical indoor sampling locations. Multivariable log-linear regression included facility, functional work area, area-specific ventilation and environmental-control deficiency, temperature, relative humidity and CO₂, with cluster-robust inference accounting for repeated measurements within physical sampling locations. Overall ECRI scores ranged from 50.1% to 53.9%, with ventilation and environmental control representing the weakest domain. Airborne fungal concentrations differed significantly between facilities, with FPF G recording the highest indoor median concentration (740 CFU/m³). Cladosporium spp. and Penicillium spp. predominated. After adjustment for facility, functional work area and environmental conditions and accounting for repeated sampling, engineering-control deficiency was not independently associated with fungal concentration (adjusted change per 10-percentage-point increase: −16.3%; 95% CI: −70.9% to 140.9%; p = 0.727). Substantial engineering-control deficiencies and airborne fungal contamination were identified; however, the independent contribution of engineering-control deficiency could not be estimated with adequate precision in this three-facility study. Larger longitudinal studies incorporating objective ventilation-performance measurements are required to clarify the contribution of specific engineering controls to occupational bioaerosol exposure. Full article

Newborn screening (NBS) in Pakistan remains limited by fragmented service delivery, uneven provincial capacity, and the absence of an implementation pathway that links policy intent to operational planning. This study aimed to co-design a provincial NBS implementation framework for Punjab. To do so, we used a sequential blended workshop model supported by visual planning methods. We conducted a qualitative, three-phase co-design process with 19 participants from laboratory medicine, pediatrics, obstetrics, public health, academia, and policy. Phase I consisted of pre-work and an online workshop to establish a shared knowledge base and identify implementation barriers and enablers. Phase II used an in-person, visually facilitated planning workshop to translate these findings into a provincial NBS implementation framework. Phase III involved a asynchronous email-based review to refine the framework and reach consensus. Content analysis from Phase I identified five implementation domains: physical and technical infrastructure, operational systems, clinical integration, workforce and engagement, and governance and policy. In Phase II, these domains were translated into a visual implementation framework that specified priorities, stakeholders, risks, enablers, and action areas for phased rollout. Congenital hypothyroidism was identified as the most feasible entry-point condition. The final framework positioned NBS not as a stand-alone pilot, but as a coordinated provincial system requiring governance, financing, referral pathways, quality assurance, and workforce development. This study contributes an implementation-oriented model for moving from fragmented NBS initiatives to a provincial implementation framework in a low- and middle-income setting. It also offers a practical foundation for broader national scale-up. Full article

Adolescent mental health is a high priority in low- and middle-income countries (LMICs), yet perspectives may differ among youth and adult providers responsible for supporting mental health within schools. These differences may create challenges for designing contextually appropriate school-based preventive strategies. This qualitative study compared adolescent and school guidance and counseling coordinator (GCC) perspectives on factors influencing adolescent mental health and support in all 12 public senior high schools in Tamale, Ghana. GCC data were collected through semi-structured interviews informed by the Consolidated Framework for Implementation Research, and adolescent data was through human-centered design workshops. Data were analyzed using rapid qualitative analysis and organized using the Social Ecological Model. At the individual level, adolescents linked emotional distress, stress, and substance use to mental health challenges, whereas GCCs more commonly framed these as behavioral or academic challenges. At the interpersonal level, both groups identified peer relationships and confidentiality as important influences on help-seeking; adolescents emphasized trusted peer relationships, while GCCs described challenges implementing peer counseling approaches within schools. At the organizational level, adolescents emphasized teacher attitudes and punitive school responses to student distress, while GCCs emphasized staffing shortages, limited infrastructure, and insufficient institutional support. At the community level, both groups identified stigma and gendered social norms as barriers to mental health support. Adolescents and GCCs identified similar concerns but differed in how they understood adolescent mental health and support within schools. Integrating both youth and provider perspectives may strengthen multilevel school-based preventive strategies in resource-constrained settings. Full article

The pressures on human animal relations are growing and were recently addressed in the 4^th International Online Conference on Animals (IOCAN). IOCAN 2026, which took place online from the 17–19 March 2026, aimed to provide opportunities for its participants to share facts and engage in discussion, relying on evidence-based veterinary medicine, animal welfare science, ethics and biology, all under a comprehensive One Health approach. The main topics and sessions of the conference were Sustainable Animal Welfare, Ethics and Human–Animal Interactions; One Health: Disease Manifestation and Management in Animals, Humans, and the Environment; Sustainable Animal Nutrition; Animal Genetics and Genomics; Environmental Challenges to Animals and Precision Livestock Farming; Animal Physiology, Reproduction, and Sustainable Animal Production; and Aquatic Animals. Building on the success of previous IOCANs, this conference had more attendees and presenters than ever before. The conference, being online, provided an opportunity for scientists from around the world to discuss the latest developments in our relationship with animals, without the necessity for anyone to travel. This particularly benefited scientists from low-income countries and those without the means or desire to attend an in-person conference. The major messages to emerge from the conference were the interconnectedness of animals, the planet and people in a One Health approach, the need for urgent action to address intensive animal farming, and the importance of improving the sustainability of our relations with animals. Full article

Accurate and scalable driver performance assessment is critical for improving road safety and reducing traffic-related injuries and fatalities, particularly in low- and middle-income countries where the majority of global road deaths occur. This paper presents an exploratory proof-of-concept framework for automated driver evaluation that combines real-world dashcam footage, YOLOv8-based object detection, and multimodal large language models (MLLMs), specifically Gemini 1.5 Flash. Two prompting strategies, narrative and rule-based, were designed to assess driver behavior against standardized licensing criteria derived from the California Department of Motor Vehicles (DMV) driving performance evaluation score sheet. The framework was evaluated across 11 manually curated driving scenarios covering intersections, pedestrian crossings, stop signs, cyclists, and emergency vehicles. Ground-truth labels were established through consensus between two traffic engineering experts cross-referencing official California DMV evaluation criteria. In this preliminary evaluation, the rule-based prompt achieved higher agreement with ground-truth assessments (10/11 scenarios, 90.9%) compared to the narrative prompt (7/11 scenarios, 63.6%), particularly in detecting clear rule violations. The narrative approach demonstrated greater contextual flexibility in ambiguous situations. These results should be interpreted as preliminary, given the small sample size, manually curated dataset, and absence of large-scale statistical validation. Nonetheless, the findings illustrate how combining visual detection with structured language-model prompting may support interpretable, policy-aligned driver evaluation. Key limitations include dependence on video quality, limited scenario diversity, absence of temporal behavioral modeling, and reproducibility constraints tied to proprietary API behavior. Future work should expand validation to larger annotated datasets, incorporate temporal sequence modeling, and explore region-specific regulatory adaptation. Full article

Background: The Mediterranean diet (MD) has well-established health benefits, yet modern food systems are driving a nutrition transition. Quantifying how Mediterranean countries have shifted relative to global trends is essential for evidence-based public health. Aim: Dietary changes between 1990 and 2018 were examined in Mediterranean coastline countries (MED) in comparison with high-income non-Mediterranean countries (HIC non-MED) and middle-/low-income non-Mediterranean countries (MLIC non-MED). Methods: Using the Global Dietary Database, within-country changes (1990 vs. 2018) for 13 food categories were analysed across 185 nations in three groups: MED countries (n = 21), HIC non-MED (n = 18), and MLIC non-MED (n = 146). MED countries were further grouped into Southern Europe (SE), Western Asia (WA), and North Africa (NA). Paired unweighted country-level analyses were the primary analyses; population-weighted analyses were sensitivity checks. Benjamini–Hochberg’s false-discovery-rate correction and centred log-ratio compositional analysis were applied. Results: MED seafood intake rose from 20.5 to 33.8 g/day (Δ = +13.3 g/day; 95% CI: +6.2 to +18.4; q = 0.003), and non-starchy vegetables increased from 135.5 to 173.6 g/day (Δ = +38.0 g/day; q = 0.626). Refined/starchy carbohydrate intake rose by 63.3 g/day in MED countries while declining by 33.6 g/day in HIC non-MED countries (between-group divergence +96.9 g/day; q = 0.006). Nuts and seeds rose across all groups; legumes declined modestly in MED countries. Saturated fatty acids + omega-6 polyunsaturated fatty acids (% kcal) rose by +0.6 percentage points in MED countries but fell in HIC non-MED countries. Monounsaturated fatty acids were stable. MED-WA showed the greatest overall divergence from the SE 1990 pattern. Conclusions: These findings highlight a public health paradox: the MD is globally promoted as a model of healthy eating, yet adherence within its region of origin is declining. Targeted, region-specific strategies are urgently needed to preserve beneficial MD elements while addressing emerging diet-related risks. Full article

Objective: To investigate the burden of environmental enteric dysfunction (EED) and its association with water, sanitation, and hygiene (WASH) and linear growth amongst infants in rural Central Java, Indonesia. Study design: A longitudinal study of 119 infants aged from 5–19 months was conducted in five villages of Wonosobo District, Central Java, Indonesia. Infant length and weight were measured at baseline and 5-month follow-up and stool samples were collected for the investigation of alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO) levels. Linear mixed-effects regression (LMER) models estimated the associations between WASH and height-for-age z-score (HAZ) on biomarker concentrations. Results: Biomarkers increased from baseline to follow-up where AAT, NEO, and MPO were elevated in 68.7%, 79.0%, and 71.4% of infants. Breastfed infants and infants with recent diarrhoea had higher biomarker levels than non-breastfed infants. After correction for multiple testing, few significant associations between EED biomarkers and WASH variables or HAZ were detected. EED biomarkers measured at baseline or follow-up were not significantly associated with growth faltering over the follow-up period. In cross-sectional analysis, compared to infants at risk of stunting (−2 < HAZ ≤ −1), infants with HAZ > −1 had lower AAT at baseline (β = −0.43, 95% CI = −0.82 to −0.05, p_adj < 0.05). Conclusions: Elevated EED biomarker levels were frequently observed and had mixed associations with WASH and HAZ, highlighting the complexity of EED and need to understand EED etiology through intervention studies. Full article

In the context of growing international recognition of geospatial information as a strategic driver of evidence-based decision-making, digital transformation, and sustainable development, robust assessment frameworks are essential for guiding the development of National Spatial Data Infrastructures (NSDIs). This paper presents the first baseline assessment of Senegal’s NSDI using the United Nations Integrated Geospatial Information Framework (UN-IGIF). Drawing on the UN-IGIF Diagnostic Tool, supplemented by surveys, semi-structured interviews, and multi-stakeholder consultations, the analysis reveals a low overall maturity level (33/100), despite relatively better performance in institutional governance and geospatial data availability. Significant weaknesses persist in the areas of legislation, funding, standards implementation, innovation, partnerships, communication, and capacity building. The findings confirm the relevance of the UN-IGIF for assessing challenges related to geospatial governance in Francophone African countries and identify priority areas for reform, including strengthening coordination mechanisms, legal and regulatory modernization, sustainable financing, and strategic planning. By providing empirical evidence on both the NSDI maturity level and the operational applicability of the UN-IGIF, this study contributes to the international literature on geospatial governance and offers a solid foundation for future reforms in Senegal and other low- and middle-income countries. Full article

(1) Background: Brazil features one of the largest recycling workforces worldwide, with around 800,000 informal waste pickers, mostly living in urban areas of major cities and dealing with low income and precarious working conditions. This context of vulnerability may lead to a high risk of food insecurity, which may be associated with infectious diseases, particularly toxocariasis, a cosmopolitan neglected parasitic zoonosis with high seroprevalence in tropical countries. (2) Methods: Accordingly, this study assessed Toxocara spp. seropositivity and associated risk factors (including food insecurity) in recycling workers of Curitiba, a major Brazilian (fully urban) city currently ranked 8th in population with 1.83 million habitants, 7th in Gross Domestic Product (GDP), and 10th in Human Development Index (HDI) with 0.823 (very high), out of 5569 Brazilian cities. Recycling and non-recycling (used as population control) workers living in the same neighborhood were invited, voluntarily signed consent forms, and had blood serum samples collected and tested by ELISA for detecting anti-Toxocara spp. (IgG) antibodies; in addition, an epidemiological questionnaire (socioeconomic characteristics, owning dog/cat, food and hygiene habits) was applied. (3) Results: Overall, 95/177 (53.7%) recycling and 38/100 (38.0%) non-recycling workers tested positive by ELISA, with recycling workers more likely seropositive than non-recycling population (53.7% vs. 38.0%; OR: 1.89; 95% CI: 1.15–3.12%). Food insecurity (OR = 2.01, 95% CI: 1.04–3.91) and low (<1 minimum wage) monthly household income (OR = 3.03, 95% CI: 1.01–9.71) were associated with Toxocara spp. seropositivity by multivariate analysis. As expected, cohabitation with both dogs and cats was also significantly associated with seropositivity (OR = 3.75, 95% CI: 1.48–9.75). However, other assessed variables (gender, age, ethnicity, hygienic habits, contact with soil, raw meat ingestion) were not associated with seropositivity. (4) Conclusions: The study herein has filled a gap regarding toxocariasis in vulnerable populations and suggests food insecurity as a socioeconomic indicator for Toxocara spp. seropositivity in recycling workers. Furthermore, recycling workers are at higher risk of infection and, as such, need to be prioritized in healthcare programs. Full article

South Korea faces an imminent spent nuclear fuel (SNF) storage bottleneck that threatens reactor operations and the country’s low-carbon transition. Using data from a nationwide, stratified face-to-face survey conducted in late 2024, this study examines public acceptance of an interim SNF storage facility (ISF) in South Korea. The survey included 1000 adults aged 20–65. Public acceptance was measured using a 1–9 support scale. We investigate its associations with respondents’ socioeconomic, regional, and attitudinal characteristics using ordered probit and ordinary least squares specifications. Opposition (47.4%) exceeds support (35.4%). In the preferred baseline ordered probit model, acceptance is positively associated with residence in the Seoul Metropolitan Area, self-reported familiarity with SNF management, stated tariff-cost-sharing orientation, age, education, income, and household headship, and negatively associated with province-level residence in an area containing one or more NPPs and with life satisfaction. Partial ordinal models indicate that the statistical significance of Education, Income, and Satisfaction is not robust across specifications. This study is grounded in the broader literature on procedural fairness, information asymmetry, and distributive equity. Within this framework, the observed associations inform a set of policy considerations. These considerations span transparent risk communication, tariff-linked cost sharing, independent monitoring, and community-benefit arrangements. This nationally representative evidence informs sustainable SNF governance and practical regulatory design for maintaining electricity reliability during the energy transition. Full article