Search Results (408)

Background: Measles remains a major cause of morbidity and mortality among children in low- and middle-income countries (LMICs), despite widespread implementation of routine two-dose measles-containing vaccine (MCV) schedules. Serological assessment provides an objective measure of vaccine-induced immunity; however, evidence describing post-vaccination serological protection among children in LMICs remains fragmented and methodologically heterogeneous. Objective: To synthesize evidence on serological protection following routine two-dose MCV among children aged 1–5 years in LMICs and to identify determinants of immunity, methodological limitations, and evidence gaps relevant to immunization programmes. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and prospectively registered in PROSPERO (CRD420261300545). Literature searches were conducted in PubMed, MEDLINE, Scopus, Cochrane Library, CINAHL (EBSCO), and SciSpace on 21 January 2026. Two reviewers independently screened studies, extracted data, and assessed quality of evidence using Joanna Briggs Institute critical appraisal tools. Substantial clinical and methodological heterogeneity precluded meta-analysis; therefore, findings were synthesized narratively. Results: Eighteen studies met the eligibility. These studies were from 14 LMICs across four WHO regions (61.1% African Region, 27.8% Eastern Mediterranean Region, 5.6% each South-East Asia and the region of the Americas). Reported MCV seroprotection following completion of the two-dose schedule generally ranged from 30.6% to 100%, with the highest levels (87–100%), but with evident lower protection in specific settings, such as rural Pakistan (30.6%) and Ethiopia (40–54%) despite having documented vaccination records. Lower protection was consistently associated with undernutrition, human immunodeficiency virus (HIV) infection, incomplete or delayed vaccination, younger age at first dose, and weak programme performance. Considerable variability was observed in study design, vaccination schedules, laboratory assays (ELISA, PRNT, haemagglutination inhibition, and others), seroprotective thresholds, timing of antibody assessment, and participant characteristics. Risk of bias was largely moderate-to-high, and certainty of evidence ranged from low to very low. Conclusions: Routine two-dose measles vaccination generally provides substantial serological protection among children aged 1–5 years in LMICs. Nevertheless, methodological heterogeneity and geographical evidence gaps limit direct comparisons and reduce confidence in cross-study interpretation. Greater standardization of serological assessment and thresholds, harmonized reporting methods, and well-designed longitudinal studies are needed to strengthen the evidence base and support immunization policies aimed at achieving and sustaining measles elimination. Full article

Background/Objectives: Tanzania is a low-to-middle-income-country (LMIC) which endures significant adverse impact from HIV-1- and HPV-associated malignancies. We investigated the performance of visual inspection with acetic acid (VIA) compared to the Pap smear. Methods: Screening performance was assessed in a cross-sectional study design across rural catchment clinics in Bagamoyo and Chalinze, and an urban site, Ocean Road Cancer Institute (ORCI), in Dar es Salaam. Pap smears were performed and were read in triplicate by readers blinded to HIV status and patient demographic data. Blood samples were collected for HIV status confirmation. All cytopathology, VIA, and HIV status data were compared with patient demographic factors. Results: Here we present results from 672 patients. Analysis of participants across the cohort revealed a high rate of HIV (25%) and exchange of “sex for money” in the rural site of Chalinze. Bagamoyo and ORCI had slightly lower HIV rates of about 16% and 12%, respectively. Despite the high HIV rates in Chalinze (25%), there was a contrastingly low-level of detectable lesions by VIA (9%) in this region. Conclusions: Overall, VIA-positive cases were 26% HSIL-positive, whereas VIA-negative cases were 14% HSIL-positive, suggesting that performance of VIA is limited. Full article

Background/Objectives: Trauma remains a leading global cause of mortality and morbidity, particularly in low- and middle-income countries. Multitrauma patients often require intensive care and exhibit high mortality rates. Prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Revised Trauma Score (RTS) are widely used to predict outcomes; however, their performance in middle-income settings like Turkey has not been well established. This study aimed to evaluate the prognostic accuracy of APACHE II and RTS in predicting intensive care unit (ICU) mortality among multitrauma patients. Methods: This retrospective observational study was conducted in the General ICU of Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2022 and December 2024. Adult patients (≥18 years) with multitrauma involving at least two anatomical regions were included. Demographic data, clinical scores (APACHE II, RTS, Sequential Organ Failure Assessment [SOFA], Injury Severity Score [ISS], Trauma and Injury Severity Score [TRISS]), laboratory parameters, complications, and outcomes were recorded. Univariate and multivariate logistic regression analyses identified independent predictors of ICU mortality. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of prognostic scores. Results: A total of 145 patients were analyzed, with an ICU mortality rate of 13.1%. Non-survivors had significantly higher APACHE II (27 ± 4 vs. 13 ± 6, p < 0.001) and SOFA scores (7 [4–13] vs. 2 [1–6], p < 0.001) and lower RTS (4.2 ± 1.7 vs. 7.2 ± 1.1, p < 0.001). Acute kidney injury, sepsis, septic shock, and mechanical ventilation were more frequent among non-survivors (p < 0.01 for all). In multivariate analysis, APACHE II (odds ratio [OR]= 1.54, 95% confidence interval [CI] 1.16–2.04, p = 0.003) and RTS (OR = 0.36, 95% CI 0.16–0.81, p = 0.013) were independent predictors of ICU mortality. ROC analysis showed excellent prognostic performance for APACHE II (area under the curve [AUC] = 0.959) and RTS (AUC = 0.888). Conclusions: In this retrospective single-center cohort, APACHE II and RTS were independently associated with ICU mortality and demonstrated good discriminatory performance for early risk stratification in critically ill multitrauma patients. The lower mortality observed in our cohort should be interpreted cautiously, as it may also reflect differences in case-mix, injury severity, ICU admission practices, and referral patterns. These findings require external validation in larger multicenter cohorts before broader generalization. Future studies should also validate the identified cut-off values and further investigate the prognostic role of biomarkers such as procalcitonin. Full article

Background: Maternal anemia remains a major public health concern in low- and middle-income countries, including Indonesia, where access to hemoglobin and iron-status measurements remains uneven. Although non-laboratory screening cannot confirm anemia or iron deficiency, digital collection of anemia-related symptoms, clinical signs, nutritional indicators, and reproductive risk factors may support preliminary risk identification in settings with limited diagnostic capacity. This study aimed to describe the nationwide implementation of a digital composite anemia-risk checklist and to examine maternal, reproductive, and regional factors associated with screening-positive status among pregnant women in Indonesia. Methods: A retrospective cross-sectional study was conducted using secondary data recorded through the e-Nutri mobile application during routine antenatal care from February to April 2025. The analysis included 205,822 pregnant women recorded across all 34 Indonesian provinces. Screening-positive anemia-related risk was defined operationally as at least one positive response among ten checklist indicators. Associations between maternal age, gestational age, parity, birth spacing, geographic region, and screening-positive status were examined using Poisson regression with robust variance estimation to obtain adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Results: Overall, 65.3% of participants met the operational criterion for screening-positive anemia-related risk. Multiparity was associated with a higher prevalence of screening-positive status (aPR 1.20; 95% CI 1.19–1.21), as was a birth interval of less than two years (aPR 1.10; 95% CI 1.09–1.11). Screening-positive status was slightly less prevalent during the second and third trimesters than during the first trimester. Compared with Sulawesi, the adjusted prevalence was higher in Kalimantan and lower in Sumatra and Maluku–Papua. Although 91.6% of participants reported iron supplementation use, the available data did not measure dosage, duration, adherence, or biochemical response. Conclusions: Nearly 7 of 10 pregnant women are at risk of anemia. Digital symptom-based screening conducted at a national scale identified widespread maternal anemia risk and consistent associations with cumulative reproductive burden and regional context. This approach potentially offers an alternative complement to laboratory-based surveillance in resource-limited settings. Full article

Introduction: India’s immunization initiatives are among the largest globally, characterized by a substantial birth cohort of 27 million children annually, and have achieved significant progress in increasing coverage through the UIP. However, there are still challenges that persist, and multiple determinants contribute to the existing challenges; migration is one of them. Migration has always been a key driver of socio-economic and demographic changes, particularly in low and middle-income countries (LMICs). Specifically, there is a need to better understand the vulnerabilities of immunization among recent migrants. To examine this, the study explores the association between a mother’s recent migration and the full immunization coverage of children aged 12–23 months in India. Data & Methods: Our study utilized data from the National Family Health Survey-5 (2019–21). The outcome variable of interest in this study is the full immunization among children aged 12–23 months (receipt of all basic vaccinations). The primary predictor variable in this study was recent maternal migration, defined as the mother’s duration of residence at the current place of residence. We used a series of multivariate logistic regression models to examine the relationship between full Immunization among children and maternal migration status, with some data restrictions in the models. Results: The results show a 17 percentage-point difference in full immunization between children of migrant and non-migrant mothers. The adjusted odds ratios of children of mothers who had recently migrated had significantly lower odds of full immunization (aOR: 0.39, 95% CI: 0.35–0.43) compared to children whose mothers had not recently migrated. Even across the household wealth quintile and social groups, the recent migration of the mother was associated with being less likely to be fully immunized among children 12–23 months. Conclusions: The findings of this study provide significant quantitative evidence that recent migration (less than 3 years) of mother is a key factor influencing Immunization coverage and is a predictor of full immunization among children aged 12–23 months in India. The recent migration was consistently linked with lower odds of full immunization coverage across different household wealth levels and social groups. This study suggests that children of recently migrated mother are a vulnerable subgroup of the population at risk of not receiving full immunization among children aged 12–23 months. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Background/Objectives: Chronic low back pain (CLBP) is the leading global cause of years lived with disability, but long-term real-world evidence for non-surgical management remains scarce, particularly in low- and middle-income countries. This study aimed to describe 5-year trajectories of pain, disability, healthcare utilization, patient satisfaction, and surgical conversion among patients with non-specific CLBP initially managed non-surgically at a tertiary spine center in Northwest China. We also compared long-term outcomes between unimodal therapy and multidisciplinary biopsychosocial care and examined baseline demographic, clinical, and psychosocial predictors of treatment success and conversion to surgery. Methods: We conducted a 5-year retrospective cohort study of consecutive patients with non-specific CLBP at a tertiary spine center in Northwest China. Of 485 consecutive patients screened for eligibility, 420 were enrolled and were compared on the basis of unimodal therapy with multidisciplinary biopsychosocial care. Primary outcomes were pain (Numerical Pain Rating Scale, NPRS) and disability (Oswestry Disability Index, ODI), analyzed using linear mixed-effects models; predictors of surgical conversion were identified via multivariable Cox regression. Results: Of the 420 patients, 352 (83.8% retention) completed the 5-year follow-up. Both pain and disability improved substantially during the first 12 months. Thereafter, pain intensity increased slightly (NPRS from 4.8 to 5.4), whereas functional disability continued to improve (ODI from 31.7 to 26.5). Early multidisciplinary care was associated with sustained superior outcomes (adjusted functional disability (ODI) difference: −8.2 points at 5 years) and a 42% lower observed risk of surgery (HR = 0.58). The cumulative 5-year surgical rate was 14.2%, with high pain catastrophizing as the strongest independent predictor (HR = 3.10). Conclusions: In patients with non-specific CLBP, non-surgical management yields substantial 12-month gains; function continues to improve through 5 years, while pain shows partial recurrence. Early multidisciplinary biopsychosocial care was associated with more durable outcomes and lower surgical conversion; because treatment was not randomized, these associations warrant confirmation in pragmatic trials and support routine psychosocial screening and stratified care. Full article

Oral, live-attenuated rotavirus vaccines (ORVs) have significantly reduced severe diarrheal disease and deaths; however, vaccine performance in low- and middle-income countries (LMICs) remains lower than in high-income countries. With increasing global use, real-world data now provide important insights into strategies to improve vaccine impact in these settings. This review summarizes current evidence on the effectiveness and impact of ORVs in LMICs, with a focus on approaches to optimize performance, including alternative dosing schedules, booster doses in late infancy, and mixed vaccine regimens. Evidence on vaccine interchangeability offers practical solutions for countries facing supply disruptions and financial constraints. The review also highlights the growing importance of economic sustainability, particularly in the context of transitions from external funding support. Despite lower efficacy, ORVs continue to provide substantial public health benefits in LMICs. Sustained impact will depend on strengthening programme delivery, ensuring stable vaccine supply, and advancing next-generation vaccines. Continued evaluation of effectiveness, cost, and implementation strategies will be critical to maximizing long-term benefits in high-burden settings. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly in low- and middle-income countries. Although elevated cholesterol is a well-established modifiable risk factor for atherosclerotic CVD, the phenomenon known as the “cholesterol paradox” has raised uncertainty regarding the prognostic significance of admission cholesterol levels in patients with acute coronary syndrome (ACS). Therefore, this study aimed to evaluate the association between admission total cholesterol (TC) levels and in-hospital mortality among patients with first-episode ACS. Methods: Data were obtained from the National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry, where this cross-sectional study implemented a consecutive sampling of the nationwide ACS patient database for eligible records from January 2006 to December 2015. The patients were then classified into quartiles according to their TC levels, with the corresponding all-cause in-hospital mortality considered the outcome. Following adjustments for potential confounding factors, multilevel analysis ensued to determine the association between cholesterol groups and mortality. Results: The quartile two (Q2) group (4.50–5.36 mmol/L) was employed as the reference for this study. From the 16,860 ACS cases (mean age = 54.1 years; 83.9% male) analysed, which included 648 in-hospital fatalities, lower cholesterol levels were linked to higher mortality rates, except among patients with unstable angina. Interestingly, patients with non-ST-segment elevation myocardial infarction (NSTEMI) demonstrated a U-shaped trend. The results also revealed adjusted odds ratio (OR) for mortality (95% CI: 1.15–4.03) for Q1 at 2.15 (2.00–4.49 mmol/L), 2.01 (95% CI: 1.01–3.98) for Q3 (5.37–6.25 mmol/L), and 2.15 (95% CI: 1.08–4.26) for Q4 (>6.25 mmol/L), suggesting an increased mortality among patients with low and high cholesterol levels. Conclusions: Among first-episode ACS patients, both low and high cholesterol levels were associated with increased in-hospital mortality. A significant U-shaped relationship was observed among NSTEMI patients. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. Full article

Background: Empiric antibiotic prescribing is frequently used in low- and middle-income countries because microbiological diagnostic capacity is often limited, highlighting the need for locally generated microbiological data to support evidence-informed empiric antibiotic selection. However, data on pediatric antibiotic prescribing practices in Mozambique remain scarce. This study aimed to characterize empiric antibiotic prescribing among hospitalized pediatric patients at Maputo Central Hospital prior to the implementation of a syndromic antibiogram intervention. Methods: An exploratory, retrospective, descriptive baseline analysis was conducted among pediatric patients aged 1 month to 14 years admitted with suspected bacterial infections between January and December 2023, prior to the implementation of a syndromic antibiogram intervention. Sociodemographic, clinical, microbiological, and antibiotic prescribing data were extracted from clinical records. Antibiotics were classified according to the WHO AWaRe framework, and associations between patient characteristics, treatment strategies, and outcomes were analyzed using R software version 4.6.0. Results: A total of 358 pediatric patients were included, with a median age of 14 months (IQR: 6–48), and 57% were male. Lower respiratory tract infections were the most frequent diagnosis. Empiric treatment predominated, accounting for 89% of cases, whereas microbiologically guided therapy was observed in only 11%. Urinary tract infections showed significantly higher proportions of microbiologically guided treatment compared with respiratory infections (p < 0.001). Monotherapy predominated, while Watch antibiotics accounted for 64.7% of prescriptions. Prolonged hospitalization was associated with respiratory distress, decreased skin turgor, referral status, infection type, and anemia. Conclusions: Pediatric antibiotic prescribing was characterized by extensive empiric therapy and high Watch antibiotic use, highlighting important antimicrobial stewardship challenges in Mozambique. Full article

Green ODA supports renewable energy and low-carbon structural transformation. Limited studies have explicitly evaluated whether Green ODA reduces emissions or examined the structural conditions that enable climate-oriented aid to produce meaningful decarbonisation outcomes. In this study, we examined the relationship between Green ODA and carbon dioxide emissions and investigated whether this relationship differs across the stages of renewable energy transition. Using annual panel data for 63 developing countries selected from the OECD Development Assistance Committee (DAC) List of ODA Recipients, including low-income, lower-middle-income, and eligible upper-middle-income economies, between 2010 and 2021, a dynamic panel threshold regression model was employed, with renewable energy consumption as the threshold variable. Renewable energy consumption was significantly associated with lower carbon emissions. However, the effects of Green ODA varied depending on the level of renewable energy development. The estimated threshold value for renewable energy consumption was 78.2%. When renewable energy consumption remained below this threshold, Green ODA was associated with increased carbon emissions. Following threshold exceedance, the effect became negative, although it remained statistically insignificant. These findings suggest that the relationship between Green ODA and carbon emissions differs across the stages of renewable energy transition in recipient countries. Full article

Background/Objectives: Obesity-related inflammation may disrupt iron homeostasis and increase the risk of iron deficiency, yet evidence among women in low- and middle-income countries remains limited. This study examined the independent association between overweight/obesity and iron status among Indonesian women of reproductive age. Methods: A case–control study was conducted among 340 nonpregnant women aged 20–29 years in Surabaya, Indonesia. Sociodemographic, dietary, menstrual, and anthropometric data were collected alongside venous blood samples. Logistic regression models were used to examine associations between adiposity measures and iron deficiency (ID), anaemia, and iron deficiency anaemia (IDA), adjusting for potential confounders. Results: Inflammation-adjusted serum ferritin was significantly higher among women with overweight/obesity than among normal-weight women (22.39 ± 21.7 vs. 17.78 ± 17.6 µg/L; p = 0.033). Consistent with this, the prevalence of ID was lower among women with overweight/obesity, likely reflecting inflammation-related ferritin elevation that may influence diagnostic classification. BMI-defined overweight/obesity was not independently associated with ID, anaemia, or IDA. In contrast, higher body fat percentage was inversely associated with ID (AOR 0.93; 95% CI 0.86, 0.99) and IDA (AOR 0.86; 95% CI 0.75, 0.99). Elevated alpha-1-acid glycoprotein (AGP) was independently associated with higher odds of IDA, and menstrual iron loss was an independent predictor of anaemia and IDA. Conclusions: BMI alone is insufficient to capture the relationship between adiposity and iron status in women of reproductive age. Body fat percentage appears to be a more sensitive indicator of adiposity-related iron risk. These findings suggest that inflammation associated with adiposity may alter iron biomarkers, and reliance on BMI alone may obscure the true burden of iron deficiency in this population. Full article

This study empirically investigates the factors affecting macroeconomic stability across 79 countries spanning low, lower-middle, upper-middle, and high-income groups, using data from 2000 to 2023. A Macroeconomic Stability Index was constructed using a z-score method combining inflation rate, inflation volatility, government budget balance, and current account balance. Econometric analysis employed Pesaran CD, CIPS unit root, and Westerlund cointegration tests. Long-run coefficients for the low-, lower-middle-, and upper-middle-income groups were estimated using CCEMG, whereas the high-income group was examined using a stationary short-run FE–DK model. Independent variables included per capita income, trade openness, natural resource rents, financial development, institutional quality (control of corruption and government effectiveness), and public debt. The results indicate income-group-specific associations with macroeconomic stability. In the long run, trade openness is negatively associated with MSI in the upper-middle-income group, while public debt has a negative association in the lower-middle-income group. Given the small low-income sample and the variation across specifications, we treat the negative FD and INST coefficients as exploratory. In the high-income short-run model, public debt is negatively associated with MSI, while financial development displays a weaker negative association. In the short-run pooled interaction model, changes in natural resource rents are positively associated with MSI in the lower-middle-income group at the 10% level and in the upper-middle- and high-income groups at the 1% level. Coefficient equality across income groups is rejected at the 10% level (p = 0.058), whereas the long-run natural-resource-rent coefficients remain statistically insignificant. System-GMM primarily confirms strong MSI persistence. Taken together, the results provide no general evidence of a resource curse or of a stabilizing role for public debt across income groups. Policy implications should therefore be considered separately for each income group. Full article

The World Health Organization targets hepatitis C virus (HCV) elimination as a public-health threat by 2030. Phetchabun province, in lower northern Thailand, has historically reported one of the country’s highest HCV seroprevalence rates. We describe a province-wide, decentralized test-to-treat micro-elimination program implemented within Thailand’s universal health-coverage system. Adults aged 35–64 years (2020–2024) and individuals born before 1992 (late 2023) across all 11 districts were screened using fingerstick anti-HCV rapid diagnostic tests at sub-district health-promoting hospitals. Reactive participants underwent confirmatory HCV-RNA testing at three regional nodes. Eligible patients received pangenotypic sofosbuvir/velpatasvir for 12 weeks, with ribavirin added for cirrhosis. Sustained virological response at 12 weeks post-treatment (SVR12) was the primary outcome. Of 400,567 targeted individuals, 389,547 (97.3%) were screened; 18,340 (4.71%) were anti-HCV reactive. Confirmatory HCV-RNA testing was completed in 14,845 (80.9%), of whom 10,996 (74.1%) had active infection. Of 8961 treatment-eligible patients, 8842 (98.7%) received DAA therapy. Among 6719 evaluable for SVR12, 6474 (96.4%) achieved cure. This simplified, domestically financed, decentralized test-to-treat model achieved WHO-target-level diagnosis, treatment, and cure rates at provincial scale, offering a scalable framework for HCV micro-elimination in low- and middle-income countries. Full article