Annals of Global Health Feed

Post‑Measles Complications and Mortality in Children under Five Years in Low‑ and Middle‑Income Countries: A Narrative Review

Mon, 26 Oct 2026 00:00:00 GMT

Background: Global measles vaccination programs have achieved significant reductions in measles‑related mortality, with World Health Organization (WHO)‑led initiatives expanding vaccine coverage to over 85% of children worldwide. Despite this progress, measles elimination remains elusive, undermined by anti‑vaccine sentiment, armed conflicts, migration, refugee crises, and post‑COVID‑19 disruptions. No WHO region has achieved or sustained measles elimination status since the COVID‑19 pandemic, and elimination remains challenging in resource‑limited and conflict‑affected contexts. A critical yet underappreciated consequence of this ongoing burden is the rise of post‑measles complications (PMCs). Vaccine‑preventable diseases and malnutrition constitute two critical global health priorities; PMCs represent an important intersection of these agendas that warrant greater attention within the global health framework. Objectives: To review and synthesize current epidemiological evidence on PMCs, examine their pathogenesis, and understand the need for integrated post‑measles care strategies in vulnerable populations. Methods: This narrative review included all papers that published primary data on any of the PMCs in the last 55 years, identified through PubMed and Google Scholar. Findings: Epidemiological data show that 30–40% of measles cases in low‑ and middle‑income countries (LMICs) develop complications, including pneumonia, diarrhea, otitis media, and, less commonly, encephalitis and ocular disease. PMCs are frequently misattributed to independent illnesses because they often emerge after a delay following the acute infection. Compounding this, measles‑induced immune amnesia renders affected individuals vulnerable to secondary infections for up to 2–3 years post‑infection. In LMICs and conflict‑affected settings, this prolonged immunological vulnerability intersects with pre‑existing risk factors such as malnutrition, micronutrient deficiencies, and poor healthcare access, which amplify the consequences substantially. Conclusions: As measles cases resurge globally, the associated burden of PMCs is expected to increase correspondingly. Where PMCs represent a pressing, underaddressed concern, integrated post‑measles care strategies are urgently needed from a global health perspective, especially in resource‑limited and conflict‑affected settings.

Mixed Training Team Implementation of the Basic Emergency Care Course in Liberia

Fri, 16 Oct 2026 00:00:00 GMT

Background: The Basic Emergency Care (BEC) course was developed to improve the management of acute illness and injury in resource‑limited settings. Although BEC materials are freely available, formal instructor credentialing requires time and resources that may limit rapid implementation. In remote areas, such as Maryland County, Liberia, innovative approaches to BEC training are needed. Objective: To evaluate the effectiveness of a BEC course delivered by a mixed instructor team consisting of credentialed and non‑credentialed facilitators in improving emergency care knowledge and self‑efficacy among healthcare providers in Liberia. Methods: We conducted a mixed‑methods evaluation of two consecutive five‑day BEC courses held in Maryland County, Liberia, in August 2022. Course participants included physicians, medical interns, physician assistants, and nurses. The instructional team included one credentialed BEC Registered Facilitator and four non‑credentialed physician specialists. To promote course fidelity, instructors completed an independent review of course materials, participated in a two‑day pre‑course preparation workshop, and conducted daily planning and debriefing sessions throughout the training. The effectiveness of this model was evaluated by measuring improvements in participants’ emergency care knowledge and confidence using pre‑ and post‑course examinations and self‑efficacy surveys. Findings: Participants demonstrated significant improvements in emergency care knowledge, with examination scores increasing from 64.0% pre‑course to 86.6% post‑course (P < 0.001). Self‑efficacy surveys also showed substantial gains in participants’ comfort, confidence, and preparedness to manage critically ill and injured patients. Structured instructor preparation and ongoing coordination supported consistent course delivery despite the mixed facilitator model. Conclusions: A BEC course delivered by a mixed team of credentialed and non‑credentialed instructors significantly improved emergency care knowledge and self‑efficacy among Liberian healthcare providers. This pragmatic, resource‑conscious approach may offer a scalable strategy for expanding access to BEC training in remote settings while maintaining course quality and educational effectiveness.

International Research Collaboration Supported by the U.S. National Institutes of Health: An Analysis of Coauthor Country Affiliations – 2014–23

Fri, 16 Oct 2026 00:00:00 GMT

Importance: International collaboration is a critical component of biomedical and behavioral health research, but recent trends in its extent and impact in research funded by the U.S. National Institutes of Health (NIH), the world’s largest funder of health research, are not well characterized. Objective: To characterize the extent and scientific impact of international collaboration in NIH‑funded research from 2014 to 2023. Design, setting, and participants: Bibliometric analysis of NIH‑funded publications from 2014 to 2023 using the InCites Analytics database (Clarivate, London, UK). Main outcomes and measures: Publication counts and author country affiliations for NIH‑funded publications from 2014 to 2023 and scientific impact measured by Category Normalized Citation Impact (CNCI) for publications in 2023. Results: The average annual number of NIH‑funded publications from 2014 to 2023 was 112,633; this declined by 25.1% from 2021 to 2023. In 2023, 68.1% of publications had U.S.‑affiliated authors only, 27.4% had both U.S.‑ and non–U.S.‑affiliated authors, and 4.5% had non–U.S.‑affiliated authors only. Overall, 31.9% of NIH‑funded publications had non–U.S.‑affiliated coauthors in 2023, a decline from a peak of 34.1% in 2018. Although CNCI values are not directly comparable across groups, publications with both U.S.‑ and non‑U.S.‑affiliated authors had a higher scientific impact (CNCI = 1.48) than those with U.S. authors only (1.32) or non‑U.S. authors only (1.44). Conclusions and relevance: International collaboration is a substantial component of NIH‑supported research and is associated with higher citation impact. Nearly one‑third of NIH‑funded publications included non–U.S.‑affiliated coauthors, and these publications demonstrated higher citation impact than those with U.S.‑affiliated authors only, supporting the importance of global collaboration in biomedical research.

Cost-Utility and Clinical Impact of a Multicomponent Maternal Safety and High-Dependency Care Model in Three Colombian Caribbean Hospitals: A Before-and-After Study

Fri, 16 Oct 2026 00:00:00 GMT

Background: Obstetric high‑dependency units may improve rescue care when embedded within broader maternal safety strategies. Objective: To evaluate a multi‑component maternal safety and technological strengthening model, including obstetric high‑dependency capacity, across three Colombian Caribbean institutions with different governance models. Methods: We conducted a multisite before‑and‑after implementation evaluation within a Ministry‑funded maternal safety project. The model was implemented in one private clinic and two public hospitals in La Guajira and Bolívar, Colombia, with staggered implementation and varying data maturity. Data sources included billing records, administrative databases, and monthly quality indicators. Costs, severe maternal morbidity indicators, and longitudinal quality metrics were analysed by institutional implementation window. Pandemic‑period variation from 2018 to 2023 was treated descriptively. Interrupted time series analyses were performed where post‑implementation data allowed. Findings: Implementation was associated with heterogeneous but generally favourable patterns. At Clínica CEDES, costs increased after implementation, while intensive care utilisation and several severe maternal morbidity indicators declined. At ESE Hospital San José de Maicao, mature post‑implementation economic and conventional pre/post‑clinical comparisons were unavailable; however, interrupted time series analyses showed favourable changes in longitudinal quality indicators, including reductions in weighted adverse outcome score (WAOS) level (β = −8.30, P = 0.0016) and slope (β = −1.20, P = 0.0064), adverse outcome index (AOI) level (β = −1.13, P = 0.0032), and severity index (SI) slope (β = −0.27, P = 0.030). ESE Hospital La Divina Misericordia showed mixed early clinical signals and descriptive quality improvement, but follow‑up was limited. Conclusions: A multi‑component maternal safety model including obstetric high‑dependency capacity may improve maternal care in high‑risk settings, although effects vary by institutional context. High‑dependency units appear most effective as part of an integrated rescue system rather than isolated infrastructure.

Chronic Non-Communicable Disease Burden among Recently Arrived Refugees in Syracuse, New York

Thu, 15 Oct 2026 00:00:00 GMT

Background: Refugees resettling in the United States often come from regions with limited healthcare infrastructure. While communicable diseases are routinely screened for, non‑communicable diseases (NCDs), including hypertension and diabetes mellitus, remain underrecognized. Lifetime adverse events contributing to chronic stress further increase cardiovascular disease risk in refugees. Objective: To evaluate the chronic disease burden of blood pressure measurements in the hypertensive range and point‑of‑care capillary glucose values in the prediabetic and diabetic ranges among refugees arriving in Syracuse, New York and to examine how a community‑based health screening program informs current U.S. refugee screening practices. Associations between elevated cardiometabolic measures (blood glucose, blood pressure, and heart rate) and demographic and clinical characteristics are explored. Methods: We conducted a retrospective cross‑sectional analysis of health screening data collected from recently arrived adult refugees in Syracuse, New York, between May 2023 and March 2025. Health screenings were conducted within the first few months of arrival and were offered to refugees aged 18 and older, with 529 total participants. Findings: Participants were 55.8% female, with 69.8% of participants between 18 and 44 years old. Predominant regions of origin included the Eastern Mediterranean region (39.3%, including Somalia 14.2%, Syria 13.2%), the African region (36.1%, including Democratic Republic of Congo 17.8%), and region of the Americas (12.5%, including Venezuela 7.0%). Elevated heart rate was associated with glucose values in the diabetic range and gender. Glucose values in diabetic range were associated with blood pressure and age. Blood pressure was associated with age, gender, and BMI. Conclusions: Our refugee cohort showed a notable burden of undiagnosed NCDs, including hypertension and hyperglycemia in the prediabetic/diabetic ranges. Statistically significant associations between cardiometabolic risk factors, including increased BMI, age, and gender, with chronic diseases underscore the need for continued interventions to improve access and uptake of preventive health services for refugees.

Advancing Equity for Global Health Author Teams within the Publishing Ecosystem

Wed, 30 Sep 2026 00:00:00 GMT

The global health literature reflects the need to restructure systems that balance power, remove financial barriers, and ultimately enhance equity, but immediate strategies to enhance equity are often underappreciated, particularly with regard to navigating the publishing ecosystem. Our paper describes how researchers can navigate the publishing ecosystem to create greater equity within their author teams, including those related to communication, supporting junior investigators in building their writing and professional skills, selecting journals that prioritize equity, ensuring transparent recognition of all contributors, and understanding institutional requirements for professional advancement. We also suggest changes in the publishing ecosystem to further enhance equity related to the presentation and recognition of joint authorship, developing a system for identifying predatory journals, and how publishing agreements might better promote equity in authorship. Our advice can help research teams position themselves to achieve greater equity among themselves. Additionally, our suggested changes to the publishing ecosystem will encourage future efforts toward equity.

The Role of Greenness in Heat‑Related Mortality: A Systematic Review and Meta‑Analysis

Fri, 25 Sep 2026 00:00:00 GMT

Background: Rising temperatures and the frequency of heat waves are challenges that have an impact on the health and mortality of populations. A high level of greenness is emerging as a strategy to mitigate the effects of extreme heat. Objective: To assess whether higher levels of greenness are associated with reduced mortality compared with lower greenness during periods of extreme heat. Methods: In this systematic review and meta‑analysis, we searched MEDLINE, SCOPUS, WEB OF SCIENCE, CINHAL, Environment Complete, and GreenFILE. Observational studies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated via a random‑effects model. Results: The systematic review and meta‑analysis included 11 articles. These cover data from China, France, Germany, Jordan, Switzerland, and the USA, as well as a global analysis covering 24 countries. The meta‑analysis suggested that heat waves significantly increased mortality in areas with the lowest greenness (RR = 1.33; 95% CI: 1.15–1.55; I2 = 99.4%) and in areas with the highest greenness (RR = 1.18; 95% CI: 1.03–1.36; I2 = 97.9%). The pooled ratio of RR (RoR) indicated that the association was significantly stronger in low‑greenness areas than in high‑greenness areas (RoR = 1.11; 95% CI: 1.06–1.15; I2 = 90.5%), indicating that the heat–mortality association was 11% stronger in low‑greenness areas. The pooled associations varied descriptively across subgroup analyses, although no statistically significant differences were observed between geographical regions or study settings. Conclusion: Higher temperatures were associated with increased mortality in both low‑ and high‑greenness areas; however, the heat–mortality association was 11% stronger in low‑greenness areas. These findings suggest that greater greenness may attenuate vulnerability to extreme heat, although the limited evidence base and considerable between‑study heterogeneity warrant cautious interpretation.

Integrating Community Health System Activities and Participation into the Primary Healthcare System for Ensuring Effective Community Participation and Achieving Health Goals in Nigeria

Fri, 18 Sep 2026 00:00:00 GMT

Introduction: In Nigeria, communities have long organised health and social actions that address local needs but remain weakly integrated into the formal primary healthcare (PHC) system. Understanding these approaches and how they interface with PHC is important for advancing universal health coverage (UHC). Objective: This study examined community‑driven health and social actions and explored pathways for their integration into the formal PHC system. Method: A qualitative study was conducted in three purposively selected Nigerian states: Anambra, Akwa Ibom, and Kano. Data were collected through face‑to‑face in‑depth interviews with 11 formal healthcare providers, 31 informal healthcare providers, and 19 traditional and religious leaders, and 12 focus group discussions with community members. Data were analysed deductively using the Expanded Health System Building Blocks and the World Health Organization Operational Framework for Primary Health Care. Results: Communities across the study sites had established diverse, self‑organised health and social actions that filled gaps in primary healthcare delivery. These included community‑financed drug distribution and insurance schemes, subsidised care by informal providers, health education, sanitation, food support, and community safety initiatives. Led by local leadership structures, these activities were sustained through collective responsibility. Interfaces with the PHC system had emerged in several settings, including PHC‑led training of traditional birth attendants and informal providers, revealing a community‑generated layer of healthcare delivery with potential for systematic integration. Conclusion: Our findings highlight opportunities to strengthen linkages between existing community initiatives and PHC governance, financing, and accountability structures to better harness community contributions to health and its social determinants and support progress towards UHC.

Disclosure without accountability: Air pollution reporting by major South African industrial companies

Fri, 18 Sep 2026 00:00:00 GMT

Spiritual Care in Serious Illness: A Narrative Review of Low- and Middle-Income Country Evidence

Fri, 18 Sep 2026 00:00:00 GMT

Background: Spiritual care (SC) is a component of person‑centered care in serious illness, yet most evidence derives from high‑income countries (HICs). Most patients with serious illness live in low‑ and middle‑income countries (LMICs), where religion and spirituality often play distinctive social, cultural, and clinical roles. Methods: We synthesized 46 LMIC studies drawn from the Balboni et al. [1] systematic review of 371 empirical studies on spirituality in serious illness. Eligible studies were conducted in at least one LMIC, used valid spirituality measures, included ≥100 adult participants, and were rated as low or moderate risk of bias using adapted Cochrane criteria. We examined the role of spirituality in coping and outcomes, as well as the approaches used to assess and deliver SC across Asia, the Middle East and North Africa, sub‑Saharan Africa, and Latin America. Results: Across the 46 studies, higher spiritual well‑being and positive religious coping were consistently associated with better quality of life, lower psychological distress, and stronger family outcomes. Religious or spiritual struggle was associated with poorer mental health. SC was most often delivered by family members and faith communities rather than clinicians. Of the 46 studies, 38 (83%) used HIC‑developed measurement instruments. Locally developed instruments from Thailand, Iran, and Nigeria revealed culturally distinctive pathways to spiritual well‑being. Conclusion: Across diverse LMIC settings, SC emerges as a generalizable yet locally inflected component of person‑centered serious‑illness care. We propose a both/and measurement framework retaining validated global tools while integrating locally developed instruments. Health systems in LMICs should integrate SC competencies into clinical curricula while preserving partnerships with family and faith networks.

An Innovative University and Non‑Governmental Organization Partnership in Global Health: Application of the Brocher Declaration to 20 Years of Collaboration in Kenya

Wed, 16 Sep 2026 00:00:00 GMT

Background: Global health partnerships between academic institutions and non‑governmental organizations (NGOs) are increasingly recognized as essential mechanisms for strengthening health systems in low‑resource settings. Despite their proliferation, few partnerships demonstrate long‑term, equitable collaboration grounded in established ethical frameworks. Objectives: To describe and evaluate a 20‑year partnership between Lwala Community Alliance, a community‑based NGO in western Kenya, and Vanderbilt University in the United States, using the Brocher Declaration principles as an evaluative framework for ethical, sustainable, and mutually beneficial global health collaboration. Methods: We employed a qualitative descriptive case study design, drawing on internal documentation, program records, and publicly available data. The partnership was analyzed across three interdependent pillars—education and training, research, and service—and assessed against each of the six Brocher Declaration principles: mutual partnership with bidirectional learning; empowered host country and community defining needs; sustainable programs and capacity building; compliance with applicable laws and ethical standards; humility and cultural sensitivity; and accountability for actions. Findings: Over 20 years, the partnership engaged 57 graduate students in 33 discrete projects and yielded 12 peer‑reviewed publications from a longitudinal household survey encompassing more than 20,000 households. Key outcomes include a reduction in under‑five mortality from 105 to 29.5 deaths per 1000 live births, policy reforms formalizing community health worker compensation and digitization across Kenya, and sustained bidirectional capacity strengthening. Adherence to Brocher Declaration principles, including community‑led project design, ethical oversight through Kenyan review boards, and structured financial compensation to the host partner, was central to the partnership’s longevity and impact. Conclusions: This case illustrates how the Brocher Declaration can be operationalized to evaluate and strengthen long‑term academic–NGO collaborations. The Lwala–Vanderbilt model offers a replicable framework for ethical, impactful, and mutually reinforcing global health partnerships that advance health equity in low‑resource settings.

Decolonizing Local Health: Advancing from Participation to Equitable Partnership along the Thailand–Myanmar Border

Fri, 11 Sep 2026 00:00:00 GMT

Background: The movement to decolonize global health has increasingly challenged inequities in funding, leadership, knowledge production, authorship, and representation between global and local actors. However, less attention has been given to power dynamics within local and national health systems and partnerships. We propose extending the decolonization lens to local health: examining who leads, decides, speaks, controls resources, produces knowledge, and benefits within health systems themselves.Perspective: Drawing on decades of experience along the Thailand–Myanmar border, we reflect on the evolution of ethnic health organizations (EHOs), community‑based health systems, and their partnerships with donors, governments, international organizations, and intermediary organizations. The border provides a distinctive setting for this discussion: over several decades of conflict, displacement, migration, and political instability, locally developed and sustained health systems have delivered essential services to underserved populations and increasingly assumed roles in health workforce development, health information, disease control, and emergency response. These experiences demonstrate substantial progress toward locally led health systems, but also persistent asymmetries in funding, agenda setting, knowledge production, representation, and risk sharing. In particular, localization of implementation may advance without equivalent transfer of decision‑making power.Implications: Decolonizing local health requires moving beyond participation toward equitable partnership. Funding mechanisms should enable greater direct and flexible support to local organizations; partnerships should share governance and decision‑making; local actors should receive equitable opportunities for authorship and representation; and accountability and risk should be shared more fairly. The experience of the Thailand–Myanmar border suggests that decolonization is not only about shifting power between global and local actors, but also about redistributing power among actors within local health systems. Ultimately, decolonization should be judged not by whether local actors are invited to participate, but whether they are trusted and empowered to lead.

Accelerating Burden of Hypertensive Heart Disease in Low‑ and Lower‑Middle‑SDI Countries, 1990–2023: The Contribution of Cold Temperature Exposure

Fri, 11 Sep 2026 00:00:00 GMT

Background: Low‑ and lower‑middle‑socio‑demographic index (SDI) countries face a rapidly growing burden of hypertensive heart disease (HHD). However, the contribution of non‑optimal temperature, particularly cold exposure, remains poorly characterised in these populations.Methods: Using Global Burden of Disease Study 2023 data, we analysed HHD deaths, disability‑adjusted life years (DALYs), and age‑standardised rates in 79 low‑ and lower‑middle‑SDI countries from 1990 to 2023. Temporal trends were assessed using estimated annual percentage change (EAPC), socioeconomic inequality using slope index of inequality (SII) and concentration index, and temperature‑attributable burden using the GBD comparative risk assessment framework. Bayesian age–period–cohort models projected burden to 2050.Results: From 1990 to 2023, deaths from HHD in low‑ and low‑middle‑SDI countries combined increased by approximately 192% (from 157,950 to 461,110), with corresponding DALYs rising by approximately 171% across these countries. Across all SDI strata, the age‑standardizsed mortality rate increased significantly in low‑SDI countries (EAPC+ 0.58%; 95% CI: 0.53%–0.63%), whereas the increase in low‑middle‑SDI countries was not statistically significant (EAPC+ 0.06%; 95% CI: 0.00%–0.12%), with Central Sub‑Saharan Africa recording the highest 2023 rate (44.6 per 100,000). Cold temperature consistently contributed a greater temperature‑attributable HHD burden than high temperature throughout the study period. Despite the overall increase in HHD burden, the absolute cold‑attributable burden increased only modestly, whereas age‑standardised cold‑attributable rates remained largely stable, particularly in low‑SDI settings. Cross‑country absolute inequality widened substantially (SII −18.93 to −20.66). Projections indicate that HHD deaths and DALYs will increase markedly by 2050, driven mainly by population ageing among women.Conclusion: Low‑ and lower‑middle‑SDI countries face a growing HHD burden, with cold exposure representing an important environmental contributor. Its impact should be considered alongside population ageing, hypertension control, healthcare accessibility, and other cardiovascular determinants. Strengthening hypertension management and implementing low‑cost, winter‑specific cardiovascular protection strategies may help mitigate projected burden.

Global and Regional Trends in Multiple Sclerosis Incidence with Projections to 2030: A Joinpoint Regression Analysis of the GBD Data 2021 by Socio‑Demographic Index and WHO Regions

Tue, 08 Sep 2026 00:00:00 GMT

Background: Multiple sclerosis (MS) constitutes one of the foremost neurological causes of disability among younger and middle‑aged populations.Objective: This study aimed to examine global and regional trends in MS incidence from 1990 to 2021, with projections to 2030, using joinpoint regression and back‑testing validation to ensure evidence‑based scenario selection.Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 study. Joinpoint regression was used to calculate annual percentage changes (APC) and average annual percentage changes (AAPC) for 1990–2021. A retrospective validation (back‑testing) was conducted using data from 1990 to 2015 as the training period to project rates for 2016–2021, comparing predictive accuracy using mean absolute percentage error (MAPE) and root mean square error (RMSE). The method with lower error metrics was selected as the primary projection scenario for 2030, with the alternative retained for sensitivity analysis.Findings: Globally, the age‑standardized incidence rate (ASIR) decreased slightly from 0.77 to 0.75 per 100,000 (1990–2021), while new cases increased by 49.9%. High socio‑demographic index (SDI) (1.66) and EURO (2.57) regions had the highest ASIR in 2021, while low SDI (0.29) and Western Pacific Region (WPRO) (0.15) had the lowest. The back‑testing identified APC as the preferred method in 10 of 12 regions (83.3%), with the lowest MAPE in AFRO (0.05%) and the highest discrepancy in South‑East Asia Region (SEARO) (APC: 0.36% vs AAPC: 5.45%). Global ASIR is projected to decrease slightly to 0.747 by 2030, while SEARO (+12.3%) and low‑middle SDI (+8.2%) regions show the largest increases. Sensitivity analysis confirmed robust projections globally, with trend reversals observed in SEARO and low SDI regions.Conclusion: Global MS incidence is projected to rise in most regions by 2030, particularly in transitioning economies and Southeast Asia. Strengthening diagnostic infrastructure and implementing context‑specific health policies are urgently needed.

Does Periodontal Disease Influence Tuberculosis Outcomes? Insights from a Scoping Review

Mon, 07 Sep 2026 00:00:00 GMT

Background: Periodontitis and tuberculosis (TB) are common chronic infections disproportionately affecting disadvantaged groups. They share behavioural, environmental, and immunological risk factors. Emerging evidence suggests a bidirectional relationship, with TB patients often exhibiting poorer periodontal health and periodontal inflammation potentially exacerbating systemic TB.Objective: To comprehensively map and evaluate the existing evidence regarding the association between periodontal disease and TB outcomes, and to explore the potential influence of periodontal status on TB progression, treatment response, and overall disease outcomes through a scoping review.Methods: This scoping review examined human studies assessing periodontal status in TB patients, including observational studies, clinical trials, and reviews. Searches were conducted in PubMed, Scopus, and Google Scholar, complemented by reference screening. Two independent reviewers applied inclusion criteria, extracted data, and narratively synthesised the findings due to methodological diversity.Results: Out of 1,129 records screened, 8 studies met the inclusion criteria. The majority of observational studies demonstrated a significantly higher prevalence and severity of periodontitis in TB patients relative to controls, characterised by increased probing pocket depths and elevated bleeding on probing. Complementary evidence from recent reviews and microbiome analyses highlights shared inflammatory mediators, immune dysregulation, and alterations in oral microbial communities as potential mechanistic pathways underpinning the association between TB and periodontal tissue destruction.Conclusion: Current evidence supports a consistent but preliminary association between TB and deteriorated periodontal health, indicating complex bidirectional interactions rather than confirmed causality. Routine periodontal screening and oral health counselling integrated into TB management, along with heightened clinical vigilance for TB in unusual periodontal cases, may improve care. Further longitudinal and mechanistic studies are needed to clarify these relationships.

From Product Availability to Population Protection: Vaccine Deployment Readiness in Sierra Leone

Mon, 07 Sep 2026 00:00:00 GMT

Background: The 100 Days Mission has reorganised preparedness around vaccine development speed. Modelling suggests that meeting its target during the COVID‑19 pandemic could have averted more than eight million deaths, conditional on equitable distribution. Distribution depends on a national pathway from authorisation through financing, cold chain, targeting, delivery, monitoring and community trust. The Mission measures speed at only one end of this system.Objective: To develop and apply a country‑anchored framework for the deployment‑readiness layer of preparedness.Methods: We conducted a comparative documentary analysis of three vaccine deployment events in Sierra Leone: COVID‑19 vaccination in 2021, preventive Ebola vaccination in 2024 and mpox clade IIb vaccination in 2025. Sources included regulatory records, government and partner reports, national plans and aggregate programme records. We organised 11 established immunisation and emergency vaccination functions into a Deployment Readiness Chain. We traced constraints, handoffs, time to vaccination start and dated reach.Findings: COVID‑19 vaccination began 45 days after European Medicines Agency authorisation. Full coverage among people aged 12 years or older reached 73.2% by December 2022 and a reported 86.7% by October 2023. More than 84% of doses were delivered through surge campaigns or periodic intensification of routine immunisation. Nationwide preventive Ebola vaccination reached 17,454 of the 20,621 targeted workers, or 84.6%, in three weeks. It began 1851 days after authorisation, although a global stockpile had been in operation since 2021. Mpox vaccination began 106 days after outbreak confirmation and reached 186,053 people by 14 December through capabilities built during earlier emergencies.Conclusions: For Ebola, the 1851‑day interval spanned product authorisation, global preventive policy, financing and national activation. Product availability alone was not sufficient. Preparedness frameworks should evaluate deployment readiness alongside development speed. They should treat the global‑to‑national deployment pathway as one fundable category. Deployment readiness is built between emergencies, not during them.

Diabetes Burden and Healthcare Barriers Among Cataract Patients in Imo State, Nigeria

Mon, 07 Sep 2026 00:00:00 GMT

Background: The coexistence of diabetes and cataracts increases the risk of poor surgical outcomes. Cataract patients with uncontrolled diabetes and other comorbidities were unsafe for same‑day surgery, which excluded them from free cataract surgeries during a medical mission outreach in rural Imo State, Nigeria.Objective: This study aims to identify barriers to diabetes control among cataract patients in the community, to improve health outcomes and surgical readiness in short‑term medical missions.Methods: A total of 45 cataract patients aged 40–94 years received point‑of‑care testing for fasting blood sugar, intraocular pressure (IOP), and hemoglobin levels. Structured questionnaires assessed socio‑economic status (SES), diabetes burden, and barriers to care.Findings: Despite reported adherence to daily medications (p = 0.0007), many patients had high diabetes burden scores, which were significantly associated with frequent symptoms (p < 0.00003), and more chronic diseases (p < 0.008). Elevated IOP, a glaucoma risk factor, was linked to private drinking‑water sources (p = 0.008), and herb use was associated with lower hematocrit (p = 0.040), suggesting anemia risk. Lower hematocrit further correlated with more advanced cataracts (p = 0.018). High barriers‑to‑care scores were associated with the absence of a caregiver (p = 0.005), limited food choices (p < 0.001), the frequency of medical checks (p < 0.001), and a patient’s medication source (p = 0.030). Patients who struggled with transportation barriers reported needing help with daily tasks like going to the market or cooking meals (p = 0.004).Conclusion: Disease severity in cataract patients is influenced by overlapping medical, financial, and social barriers. Providing tools for effective diabetes self‑monitoring and mitigating comorbidities through community‑tailored interventions can improve health stability and future surgical access in this rural community.

Implementation and Access Gaps in Infectious Disease Screening for Migrants in Europe: A Structured Review with Thematic Synthesis From the ESGITM Group

Wed, 02 Sep 2026 00:00:00 GMT

Background: Infectious disease screening is widely recommended for migrants in Europe, yet implementation remains inconsistent across countries and settings. While guidance has focused on which infections to screen for, less attention has been paid to how screening is delivered, accessed, and linked to care. This structured review with thematic synthesis aimed to synthesize evidence on implementation gaps, barriers, and facilitators, with particular attention to differences across the migratory cycle. Methods: A structured search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for publications from January 2000 to February 2026, addressing infectious disease screening or related migrant health assessments in European settings. Of 49 included publications, 13 empirical studies formed the primary analytical basis and were quality‑appraised using the Mixed Methods Appraisal Tool (MMAT, 2018); the remaining 36 contextualizing publications were used to interpret findings. Eligibility screening was performed independently by two reviewers. Results: Six interconnected thematic domains shaped screening implementation: administrative and legal barriers; communication, language, and cultural mediation; trust, stigma, and perceived coercion; organizational capacity and fragmented care pathways; the role of NGOs and community actors; and contextual differences across the migratory cycle. Barriers varied across the screening‑to‑care cascade: communication barriers and mistrust primarily affected uptake; legal and organizational barriers constrained linkage to diagnosis and treatment; and legal instability and fragmented services undermined continuity of care. First‑arrival settings were characterized by systematic screening and high service pressure; long‑term settlement contexts relied more heavily on primary care capacity, trust, and legal entitlement. Conclusions: Implementation gaps are driven less by the absence of clinical guidance than by structural, organizational, and relational barriers limiting access, linkage, and continuity. Screening should be embedded within integrated, migrant‑centered care pathways supported by cultural mediation, trusted community actors, and separation from immigration enforcement.

Rapidly Deployed Phone‑Based COVID‑19 Telemedicine Clinic in Lebanon: A Retrospective Analysis

Mon, 31 Aug 2026 00:00:00 GMT

Background: In early 2021, Lebanon’s second COVID‑19 wave coincided with financial collapse, health‑workforce emigration, and the aftermath of the August 2020 Beirut port explosion, leaving hospitals saturated and many households unable to afford routine medical advice. Objectives: To describe the design, utilization, disposition outcomes, supervisory escalation, and direct operational cost of a free phone‑based telemedicine clinic rapidly deployed through an academic–nongovernmental organization (NGO) partnership, and to identify transferable lessons for other crisis‑affected, resource‑constrained settings. Methods: Beirut Arab University Healthcare Center and the Federation of Businessmen for Support and Development (IRADA), a national NGO, launched a free 24‑hour, 7‑day‑a‑week phone‑based telemedicine clinic staffed by 40 medical interns and residents using a standardized COVID‑19 management protocol under a two‑tier supervision model, with on‑call family physicians reachable throughout each shift. WhatsApp voice calls were offered to provide free access, and missed calls were returned by the on‑call responder. We retrospectively analyzed the de‑identified records of all consultations managed during 14 weeks (February 2 to May 11, 2021); disposition categories were derived from the free‑text recommendations using a rule‑based classifier. Findings: The service managed 2953 consultations from all Lebanese governorates. After clinical assessment and safety‑netting, 90.1% of consultations were managed outside hospitals at the point of consultation, 7.8% were referred to the emergency department, and 2.0% to primary care. The on‑call family physician was consulted in 6.6% of consultations, concentrated on the highest‑acuity calls (16.5% of emergency department referrals). The overnight window carried 3.7% of consultations but a higher emergency department referral proportion (12.8%). Direct operational cost was USD11,032 (USD3.74 per consultation), excluding non‑monetary university contributions. Conclusions: An academic–NGO partnership, a standardized triage protocol, and tiered supervision can mobilize a trainee workforce safely, at low cost, and within days during a public health emergency.

Universal Health Coverage in Pakistan: Challenges, Reforms, and the Road to 2030

Mon, 31 Aug 2026 00:00:00 GMT

Background: Universal Health Coverage (UHC) aims to ensure that all individuals have access to essential health services without financial hardship. Pakistan, despite constitutional commitments and policy reforms, faces significant hurdles in progressing toward this global goal due to systemic, structural, and socioeconomic challenges. Methods: This narrative review synthesizes available literature, policy documents, and programmatic evidence to examine Pakistan’s preparedness for UHC. The analysis is structured around four thematic levels: policy, institutional, population, and service delivery, identifying barriers and opportunities within each domain. Findings: At the policy level, political instability, inadequate financing (<1% of GDP), and lack of evidence‑based decision‑making undermine sustained progress. Although a comprehensive UHC benefit package has been developed, its implementation is constrained by insufficient budget allocations. Institutionally weak regulation, fragmented governance, inequitable distribution of human resources, and limited stakeholder coordination impede service delivery. At the population level, low health literacy, poor awareness of insurance entitlements, and socioeconomic disparities result in low utilization of available services. Service delivery challenges include questionable quality of care, weak hospital empanelment standards, absence of standardized treatment protocols, and poor communication between public and private sectors. Out‑of‑pocket expenditures remain catastrophically high, pushing vulnerable populations further into poverty. Conclusion: Pakistan’s path to UHC by 2030 requires a fundamental paradigm shift. Priorities include increasing health financing to at least 3% of GDP, strengthening primary healthcare as the platform for equity, scaling up social health protection programs nationwide, investing in workforce development and digital health infrastructure, and launching contextualized public awareness campaigns to improve health insurance literacy. A multi‑sectoral, governance‑focused approach is essential to translate policy intent into tangible health outcomes for all citizens.