Tropical Medicine & International Health

Objectives To investigate the differences in clinical, radiological and laboratory parameters between elderly and young patients with newly diagnosed smear‐positive pulmonary tuberculosis in Vietnam. Methods This retrospective analysis included all patients hospitalised with newly diagnosed pulmonary tuberculosis with acid‐fast bacilli‐positive smear. Clinical symptoms, laboratory results and chest X‐ray findings were collected using a standardised questionnaire. Elderly was defined as those patients aged 65 years and older. Results A total of 183 patients diagnosed with new acid‐fast bacilli‐positive pulmonary tuberculosis were included in this study, with a mean age of 56.2 ± 16.3 years (minimum = 18 and maximum = 87 years). Seventy‐seven participants were aged ≥65 years, accounting for 42.1% of participants. A total of 147 (80.3%) patients were male, and the sex ratio of male/female was 4.1. Night sweats were statistically more frequent among younger patients (34.9% vs. 20.8%, p = 0.04), whereas muscle and joint pain were more predominant among the elderly (7.6% vs. 22.1%, p = 0.01). A proportion of 67.0% of younger patients and 63.6% of the elderly group were bilaterally affected. Cavitation lesions were significantly more frequent in the younger group (55.7% vs. 39.0%, p = 0.03), whereas pulmonary fibrosis occurred more frequently in elderly patients (29.3% vs. 45.4%, p = 0.02). No other significant differences in clinical symptoms, laboratory results and chest X‐ray findings were observed. Conclusion These findings underscore the importance of considering age‐related variations in the clinical and radiological presentation of tuberculosis, which can guide tailored approaches in diagnosis, management and treatment strategies for different age groups.

Background Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks—that is ‘task‐shifting’—improved case detection and treatment outcomes in Ethiopia. Given resource and operational constraints, only a limited number of areas can be targeted by an expanded task‐shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale‐up of this task‐shifting intervention in Ethiopia. Methods We used data from various sources including District Health Information Software 2; demographic, geospatial and topographic data; and previously published implementation study findings. We developed methods to integrate these datasets and to calculate the proportion of health facilities with tuberculosis services, the district population to health centre ratio, and the proportion of district population living within 2h walking distance from a health centre. Equity and disparities were then measured in terms of: tuberculosis services coverage; health centre adequacy, that is the district population served by health centres; and spatial access adequacy, that is the district population with health centre access within a two‐hour walking distance. Subsequently, districts were ranked according to these measures to allow prioritisation of the health extension worker task‐shifting intervention. Results Tuberculosis services coverage varied from 54% in Afar region to 100% in Harari region, and health centre inadequacy ranged from 10% of districts in Benishangul‐Gumuz to 87% in Sidama. After spatial access adjustment, health centre inadequacy ranged from 7% of districts in Sidama to 91% in Somali; and tuberculosis services inadequacy from 7% of districts in Sidama to 97% in Afar. Task‐shifting implemented in inadequate districts (55% of all districts) could raise national case detection rate from 66% (currently) to 88% and treatment success rate from 93% to 99%; Benishangul‐Gumuz achieving the largest increase of all regions. Conclusions Access to effective tuberculosis services presents substantial disparities across districts in Ethiopia, due to both health system and tuberculosis‐specific factors. Jointly considering both types of factors would enable prioritisation of districts where health extension workers would be most impactful.

Acinetobacter baumannii (Ab) has emerged in the last decades as a cause of community‐acquired pneumonia (CAP) in tropical and subtropical regions. We previously conducted the first investigation on this topic in France with a case series of severe CAP‐Ab in Reunion Island over an eight‐year period. In the present work, we aim to highlight the specific aspects of CAP‐Ab by comparing our case series with an historical cohort (PAC_RUN), obtained by retrospective chart review (2016–2021) of severe community‐acquired pneumonia cases on Reunion Island, in which CAP‐Ab was ruled out. During the study period, eight CAP‐Ab cases were identified, giving an incidence of 0.1 cases per 100,000 people/year, and an incidence of 16.5 cases per 100,000 people/year for non‐Ab‐related CAP (n = 761). By comparing with non‐Ab‐related CAP, patients had more excessive alcohol use (75% vs. 25.6%, p = 0.005) and lower body mass index (21 vs. 24 kg/m², p = 0.004). Six cases (75%) of CAP‐Ab occurred during the rainy season (p = 0.06). Mortality was higher (62.5% vs. 24.3%, p = 0.02) and time to death was shorter (median 2 days vs. 7, p = 0.009) in the CAP‐Ab group. Bacteraemic pneumonia was strongly associated with CAP‐Ab (62.5% vs. 15.7%, p = 0.004). Significant differences were found in the need for renal replacement therapy (75% vs. 17.2%, p < 0.001), catecholamine use (100% vs. 54.5%, p = 0.01) and use of invasive mechanical ventilation (100% vs. 62.7%, p = 0.03). Also, in the proportion of severe acute respiratory distress syndrome (62.5% vs. 23.2%, p = 0.02), septic shock (100% vs. 40.6%, p < 0.001), and cardiogenic shock (87.5% vs. 15.9%, p < 0.001). Compared to severe non‐Ab‐related CAP, severe CAP‐Ab is characterised by higher mortality, associated with a high frequency of multiple organ failure. Excessive alcohol consumption and malnutrition seem to be risk factors. To improve outcomes, broader spectrum antibiotic therapy must be immediately proposed when CAP‐Ab is suspected.

Background Sporotrichosis is a neglected tropical disease and the most common subcutaneous mycosis, mainly caused by Sporothrix species, particularly S. brasiliensis, S. schenckii and S. globosa, which exhibit varying biological behaviours and virulence. The epidemic of sporotrichosis in Brazil, initiated in Rio de Janeiro in the late 1990s, rapidly spread to other states, including Amazonas in 2021. This study aimed to identify the specific Sporothrix species responsible for the human sporotrichosis outbreak in the Brazilian Amazon. Methods A cross‐sectional study was conducted by enrolling clinically suspected cases of sporotrichosis attended at a reference dermatologic centre, in Manaus (Brazil). Biological material was collected from their skin lesions for culture (Mycosel) and for species identification (qPCR). Results Sporothrix cultures were obtained from 150 cases. Sporotrichosis predominantly affected females (67.3%), aged 44.5 years on average, with lymphocutaneous lesions (72.7%). Sporothrix brasiliensis was identified in 89.3% of patients. Up to 83.3% of these patients reported contact with cats previously to the skin lesion, and the time‐spatial progression of the human cases followed the notification of cases in cats, in the metropolitan region of Manaus. Conclusion Sporothrix brasiliensis is the dominant species in the zoonotic outbreak of human sporotrichosis in the Brazilian Amazon, with cats identified as the primary vectors. Effective sanitary control measures, education and responsible pet ownership are crucial to mitigating zoonotic sporotrichosis' impact in Brazil and preventing its spread to neighbouring Latin American cities.

Background Environmental enteric dysfunction (EED) is an acquired subclinical condition of the small intestine with lasting health implications for nutritional status, linear growth and development among children. EED is characterised by structural and functional changes to the gut barrier. There are no standardised diagnostic criteria, however, a number of biomarkers have been evaluated to capture EED domains. While the causes of EED are not fully understood, risk factors include poor water, sanitation and hygiene conditions and exposure to enteric pathogens. Very few studies have evaluated the impact of schistosomiasis on EED despite repeated intestinal damage from parasite eggs passing across the gut barrier. Methods In a cohort of 354 preschool‐aged children aged 12–47 months with Schistosoma mansoni infection recruited from the Lake Albert region of Uganda, we assessed exposure to water, sanitation and hygiene conditions and measured markers from each EED domain: intestinal inflammation (faecal calprotectin), epithelial damage (serum intestinal fatty‐acid binding‐protein), increased permeability (urine lactulose to mannitol ratio and faecal alpha‐1 antitrypsin) and microbial translocation (serum endotoxin core antibody). Results In multivariable linear regression models, we found that children whose drinking water was sourced from Lake Albert had higher concentrations of intestinal fatty‐acid binding‐protein (β = 0.48, 95% CI 0.20–0.76, p < 0.001), and lack of toilet/latrine access was associated with higher concentrations of calprotectin (β = 0.48, 95% CI 0.18–0.78, p < 0.01). Higher schistosomiasis intensity (eggs per gram of stool) was associated with higher calprotectin (β = 0.10, 95% CI 0.02–0.17, p = 0.01), but not with other EED markers. Conclusions Few studies have investigated schistosomiasis‐related morbidities in very young children infected with schistosomiasis. Our findings from Uganda show that poor water, sanitation and hygiene conditions and heavier schistosomiasis burden are associated with intestinal inflammation and damage, contributing to EED. Improved treatment coverage for preschool‐aged children infected with schistosomiasis may reduce the burden from EED and associated long‐term morbidities.

The resurgence of mpox, declared a Public Health Emergency of International Concern by the World Health Organization in 2024, highlights gaps in global preparedness, particularly for marginalised populations. While much of the focus has been on men who have sex with men, survivors of sex trafficking remain overlooked, despite being highly vulnerable to mpox transmission. These individuals face significant health disparities, including limited access to healthcare, exposure to violence and forced sexual encounters in unsafe conditions, which amplify their risk of infection. The clandestine nature of trafficking further complicates public health interventions like contact tracing and vaccination efforts, leaving survivors at heightened risk of infection and limited access to critical health resources. Addressing these inequities requires targeted interventions, such as confidential testing, outreach, culturally sensitive healthcare and integrating mpox awareness into existing survivor support programmes. Additionally, public health systems must ensure equitable vaccine distribution, enhance surveillance and collaborate with anti‐trafficking organisations to improve prevention and care. A holistic approach that includes mental health support is crucial to address the unique challenges faced by trafficking survivors, ensuring they receive the protection and care needed during this global outbreak.

Objectives To evaluate the effectiveness and cost‐effectiveness of integrating seasonal malaria chemoprevention (SMC) with mass drug administration for helminth control among school‐aged children living in communities where the burden of malaria and helminths is high in Ghana, West Africa. Methods This cluster randomised controlled trial will enrol 1200 children aged 5–10 years. Eligible children randomised to intervention clusters will receive SMC drugs (sulphadoxine‐pyrimethamine plus amodiaquine) and anthelminthic drugs for soil‐transmitted helminths—(albendazole), and for schistosomiasis (praziquantel), while children randomised to control clusters will receive SMC drugs alone. Pre‐ and post‐intervention blood, urine and stool samples will be collected from children in both clusters. The effectiveness of the concomitant delivery will be determined by checking whether the combination of SMC and anthelminthic drugs prevents anaemia in the children randomised to the intervention clusters compared to the children in the control clusters. Cost analysis and cost‐effectiveness of this integrated delivery approach will be determined by estimating the incremental costs and effects of co‐administration of SMC drugs with mass drug administration of anthelminthic drugs compared to SMC alone, including cost savings due to cases of moderate and severe anaemia averted. Expected findings The findings of this study will provide evidence to inform public health recommendations for an integrated control of malaria and helminths among children living in the poorest countries of the world.

Introduction Mozambique is among the highest‐burden countries for drug‐resistant tuberculosis in the world. However, the spatial distribution of drug‐resistant tuberculosis, in the country is unknown. Therefore, we aimed to analyse the spatial distribution, predictors, and hotspot districts for drug‐resistant tuberculosis incidence in Mozambique. Method We carried out an ecological study using the district as the unit of analysis where we included all cases of drug‐resistant tuberculosis diagnosed in Mozambique from 2016 to 2020. We obtained the data from the Minister of Health and other open sources. Parameters of interest were estimated through a spatial Bayesian Poisson regression model using Markov Chain Monte Carlo simulation. Results A total of 5092 people with drug‐resistant tuberculosis in Mozambique were diagnosed during our study period. We found heterogeneity in the spatial distribution of drug‐resistant tuberculosis incidence across the country. Higher incidence rates were mainly observed in the south and central regions, and 26 (16.9%) districts out of 154 were identified as hotspot areas. The incidence of drug‐resistant tuberculosis increased with an increase in the HIV prevalence (Relative risk [RR]: 1.53; 95% Credibility Interval [CrI]: 1.32 to 1.76), electricity coverage rate (RR: 1.59; 95% CrI: 1.19 to 2.09), and population density (RR: 1.36; 95% CrI: 1.08 to 1.69) and decreased with an increase in the proportion of people with a bank account per district (RR: 0.71; 95% Crl: 0.51 to 0.96). Conclusion The incidence of drug‐resistant tuberculosis was not homogeneous, and it was associated with social determinants of health. Targeting interventions in hotspot districts and addressing social determinants is crucial for tuberculosis elimination in Mozambique.

Objectives Scabies is a neglected skin disease that disproportionately affects people from resource poor and overcrowded countries. Global data on prevalence and risk factors are limited. This article aims to estimate the global burden of scabies and identifies the risks associated with it. Methods Databases (PubMed, Scopus and Cochrane Reviews) were accessed to identify studies of scabies prevalence published between 2000 and 2024. Results were pooled to estimate prevalence and identify factors, which explained between‐study heterogeneity. Odds ratios (ORs), risk of bias, subgroup analyses and meta‐regression were used to describe variation in effect size and heterogeneity based on country‐level demographic and economic variables. Results Seventy studies yielded a pooled prevalence of 11.9% (95% confidence interval [CI]: 9.60–14.7) with substantial heterogeneity I2=100%τ2=1.04. Prevalence was highest in Oceania (17.9%; 95% CI: 13.9–22.8) compared to other regions. Pooled risk factors for scabies showed significant associations for demographic and behavioural factors including contact history with household members with itch (OR 11.3; 95% CI 4.82–26.51; I2=96%; n = 7), lack of soap use (OR 3.41; 95% CI: 2.56–4.54; I2=44%; n = 7), bed‐sharing (OR 2.64; 95% CI: 1.50–4.63; I2=76%; n = 7), sharing of clothes (OR 2.52; 95% CI: 1.58–4.03; I2=85%; n = 7), infrequent bathing (OR 2.13; 95% CI: 1.41–3.22; I2=77%; n = 6), presence of pets (OR 1.76; 95% CI: 1.08–2.87; I2=84%; n = 4) and being a male (OR = 1.19; 95% CI: 1.04–1.37; I2=83%; n = 22). Socioeconomic factors were not convincingly associated with scabies prevalence. Conclusion Prevalence of scabies is associated with geographic location and behavioural factors, but not between‐country socioeconomic status. In addition to mass drug administration, risk factors are identified which may be included in health promotion programmes to reduce scabies prevalence and its sequelae in the long term.

Background Accidents caused by snakes constitute a serious public health problem in Latin America and worldwide. The situation in the Brazilian Amazon region is neglected, resulting in the highest incidence of cases per capita in the country. Furthermore, the distance from urban areas makes it difficult for the population to access timely and effective medical care, including antivenom treatment. The Brazilian Amazon is characterised by high ethnic and cultural diversity, yet it lacks robust epidemiological information that would allow for the development of surveillance and prevention policies. This study aimed to assess the epidemiological profile of individuals affected by snakebite accidents from 2007 to 2021 in a poorly studied region of the Brazilian Amazon. Methods To assess the relationship between snakebite accidents, rainfall and river flood levels, cross‐correlation functions were employed. Data from the public healthcare system database was used for this analysis. Results The results indicate that the study area experiences a snakebite rate 10 times greater than the Brazilian average and double that of other Amazonian regions. The most affected victims consist of adult males residing in rural areas, with snakebite accidents being more common during the rainy season. Viperid snakes were responsible for most bites, with the lower limbs being the most common location of injury. The data revealed a positive correlation between the number of snakebite accidents both rainfall and fluvial data. Conclusions The accident peak coincides with the Brazil nut harvest season, a highly significant forest product for the economy of rural communities. Our data reinforces the need for public policies focused on environmental education and prevention, such as the use of boots and leg guards. These preventive measures have the potential to reduce the number of snakebites accidents by approximately 85%.

Objectives This study aimed to describe the prevalence of lymphatic filariasis (LF), soil‐transmitted helminthiasis (STH) and schistosomiasis (SC) in Indonesia before and after PC implementation through a systematic review and meta‐analysis. Methods Embase, MEDLINE, PubMed, Scopus, Web of Science and Google Scholar were searched for articles published between 1 January 1992 and 31 December 2022, reporting LF, STH and SC in Indonesia. Using the Ministry of Health lists of districts receiving PC programs, we identified whether data collection was conducted before or after PC implementation in that particular district. A meta‐analysis was performed with a random‐effects model applied to pool pre‐ and post‐PC prevalence of LF, STH and SC. Results Overall, 195 studies were included. The pooled prevalence of LF was 9.72% (95% CI, 5.56%–13.87%). The pre‐PC pooled prevalence of LF was 11.48% (95% CI, 5.52%–17.45%). The prevalence decreased after PC implementation, and the pooled prevalence was 7.12% (95% CI, 1.79%–12.44%). The overall prevalence of STH was 35.16% (95% CI, 30.36%–39.96%). The pre‐PC prevalence of STH was 36.29% (95% CI, 30.37%–42.20%). The post‐PC prevalence of STH decreased at 31.93% (95% CI, 24.25%–39.62%), although the difference between before and after PC was not significant (p = 0.379). Only nine studies investigated the prevalence of SC; based on the random‐effects model, the pooled prevalence was 21.90% (95% CI, 4.88%–38.92%). Owing to the scarcity of studies, we could not perform the funnel tests for publication bias and moderating variables of the pooled prevalence for SC. Conclusions The prevalence of LF and STH decreased after PC implementation, although it was not significant. The difference for SC could not be assessed because of limited post‐PC data. The uneven distribution of research and the lack of standardised sampling methods may not fully capture the situation.

Sickle cell disease is a genetic disorder characterised by abnormal haemoglobin production. This study aims to investigate the associations between haematological and inflammatory biomarkers and brain volumes in patients with sickle cell anaemia and compare brain structure between patients with sickle cell anaemia and healthy controls. This retrospective cross‐sectional study included 130 participants (70 sickle cell anaemia patients and 60 healthy controls) who underwent brain MRI examinations at King Fahad Central Hospital between January 2010 and October 2022. Demographic data and haematological and inflammatory biomarkers were collected to examine their relationships with brain volumes. Brain volumes were measured using FreeSurfer. Specific haematological and inflammatory biomarkers were correlated with brain volume in patients with sickle cell anaemia, p < 0.05. Sickle cell anaemia patients exhibited smaller volumes in the brainstem, corpus callosum and amygdala compared to healthy controls. Males had significantly higher iron levels (p < 0.001) and larger various brain structure volumes (p < 0.05) than females. This study demonstrates significant associations between specific biomarkers and brain volume in sickle cell anaemia patients, underscoring the importance of monitoring these biomarkers for early detection and management of neurological complications in sickle cell anaemia.

Objectives Influenza outbreaks of varying size occur every year, but during the COVID‐19 pandemic, many countries experienced influenza at lower levels. However, following the relaxation of COVID‐19 prevention measures in 2022, the incidence of influenza began to increase gradually. Thus, this study compared the occurrence of influenza from week 36 of 2017, before the COVID‐19 outbreak, until 2023. Methods The analysis was conducted using influenza‐like illness occurrence data available from the Korea Disease Control and Prevention Agency infectious disease website. Additionally, to examine the changes in COVID‐19 and influenza occurrence during the pandemic, COVID‐19 incidence data from 20 January 2020 to 31 August 2023 were obtained from the KDCA Coronavirus Disease 19 homepage. Results During the COVID‐19 pandemic, which corresponds to the 2020/2021 and 2021/2022 influenza seasons, there was no seasonal influenza epidemic, and the incidence rates were below the usual outbreak levels. However, in the 2022/2023 season, when the spread of COVID‐19 had eased, a seasonal pattern similar to that observed before the COVID‐19 pandemic was noted. Furthermore, correlation analysis between the rates of influenza‐like illness and COVID‐19 incidence showed no significant correlation during the entire period. However, a significant correlation emerged in 2023 (r = 0.393, p <0.05). These results suggest that influenza was suppressed during the COVID‐19 pandemic but returned to typical seasonal patterns after the COVID‐19 prevention policies were eased. Conclusion The positive correlation observed between the incidences of COVID‐19 and influenza in 2023 indicates that COVID‐19, no longer a novel pandemic‐causing infectious disease, may have transitioned to an endemic pattern similar to seasonal influenza.

Objectives Chest x‐ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource‐limited settings. Digital CXR (d‐CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d‐CXR in 12 district hospitals (DHs) in 2021–2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB‐speed decentralisation study on childhood TB diagnosis. Methods For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d‐CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d‐CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d‐CXRs and site support supervision reports. Results Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d‐CXR, including 1505, 136 and 1 children with one, two and three d‐CXRs, respectively, resulting in a total of 1780 d‐CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty‐four children had no d‐CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d‐CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d‐CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d‐CXRs due to limited internet access. Conclusion d‐CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges.

Objectives Previous studies generally used cross‐sectional data and focused on under‐five children to assess the risk factors for malnutrition among Indian children. Some recent studies have reported that recovery from or faltering in malnutrition is possible after five years of age, but socio‐demographic subgroup disparities have not been explored. This study aims to find the longitudinal disparity in height‐for‐age Z‐scores (HAZ) and body‐mass‐index‐for‐age Z‐scores (BMIAZ scores) across various sub‐groups of a cohort from childhood to adolescence. Methods This study used a cohort from the Young Lives Survey, which followed children aged of 1–15 years between 2002 and 2016–17 in the states of Andhra Pradesh and Telangana, India. Mixed‐effect models were applied to find the main, time, and interaction effects of HAZ scores and BMIAZ scores. In addition, an extended Kitagawa–Oaxaca–Blinder decomposition approach to assess group‐based differences over time was used. Results The cross‐sectional prevalence of stunting reduced across all subgroups, while thinness rose during the same period. The interactions of child sex, mother's education, place of residence, wealth index, and antenatal care with time were statistically significant at p <0.05. The gender disparity in adjusted HAZ score decreased from 0.214 units at 1 year to 0.011 units at 15 years, whereas BMIAZ score differential increased from 0.106 to 0.538 units over same timeframe. Disparities in scores were also observed across rural–urban, maternal education, social group, religion, socioeconomic status, maternal age at birth, antenatal care, and premature birth status. Conclusion The study sheds light on the nuanced dynamics of paediatric growth, emphasising the importance of longitudinal approaches in understanding and addressing the health disparities across different stages of childhood and adolescence.

Background Psoriasis is a chronic inflammatory disease often associated with serious cardiovascular comorbidities. The aim of this study was to investigate the systemic inflammatory burden in psoriasis by examining various inflammatory markers and to assess the relationship between these markers and the severity of the disease. Methods This retrospective study was conducted on medical records of patients who visited the dermatology outpatient clinic between 1 January 2016 and 31 December 2022. The study included patients with psoriasis vulgaris and healthy volunteers. Demographic data, Psoriasis Area and Severity Index score, C‐reactive protein, monocyte‐high‐density lipoprotein cholesterol ratio, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, systemic immune‐inflammation index, and Systemic Inflammation Response Index were analysed and compared. Results A total of 278 psoriasis patients and 90 healthy volunteers were analysed. Compared to the control group, psoriasis patients showed significantly higher systemic immune‐inflammation index, Systemic Inflammation Response Index, neutrophil‐to‐lymphocyte ratio, monocyte‐high‐density lipoprotein cholesterol ratio, serum C‐reactive protein levels, neutrophil count, monocyte count, body mass index, and waist circumference (p < 0.001, p = 0.001, p < 0.001, p = 0.014, p < 0.001, p < 0.001, p = 0.046, p < 0.001, and p = 0.011, respectively). Among patients with severe psoriasis (Psoriasis Area and Severity Index >10), systemic immune‐inflammation index, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and serum C‐reactive protein levels were significantly higher compared to patients with mild/moderate psoriasis (Psoriasis Area and Severity Index ≤10). In the ROC curve analysis, the optimal cut‐off (AUC, sensitivity, specificity) values for neutrophil‐to‐lymphocyte ratio, systemic immune‐inflammation index, and platelet‐to‐lymphocyte ratio were found to be 2.11 (0.592, 62%, 57%), 552.9 (0.579, 61%, 58%), and 111.9 (0.578, 64%, 46%), respectively. The inflammatory parameters that showed correlation with Psoriasis Area and Severity Index were systemic immune‐inflammation index, Systemic Inflammation Response Index, neutrophil‐to‐lymphocyte ratio, monocyte‐high‐density lipoprotein cholesterol ratio, monocyte‐to‐lymphocyte ratio, and C‐reactive protein. Conclusion The findings of this study suggest that systemic immune‐inflammation index, Systemic Inflammation Response Index, neutrophil‐to‐lymphocyte ratio, monocyte‐high‐density lipoprotein cholesterol ratio, and C‐reactive protein values have the potential to serve as simple and cost‐effective markers for assessing the inflammatory burden in individuals with psoriasis.

Background Developing the most suitable treatment against tuberculosis based on resistance profiles is imperative to effectively cure tuberculosis patients. Whole‐genome sequencing is a molecular method that allows for the rapid and cost‐effective detection of mutations in multiple genes associated with anti‐tuberculosis drug resistance. This sequencing approach addresses the limitations of culture‐based methods, which may not apply to certain anti‐TB drugs, such as pyrazinamide, because of their specific culture medium requirements, potentially leading to biased resistance culture results. Methods Thirty‐four M. tuberculosis isolates were subcultured on a Lowenstein–Jensen medium. The genome of these bacteria was subsequently isolated using cetyltrimethylammonium bromide. Genome sequencing was performed with Novaseq Illumina 6000 (Illumina), and the data were analysed using the GenTB and Mykrobe applications. We also conducted a de novo analysis to compare the two methods and performed mutation analysis of other genes encoding pyrazinamide resistance, namely rpsA and panD. Results The results revealed mutations in the pncA gene, which were identified based on the databases accessed through GenTB and Mykrobe. Two discrepancies between the drug susceptibility testing and sequencing results may suggest potential instability in the drug susceptibility testing culture, specifically concerning PZA. Meanwhile, the results of the de novo analysis showed the same result of pncA mutation to the GenTB or Mykrobe; meanwhile, there were silent mutations in rpsA in several isolates and a point mutation; no mutations were found in the panD gene. However, the mutations in the genes encoding pyrazinamide require further and in‐depth study to understand their relationship to the phenotypic profile. Conclusions Compared to the conventional culture method, the whole‐genome sequencing method has advantages in determining anti‐tuberculosis resistance profiles, especially in reduced time and bias.

Introduction The skin is the largest and most visible organ of the human body. As such, skin infections can have a significant impact on overall health, social wellbeing and self‐image. In 2019, we published a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource‐limited settings where skin infections are endemic. This current review serves as an update to assess the evidence for treatment of these conditions as well as atopic dermatitis, molluscum contagiosum and head lice in endemic settings. The data from this systematic review have supported an update to the Australian National Healthy Skin guidelines. Methods A systematic review was conducted using two separate searches in MEDLINE, PubMed, Embase, CINAHL, Cochrane and Web of Science. The first search was an update of the 2018 systematic review using the same search strategy for the same skin conditions to identify emerging literature from 2018 to 2022. The second search strategy used the same key terms but with the addition of atopic dermatitis, head lice and molluscum contagiosum from 1960 to 2022. Eligible studies included Indigenous peoples and populations in resource‐limited settings with a diagnosis of impetigo, scabies, crusted scabies, tinea capitis, atopic dermatitis, molluscum contagiosum or who presented with head lice. Studies conducted in high‐income countries were excluded. Articles were screened for inclusion independently by one author with a second group of reviewers independently double screening. Data extraction and an in‐depth quality assessment conducted by one author and checked by two others. Results Of 1466 original articles identified, 68 studies were included and key findings outlined for impetigo, scabies, crusted scabies, atopic dermatitis, head lice and molluscum contagiosum. Recommendations for each condition based on the available evidence are provided. Conclusion The importance of assessing literature relevant to the populations with heavy burden of skin infections is outlined in this systematic review. We have summarised updates to this literature, which may benefit in developing guidelines for skin infection management similar to the National Healthy Skin Guidelines for Australia.

Background This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug‐resistant tuberculosis. Methods A descriptive cross‐sectional study was conducted among 203 adults on treatment for drug‐resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis. Results Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = −0.255, p < 0.001), anxiety (B = −0.406, p < 0.001) and loneliness (B = −0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support. Conclusion In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug‐resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness.

COVID‐19 infection among pregnant women results in more severe symptoms and higher mortality rates. No comprehensive health literacy for protection against COVID‐19 among pregnant women has been available for general use in Thailand. This cross‐sectional study aimed to develop and examine an instrument for measuring health literacy of prevention COVID‐19 infection among pregnant women (HLS‐P). A total of 321 pregnant women aged older than 20 years were participated in this study, Selected through multistage cluster sampling, between September 2021 and January 2022. Data were collected using structured questions that included sociodemographic characteristics and the health literacy scale for protecting against COVID‐19 (HLS‐P) developed by the researchers. The content and construct validity of the health literacy scale were examined. Exploratory factor analysis performed with principal component analysis and Varimax rotation. Confirmatory factor analysis was conducted using IBM SPSS AMOS 26. The model fitting was evaluated using several indices namely root mean square error of approximation, normed fit index, comparative fit index, and goodness‐of‐fit index. The reliability of the scale was evaluated using Cronbach's alpha and item total correlation. As a results of exploratory factor analysis of the scale, 31 items were loaded which indicated a 6‐factors for the scale that collectively explained 62.59% of total variance. Confirmatory factor analysis also indicated a good fit to the six latent structures with root mean square error of approximation 0.03, normed fit index 0.94, comparative fit index 0.97, and goodness‐of‐fit index 0.91. Internal consistency reliability was satisfactory with Cronbach's alpha coefficient of 0.94 and the item‐total correlation between 0.34 and 0.86. The overall scale was sufficiently reliable. As a result, the HLS‐P is a reliable and relevant measure for assessing health literacy in pregnant women. Thus, this scale is profoundly used as an evaluation tool for measuring health literacy among pregnant women, providing critical information for healthcare professionals and policymakers about the health literacy needs and capacity of service receivers.

Background Visceral leishmaniasis (VL) is a severe parasitic disease transmitted by phlebotomine sandflies. VL is endemic in West Pokot County, Kenya, where effective strategies to interrupt transmission are impeded by the limited understanding of VL risk factors. Therefore, this case–control study aimed to explore environmental, behavioural and household determinants of VL in West Pokot. Methods From November 2022 to January 2023, a structured questionnaire was administered to 36 symptomatic primary VL cases attending Kacheliba Sub‐County Hospital in West Pokot and to 50 healthy controls from local villages. The VL status of all participants was confirmed using an rK39 rapid diagnostic test. Associations between questioned determinants and VL were investigated by means of age‐corrected univariate logistic regression analysis. Results Significant associations were found between VL and housing characteristics, such as window presence and floor type. VL cases more frequently reported the presence of cattle, dogs and sheep in their house yards. VL was also associated with cutting down trees in the house yard and house proximity to several Acacia tree species. Furthermore, outdoor activities, including travelling outside the residence for more than 2 weeks, activities near termite mounds, and forest activities during the rainy season, increased the risk of VL. Conclusions This work reports a number of previously undescribed risk factors for VL in the understudied West Pokot focus. The results suggest VL transmission occurs both peri‐domestically at night and outdoors during the day, particularly when sandfly resting sites are disturbed. Our findings warrant further research into sandfly ecology and potential zoonotic parasite reservoirs in West Pokot.

Objectives This study reports on the prevalence of hepatitis B virus (HBV) in children in Guinea‐Bissau before the hepatitis B vaccine was introduced. Methods Cross‐sectional study. From 2005 to 2008, 187 children aged 18 months were enrolled in a vaccine trial and had blood samples taken to test for HBV (HbsAg, anti‐HBs and anti‐HBc), hepatitis C virus (HCV) and HIV. Results HBsAg prevalence was 11.2% and prevalence of any HBV serological marker was 16.0%. No children were positive for HCV. One was positive for HIV‐1. Conclusions The prevalence of HBsAg was high compared to other sub‐Saharan African countries pre‐immunisation, underscoring the importance of broad and sustained HBV vaccination. This study indicates that the majority of HBV transmission is horizontal during childhood in Guinea‐Bissau.