Charting the evidence for climate change impacts on the global spread of malaria and dengue and adaptive responses: a scoping review of reviews

Evolutionary adaptation under climate change: Aedes sp. demonstrates potential to adapt to warming

Climate warming is expected to shift the distributions of mosquitoes and mosquito-borne diseases, promoting expansions at cool range edges and contractions at warm range edges. However, whether mosquito populations could maintain their warm edges through evolutionary adaptation remains unknown. Here, we investigate the potential for thermal adaptation in Aedes sierrensis, a congener of the major disease vector species that experiences large thermal gradients in its native range, by assaying tolerance to prolonged and acute heat exposure, and its genetic basis in a diverse, field-derived population. We found pervasive evidence of heritable genetic variation in mosquito heat tolerance, and phenotypic trade-offs in tolerance to prolonged versus acute heat exposure. Further, we found genomic variation associated with prolonged heat tolerance was clustered in several regions of the genome, suggesting the presence of larger structural variants such as chromosomal inversions. A simple evolutionary model based on our data estimates that the maximum rate of evolutionary adaptation in mosquito heat tolerance will exceed the projected rate of climate warming, implying the potential for mosquitoes to track warming via genetic adaptation.

Climate change and the emergence and exacerbation of infectious diseases: A review

Experts expressed severe concerns over the possibility of increasing burden of infectious diseases as the planet's climate began to change years ago. There have been increased rates of climate-related catastrophes and as global temperatures rise, emergence of certain viruses has become a serious concern. Vectors are susceptible to changing temperatures as they exhibit innate responses to thermal stress to increase survivability. Climate change impacts virus reservoirs, increasing transmission rates of vectors. Vector-borne diseases have already witnessed increasing numbers compared to before. Certain non-endemic areas are encountering their first-ever infectious disease cases due to increasing temperatures. Tick-borne diseases are undergoing transformations provoking a heightened prevalence. Food-borne illnesses are expected to increase owing to warmer temperatures. It is important to recognize that climate change has a multivariable impact on the transmission of viruses. With climate change comes the potential of increasing interspecies interactions promoting jumps. These factors must be considered, and an informed strategy must be formulated. Adaptation and mitigation strategies are required to curb these diseases from spreading. Despite significant evidence that climate change affects infectious diseases, gaps in research exist. We conducted this review to identify the potential role climate change plays in the emergence of new viruses.

Climate-based modelling and forecasting of dengue in three endemic departments of Peru

Amid profound climate change, incidence of dengue continues to rise and expand in distribution across the world. Here, we analysed dengue in three coastal departments of Peru which have recently experienced public health emergencies during the worst dengue crises in Latin American history. We developed a climate-based spatiotemporal modelling framework to model monthly incidence of new dengue cases in Piura, Tumbes, and Lambayeque over 140 months from 2010 to 2021. The framework enabled accurate description of in-sample and out-of-sample dengue incidence trends across the departments, as well as the characterisation of the timing, structure, and intensity of climatic relationships with human dengue incidence. In terms of dengue incidence rate (DIR) risk factors, we inferred non-linear and delayed effects of greater monthly mean maximum temperatures, extreme precipitation, sustained drought conditions, and extremes of a Peruvian-specific indicator of the El Niño Southern Oscillation. Building on our model-based understanding of climatic influences, we performed climate-model-based forecasting of dengue incidence across 2018 to 2021 with a forecast horizon of one month. Our framework enabled representative, reliable forecasts of future dengue outbreaks, including correct classification of 100% of all future outbreaks with DIR ≥ 50 (or 150) per 100,000, whilst retaining relatively low probability of 0.12 (0.05) for false alarms. Therefore, our model framework and analysis may be used by public health authorities to i) understand climatic drivers of dengue incidence, and ii) alongside our forecasts, to mitigate impacts of dengue outbreaks and potential public health emergencies by informing early warning systems and deployment of vector control resources.

Managing vector-borne diseases in a geoAI-enabled society. Malaria as an example

More than 17 % of all infectious diseases are caused by vector-borne diseases resulting in more than 1 billion cases and over 1 million deaths each year. Of these malaria continues to be a global burden in over eighty countries. As societies become more digitalised, the availability of geospatially enabled health and disease information will become more abundant. With this, the ability to assess health and disease risks in real-time will become a reality. The purpose of this study was to examine how geographic information, geospatial technologies and spatial data science are being used to reduce the burden of vector-borne diseases such as malaria and explore the opportunities that lie ahead with GeoAI and other geospatial technology advancements. Malaria is a dynamic and complex system and as such a range of data and approaches are needed to tackle different parts of the malaria cycle at different local and global scales. Geospatial technologies provide an integrated framework vital for monitoring, analysing and managing vector-borne diseases. GeoAI and technological advancements are useful for enhancing real-time assessments, accelerating the decision making process and spatial targeting of interventions. Training is needed to enhance the use of geospatial information for the management of vector-borne diseases.

Intersections between climate change and antimicrobial resistance: a systematic scoping review

Climate change and antimicrobial resistance (AMR) present crucial challenges for the health and wellbeing of people, animals, plants, and ecosystems worldwide, yet the two are largely treated as separate and unrelated challenges. The aim of this systematic scoping Review is to understand the nature of the growing evidence base linking AMR and climate change and to identify knowledge gaps and areas for further research. We conducted a systematic search of the peer-reviewed literature in Scopus, Web of Science, and PubMed on 27 June, 2022. Our search strategy identified and screened 1687 unique results. Data were extracted and analysed from 574 records meeting our inclusion criteria. 222 (39%) of these reviewed articles discussed harmful synergies in which both climate change and AMR exist independently and can interact synergistically, resulting in negative outcomes. Just over a quarter (n=163; 28%) of the literature contained general or broad references to AMR and climate change, whereas a fifth (n=111; 19%) of articles referred to climate change influencing the emergence and evolution of AMR. 12% of articles (n=70) presented positive synergies between approaches aimed at addressing climate change and interventions targeting the management and control of AMR. The remaining literature focused on the shared drivers of AMR and climate change, the trade-offs between climate actions that have unanticipated negative outcomes for AMR (or vice versa), and, finally, the pathways through which AMR can negatively influence climate change. Our findings indicate multiple intersections through which climate change and AMR can and do connect. Research in this area is still nascent, disciplinarily isolated, and only beginning to converge, with few documents primarily focused on the equal intersection of both topics. Greater empirical and evidence-based attention is needed to investigate knowledge gaps related to specific climate change hazards and antimicrobial resistant fungi, helminths, protists, and viruses.

Perspectives of patients with type 1 and type 2 diabetes on barriers to diabetes care: a qualitative study

BACKGROUND

Diabetes care incorporates multiple integrated elements like self-care practices, patient education and awareness, societal support, equitable access to healthcare facilities and trained healthcare professionals, commitment from the diabetes associations and government policies. There is a dearth of research exploring the barriers experienced by both People with Type 1 diabetes (PwT1D) and People with Type 2 diabetes (PwT2D) in accessing the holistic elements of diabetes care. This study thus aimed at exploring the perceived barriers among PwT1D and PwT2D in accessing diabetes care services in urban and rural areas of Nepal.

METHOD

This study was a qualitative research using phenomenological approach where an in-depth interview with 23 participants on insulin was conducted. This included 15 PwT1D and 8 PwT2D, residing in the capital and rural areas and attending the hospitals and clinic in the urban and semi-urban regions in Nepal. A semi-structured questionnaire was used for the interview. The interviews were transcribed verbatim and deductive thematic analysis was done.

RESULTS

Majority were female participants and most had received a formal education and were visiting the hospitals located in capital city. Mean age for PwT1D was (27.86 ± 1.85) years whereas the median age for PwT2D was [47.5 (IQR, 16.5)] years. Seven themes were generated from the study representing key barriers from patient's perspective. These were: Theme (1) Double stigma: Diabetes diagnosis and insulin use, Theme (2) Non-adherence to insulin and Self-Monitoring of Blood Glucose (SMBG), Theme (3) Logistic challenges in rural areas: Scarcity of healthcare professionals and other healthcare facilities, Theme (4) Dissatisfaction with healthcare services, Theme (5) Patients seeking alternative treatment strategies over allopathic treatment, Theme (6) Limitations of health insurance scheme and Theme (7) Limited role of national diabetes organizations.

CONCLUSION

There is a need in raising awareness among general public especially on T1DM to address the issue of diabetes stigma. An effort in implementation of policies supporting diabetes care and refinement of National Health Insurance Scheme is equally essential. Similarly, strengthening of Health Care System by ensuring availability of insulin, laboratory facilities and trained healthcare professionals in rural areas should be focused to address the inequity in access to healthcare in rural and urban sectors.

The Influence of Climate Change on Vector-Borne Diseases in a Wilderness Medicine Context

The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.

Impacts of climate change on water-related mosquito-borne diseases in temperate regions: A systematic review of literature and meta-analysis

Mosquito-borne diseases are a known tropical phenomenon. This review was conducted to assess the mecha-nisms through which climate change impacts mosquito-borne diseases in temperate regions. Articles were searched from PubMed, Scopus, Web of Science, and Embase databases. Identification criteria were scope (climate change and mosquito-borne diseases), region (temperate), article type (peer-reviewed), publication language (English), and publication years (since 2015). The WWH (who, what, how) framework was applied to develop the research question and thematic analyses identified the mechanisms through which climate change affects mosquito-borne diseases. While temperature ranges for disease transmission vary per mosquito species, all are viable for temperate regions, particularly given projected temperature increases. Zika, chikungunya, and dengue transmission occurs between 18-34 °C (peak at 26-29 °C). West Nile virus establishment occurs at monthly average temperatures between 14-34.3 °C (peak at 23.7-25 °C). Malaria establishment occurs when the consecutive average daily temperatures are above 16 °C until the sum is above 210 °C. The identified mechanisms through which climate change affects the transmission of mosquito-borne diseases in temperate regions include: changes in the development of vectors and pathogens; changes in mosquito habitats; extended transmission seasons; changes in geographic spread; changes in abundance and behaviors of hosts; reduced abundance of mosquito predators; interruptions to control operations; and influence on other non-climate factors. Process and stochastic approaches as well as dynamic and spatial models exist to predict mosquito population dynamics, disease transmission, and climate favorability. Future projections based on the observed relations between climate factors and mosquito-borne diseases suggest that mosquito-borne disease expansion is likely to occur in temperate regions due to climate change. While West Nile virus is already established in some temperate regions, Zika, dengue, chikungunya, and malaria are also likely to become established over time. Moving forward, more research is required to model future risks by incorporating climate, environmental, sociodemographic, and mosquito-related factors under changing climates.

Evolutionary adaptation under climate change: Aedes sp. demonstrates potential to adapt to warming

Climate warming is expected to shift the distributions of mosquitoes and mosquito-borne diseases, facilitating expansions at cool range edges and contractions at warm range edges. However, whether mosquito populations could maintain their warm edges through evolutionary adaptation remains unknown. Here, we investigate the potential for thermal adaptation in Aedes sierrensis, a congener of the major disease vector species that experiences large thermal gradients in its native range, by assaying tolerance to prolonged and acute heat exposure, and its genetic basis in a diverse, field-derived population. We found pervasive evidence of heritable genetic variation in acute heat tolerance, which phenotypically trades off with tolerance to prolonged heat exposure. A simple evolutionary model based on our data shows that the estimated maximum rate of evolutionary adaptation in mosquito heat tolerance typically exceeds that of projected climate warming under idealized conditions. Our findings indicate that natural mosquito populations may have the potential to track projected warming via genetic adaptation. Prior climate-based projections may thus underestimate the range of mosquito and mosquito-borne disease distributions under future climate conditions.

Climate change, malaria and neglected tropical diseases: a scoping review

To explore the effects of climate change on malaria and 20 neglected tropical diseases (NTDs), and potential effect amelioration through mitigation and adaptation, we searched for papers published from January 2010 to October 2023. We descriptively synthesised extracted data. We analysed numbers of papers meeting our inclusion criteria by country and national disease burden, healthcare access and quality index (HAQI), as well as by climate vulnerability score. From 42 693 retrieved records, 1543 full-text papers were assessed. Of 511 papers meeting the inclusion criteria, 185 studied malaria, 181 dengue and chikungunya and 53 leishmaniasis; other NTDs were relatively understudied. Mitigation was considered in 174 papers (34%) and adaption strategies in 24 (5%). Amplitude and direction of effects of climate change on malaria and NTDs are likely to vary by disease and location, be non-linear and evolve over time. Available analyses do not allow confident prediction of the overall global impact of climate change on these diseases. For dengue and chikungunya and the group of non-vector-borne NTDs, the literature privileged consideration of current low-burden countries with a high HAQI. No leishmaniasis papers considered outcomes in East Africa. Comprehensive, collaborative and standardised modelling efforts are needed to better understand how climate change will directly and indirectly affect malaria and NTDs.

Incidence of acute liver failure and its associated mortality in patients with dengue infection: A systematic review and meta-analysis

Acute liver failure (ALF) is a devastating consequence of dengue infection. This systematic review and meta-analysis assessed the incidence of ALF in dengue infection and its associated mortality. We systematically searched the EMBASE and MEDLINE databases from inception to December 2023 for observational studies reporting ALF incidence and mortality in dengue patients. Twenty-one studies encompassing 26,839 dengue-infected patients were included. Meta-analysis revealed a pooled incidence of ALF in cases of general dengue infection of 2.0 % (95 % CI, 1.2-3.0 %), with 1.2 % (95 % CI, 0.6-2.1 %) in adults and 5.0 % (95 % CI, 1.5-10.2 %) in children. ALF incidence was 17.3 % (95 % CI, 6.5 %-31.5 %) in severe dengue and 7.4 % (95 % CI, 0.8-18.5 %) in dengue shock syndrome. The pooled mortality rate of dengue-associated ALF was 47.0 % (95 % CI, 32.9-61.2 %). These findings underscore the detrimental impact of dengue infection on the development of the relatively uncommon, albeit life-threatening, condition of ALF.

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

BACKGROUND

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

METHODS

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

RESULTS

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

CONCLUSIONS

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Modelling and stability analysis of the dynamics of measles with application to Ethiopian data

Measles, a highly contagious airborne disease, remains endemic in many developing countries with low vaccination coverage. In this paper, we present a deterministic mathematical compartmental model to analyze the dynamics of measles. We establish global stability conditions for both disease-free and endemic equilibria using the Lyapunov functional stability method. By using arbitrary parameters, we find that the proposed model exhibits forward bifurcation. To simulate the solution of the model for the forward problem, we perform numerical integration using MATLAB software. Moreover, we calibrate the model with real data from Ethiopia and estimate the parameters along with a 95 percent confidence interval (CI) by formulating an inverse problem. It is noteworthy that our model fits well with the actual data from Ethiopia. The estimated basic reproduction number (R 0 ) is determined to beR 0 = 1.3973 , demonstrating the endemic status of the disease. Additionally, our local sensitivity analysis indicates that reducing the transmission rate and increasing vaccination coverage can effectively minimizeR 0 .

Immunogenicity, safety, and efficacy of a tetravalent dengue vaccine in children and adolescents: an analysis by age group

BACKGROUND

Dengue is an increasing threat to global health. This exploratory analysis evaluated the immunogenicity, safety, and vaccine efficacy (VE) of a live-attenuated tetravalent dengue vaccine (TAK-003) in participants enrolled in the phase 3 DEN-301 trial (NCT02747927), stratified by baseline age (4-5 years; 6-11 years; or 12-16 years).

METHODS

Participants were randomized 2:1 to receive 2 doses of TAK-003, administered 3 months apart, or placebo. Dengue serostatus was evaluated at enrolment. VE against virologically-confirmed dengue (VCD) and hospitalized VCD; immunogenicity (geometric mean titers; GMTs); and safety were evaluated per age group through ∼4 years post-vaccination.

RESULTS

VE against VCD across serotypes was 43.5% (95% confidence interval: 25.3%, 57.3%) for 4-5 year-olds; 63.5% (56.9%, 69.1%) for 6-11 year-olds, and 67.7% (57.8%, 75.2%) for 12-16 year-olds. VE against hospitalized VCD was 63.8% (21.1%, 83.4%), 85.1% (77.1%, 90.3%), and 89.7% (77.9%, 95.2%), for the three age groups, respectively. GMTs remained elevated against all four serotypes for ∼4 years post-vaccination, with no evident differences across age groups. No clear differences in safety by age were identified.

CONCLUSIONS

This exploratory analysis shows TAK-003 was efficacious in dengue prevention across age groups in children and adolescents 4-16 years of age living in dengue endemic areas. Relatively lower VE in 4-5 year-olds was potentially confounded by causative serotype distribution, small sample size, and VE by serotype, and should be considered in benefit-risk evaluations in this age group.

Stem cell-derived exosomes as a potential therapy for schistosomal hepatic fibrosis in experimental animals

Schistosomiasis is a neglected tropical disease. Egg-induced granuloma formation and tissue fibrosis are the main causes of the high morbidity and mortality of schistosomiasis. Mesenchymal stem cells (MSCs)-derived exosomes play an important role with a superior safety profile than MSCs in the treatment of liver fibrosis. Therefore, the aim of this study was to investigate the potential therapeutic effect of MSCs-derived exosomes on schistosomal hepatic fibrosis. Exosomes were isolated from bone marrow MSCs and characterized. A total of 85 mice were divided into four groups: group I (control group), group II (PZQ group) infected and treated with PZQ, group III (EXO group) infected and treated with MSCs-derived exosomes and group IV (PZQ+EXO group) infected and treated with both PZQ and MSCs-derived exosomes. Assessment of treatment efficacy was evaluated by histopathological and immunohistochemical examination of liver sections by proliferating cell nuclear antigen (PCNA) and nuclear factor-κB (NF-κB). The results showed significant reduction of the number and diameter of hepatic granulomas, hepatic fibrosis, upregulation of PCNA expression and reduction of NF-κB expression in EXO and PZQ+EXO groups as compared to other groups at all durations post infection. Additionally, more improvement was observed in PZQ+EXO group. In conclusion, MSCs-derived exosomes are a promising agent for the treatment of schistosomal hepatic fibrosis, and their combination with PZQ shows a synergistic action including antifibrotic and anti-inflammatory effects. However, further studies are required to establish their functional components and their mechanisms of action.

Cambodia's Imminent Graduation from Least Developed Country Status: What Will be the Impact of the TRIPS Agreement on Access to HIV and Hepatitis C Medicines in Cambodia?

Cambodia has experienced exponential economic growth in recent years and is expected to graduate from least developed country (LDC) status within the next decade. Membership of the World Trade Organization (WTO) will require Cambodia to grant product and process patents for pharmaceuticals upon LDC graduation. This study aims to measure the impact of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) on the price of HIV and hepatitis C medicine in Cambodia once it graduates from LDC status and is obliged to make patents available for pharmaceutical products and processes. Using scenarios based on likely outcomes of accession to the TRIPS Agreement, it measures the impact on the price of the HIV treatment program and compares that impact with the hepatitis C treatment program. Graduation from LDC status would be expected to result in a modest increase in the cost of the antiretroviral (ARV) treatment program and very large increases in the cost of the direct acting antivirals (DAA) treatment program. If annual treatment budgets remain constant, patent protection could see 1,515 fewer people living with HIV able to access ARV treatment and 2,577 fewer people able to access DAA treatment (a drop in treatment coverage of 93%).

Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana's health insurance claims data

Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana's National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019-February 2020) relative to the target/pandemic period (March 2020-February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95% CI: $21-$25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review

BACKGROUND

West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

MAIN BODY

We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations (n = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV (n = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies (n = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

CONCLUSIONS

This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local contexts.

Climate change impacts on child and adolescent health and well-being: A narrative review

Background

Worldwide, the climate is changing and affecting the health and well-being of children in many ways. In this review, we provided an overview of how climate change-related events may affect child and adolescent health and well-being, including children's mental and physical health, nutrition, safety and security, learning opportunities, and family caregiving and connectedness.

Methods

In this narrative review, we highlighted and discussed peer-reviewed evidence from 2012-23, primarily from meta-analyses and systematic reviews. The search strategy used a large and varied number of search terms across three academic databases to identify relevant literature.

Results

There was consistent evidence across systematic reviews of impact on four themes. Climate-related events are associated with a) increases in posttraumatic stress and other mental health disorders in children and adolescents, b) increases in asthma, respiratory illnesses, diarrheal diseases and vector-borne diseases, c) increases in malnutrition and reduced growth and d) disruptions to responsive caregiving and family functioning, which can be linked to poor caregiver mental health, stress and loss of resources. Evidence of violence against children in climate-related disaster contexts is inconclusive. There is a lack of systematic review evidence on the associations between climate change and children's learning outcomes.

Conclusions

Systematic review evidence consistently points to negative associations between climate change and children's physical and mental health, well-being, and family functioning. Yet, much remains unknown about the causal pathways linking climate-change-related events and mental and physical health, responsive relationships and connectedness, nutrition, and learning in children and adolescents. This evidence is urgently needed so that adverse health and other impacts from climate change can be prevented or minimised through well-timed and appropriate action.

Future malaria environmental suitability in Africa is sensitive to hydrology

Changes in climate shift the geographic locations that are suitable for malaria transmission because of the thermal constraints on vector Anopheles mosquitos and Plasmodium spp. malaria parasites and the lack of availability of surface water for vector breeding. Previous Africa-wide assessments have tended to solely represent surface water using precipitation, ignoring many important hydrological processes. Here, we applied a validated and weighted ensemble of global hydrological and climate models to estimate present and future areas of hydroclimatic suitability for malaria transmission. With explicit surface water representation, we predict a net decrease in areas suitable for malaria transmission from 2025 onward, greater sensitivity to future greenhouse gas emissions, and different, more complex, malaria transmission patterns. Areas of malaria transmission that are projected to change are smaller than those estimated by precipitation-based estimates but are associated with greater changes in transmission season lengths.

An optical system to detect, surveil, and kill flying insect vectors of human and crop pathogens

Sustainable and effective means to control flying insect vectors are critically needed, especially with widespread insecticide resistance and global climate change. Understanding and controlling vectors requires accurate information about their movement and activity, which is often lacking. The Photonic Fence (PF) is an optical system that uses machine vision, infrared light, and lasers to identify, track, and interdict vectors in flight. The PF examines an insect's outline, flight speed, and other flight parameters and if these match those of a targeted vector species, then a low-power, retina-safe laser kills it. We report on proof-of-concept tests of a large, field-sized PF (30 mL × 3 mH) conducted with Aedes aegypti, a mosquito that transmits dangerous arboviruses, and Diaphorina citri, a psyllid which transmits the fatal huanglongbing disease of citrus. In tests with the laser engaged, < 1% and 3% of A. aegypti and D. citri, respectfully, were recovered versus a 38% and 19% recovery when the lacer was silenced. The PF tracked, but did not intercept the orchid bee, Euglossa dilemma. The system effectively intercepted flying vectors, but not bees, at a distance of 30 m, heralding the use of photonic energy, rather than chemicals, to control flying vectors.

Transcription factor B-H2 regulates CYP9J34 expression conveying deltamethrin resistance in Culex pipiens pallens

BACKGROUND

Mosquitoes are vectors of various diseases, posing significant health threats worldwide. Chemical pesticides, particularly pyrethroids like deltamethrin, are commonly used for mosquito control, but the emergence of resistant mosquito populations has become a concern. In the deltamethrin-resistant (DR) strain of Culex pipiens pallens, the highly expressed cytochrome P450 9 J34 (CYP9J34) gene is believed to play a role in resistance, yet the underlying mechanism remains unclear.

RESULTS

Quantitative polymerase chain reaction with reverse transcription (qRT-PCR) analysis revealed that the expression of CYP9J34 was 14.6-fold higher in DR strains than in deltamethrin-susceptible (DS) strains. The recombinant production of CYP9J34 protein of Cx. pipiens pallens showed that the protein could directly metabolize deltamethrin, yielding the major metabolite 4'-OH deltamethrin. Through dual luciferase reporter assays and RNA interference, the transcription factor homeobox protein B-H2-like (B-H2) was identified to modulate the expression of the CYP9J34 gene, contributing to mosquito resistance to deltamethrin.

CONCLUSIONS

Our findings demonstrate that the CYP9J34 protein could directly degrade deltamethrin, and the transcription factor B-H2 could regulate CYP9J34 expression, influencing the resistance of mosquitoes to deltamethrin. © 2023 Society of Chemical Industry.

Upsurge of dengue outbreaks in several WHO regions: Public awareness, vector control activities, and international collaborations are key to prevent spread

Background

Dengue, the world's fastest-growing vector-borne disease, has skyrocketed in the 21st century. Dengue has harmed human health since its first known cases among Spanish soldiers in the Philippines to its 21st-century outbreaks in Southeast Asia, the Pacific, and the Americas. In light of the current circumstances, it is imperative to investigate its origin and prevalence, enabling the implementation of effective interventions to curb the upsurge.

Methods

Our study examines the history of dengue outbreaks, and evolving impact on public health, aiming to offer valuable insights for a more resilient public health response worldwide. In this comprehensive review, we incorporated data from renowned databases such as PubMed, Google Scholar, and Scopus to provide a thorough analysis of dengue outbreaks.

Results

Recent dengue outbreaks are associated with rapid urbanization, international travel, climatic change, and socioeconomic factors. Rapid urbanization and poor urban design and sanitation have created mosquito breeding places for dengue vectors. Also, international travel and trade have spread the pathogen. Climate change in the past two decades has favored mosquito habitats and outbreaks. Socioeconomic differences have also amplified the impact of dengue outbreaks on vulnerable communities. Dengue mitigation requires vector control, community engagement, healthcare strengthening, and international cooperation.

Conclusion

Climate change adaptation and urban planning are crucial. Although problems remain, a comprehensive vector control and community involvement plan may reduce dengue epidemics and improve public health in our interconnected world.

Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis

BACKGROUND

Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low- and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time.

METHODS

We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al. for nonlinear response models.

RESULTS

CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, 2010: 36.16%, 2016: 33.61%), highest consumption quintile (2005: 32.35%, 2010: 15.32%, 2016: 18.39%), and exclusive reliance on informal healthcare sources (2005: -36.46%, 2010: -10.17%, 2016: -12.58%). Distinctively, the presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%, p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%, p-value ≤ 0.01) and secondary or higher education (7.44%, p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010.

CONCLUSIONS

Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangladesh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.

The One Health Concept

The concept of One Health has been developed as the appreciation that human health is intricately connected to those of other animals and the environment that they inhabit. In recent years, the COVID-19 pandemic and noticeable effects of climate change have encouraged national and international cooperation to apply One Health strategies to address key issues of health and welfare. The United Nations (UN) Sustainable Development Goals have established targets for health and wellbeing, clean water and sanitation, climate action, as well as sustainability in marine and terrestrial ecosystems. The One Health Quadripartite comprises the World Health Organization (WHO), the World Organization for Animal Health (WOAH-formerly OIE), the United Nations Food and Agriculture Organization (FAO) and the United Nations Environment Programme (UNEP). There are six areas of focus which are Laboratory services, Control of zoonotic diseases, Neglected tropical diseases, Antimicrobial resistance, Food safety and Environmental health. This article discusses the concept of One Health by considering examples of infectious diseases and environmental issues under each of those six headings. Biomedical Scientists, Clinical Scientists and their colleagues working in diagnostic and research laboratories have a key role to play in applying the One Health approach to key areas of healthcare in the 21st Century.

Dengue and chikungunya: future threats for Northern Europe?

Arthropod-borne viral diseases are likely to be affected by the consequences of climate change with an increase in their distribution and intensity. Among these infectious diseases, chikungunya and dengue viruses are two (re)emergent arboviruses transmitted by Aedes species mosquitoes and which have recently demonstrated their capacity for rapid expansion. They most often cause mild diseases, but they can both be associated with complications and severe forms. In Europe, following the establishment of invasive Aedes spp, the first outbreaks of autochtonous dengue and chikungunya have already occurred. Northern Europe is currently relatively spared, but climatic projections show that the conditions are permissive for the establishment of Aedes albopictus (also known as the tiger mosquito) in the coming decades. It is therefore essential to question and improve the means of surveillance in northern Europe, at the dawn of inevitable future epidemics.

Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis

INTRODUCTION

Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns.

METHODS

This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths.

RESULTS

A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors.  CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.

The impact of anthropogenic climate change on pediatric viral diseases

The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State

Background

There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes.

Methods

This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software.

Results

The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis.

Conclusion

The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.

Examining corruption risks in the procurement and distribution of COVID-19 vaccines in select states in Nigeria

BACKGROUND

Public health emergencies raise significant concerns about corruption and accountability; however, these concerns can manifest in different ways across diverse locations. For instance, more developed countries with a stronger rule of law may experience more corruption in vaccine procurement, whereas developing countries may experience more corruption at the point of distribution and delivery to end users. This research focuses on corruption concerns in Nigeria, specifically examining the procurement and distribution of COVID-19 vaccines.

METHODS

This paper utilizes a scoping review and a qualitative research approach. Key informants (n = 40) involved in the procurement and distribution of COVID-19 vaccines across two states in Nigeria were interviewed. Findings from the scoping review were summarized, and collected data were inductively coded and analysed in themes, revealing clear examples of implementation irregularities and corruption in the country's COVID-19 vaccination processes.

RESULTS

Vaccination programme budgeting processes were unclear, and payment irregularities were frequently observed, resulting in vaccinators soliciting informal payments while in the field. Recruitment and engagement of vaccination personnel was opaque, while target vaccination rates incentivized data falsification during periods of vaccine hesitancy. Accountability mechanisms, such as health worker supervision, vaccination data review, and additional technical support provided by donors were implemented but not effective at preventing corruption among frontline workers.

CONCLUSIONS

Future accountability measures should be evidence-driven based on findings from this research. Personnel recruitment, contracting, budgeting, and remuneration should focus on transparency and accountability.

Local Weather Station Design and Development for Cost-Effective Environmental Monitoring and Real-Time Data Sharing

Current weather monitoring systems often remain out of reach for small-scale users and local communities due to their high costs and complexity. This paper addresses this significant issue by introducing a cost-effective, easy-to-use local weather station. Utilizing low-cost sensors, this weather station is a pivotal tool in making environmental monitoring more accessible and user-friendly, particularly for those with limited resources. It offers efficient in-site measurements of various environmental parameters, such as temperature, relative humidity, atmospheric pressure, carbon dioxide concentration, and particulate matter, including PM 1, PM 2.5, and PM 10. The findings demonstrate the station's capability to monitor these variables remotely and provide forecasts with a high degree of accuracy, displaying an error margin of just 0.67%. Furthermore, the station's use of the Autoregressive Integrated Moving Average (ARIMA) model enables short-term, reliable forecasts crucial for applications in agriculture, transportation, and air quality monitoring. Furthermore, the weather station's open-source nature significantly enhances environmental monitoring accessibility for smaller users and encourages broader public data sharing. With this approach, crucial in addressing climate change challenges, the station empowers communities to make informed decisions based on real-time data. In designing and developing this low-cost, efficient monitoring system, this work provides a valuable blueprint for future advancements in environmental technologies, emphasizing sustainability. The proposed automatic weather station not only offers an economical solution for environmental monitoring but also features a user-friendly interface for seamless data communication between the sensor platform and end users. This system ensures the transmission of data through various web-based platforms, catering to users with diverse technical backgrounds. Furthermore, by leveraging historical data through the ARIMA model, the station enhances its utility in providing short-term forecasts and supporting critical decision-making processes across different sectors.

Efficient sex separation by exploiting differential alternative splicing of a dominant marker in Aedes aegypti

Only female mosquitoes consume blood giving them the opportunity to transmit deadly human pathogens. Therefore, it is critical to remove females before conducting releases for genetic biocontrol interventions. Here we describe a robust sex-sorting approach termed SEPARATOR (Sexing Element Produced by Alternative RNA-splicing of A Transgenic Observable Reporter) that exploits sex-specific alternative splicing of an innocuous reporter to ensure exclusive dominant male-specific expression. Using SEPARATOR, we demonstrate reliable sex selection from early larval and pupal stages in Aedes aegypti, and use a Complex Object Parametric Analyzer and Sorter (COPAS) to demonstrate scalable high-throughput sex-selection of first instar larvae. Additionally, we use this approach to sequence the transcriptomes of early larval males and females and find several genes that are sex-specifically expressed. SEPARATOR can simplify mass production of males for release programs and is designed to be cross-species portable and should be instrumental for genetic biocontrol interventions.

The regulation of endocrine-disrupting chemicals to minimize their impact on health

Endocrine-disrupting chemicals (EDCs) are substances generated by human industrial activities that are detrimental to human health through their effects on the endocrine system. The global societal and economic burden posed by EDCs is substantial. Poorly defined or unenforced policies can increase human exposure to EDCs, thereby contributing to human disease, disability and economic damage. Researchers have shown that policies and interventions implemented at both individual and government levels have the potential to reduce exposure to EDCs. This Review describes a set of evidence-based policy actions to manage, minimize or even eliminate the widespread use of these chemicals and better protect human health and society. A number of specific challenges exist: defining, identifying and prioritizing EDCs; considering the non-linear or non-monotonic properties of EDCs; accounting for EDC exposure effects that are latent and do not appear until later in life; and updating testing paradigms to reflect 'real-world' mixtures of chemicals and cumulative exposure. A sound strategy also requires partnering with health-care providers to integrate strategies to prevent EDC exposure in clinical care. Critical next steps include addressing EDCs within global policy frameworks by integrating EDC exposure prevention into emerging climate policy.

Associations between Dengue Incidence, Ecological Factors, and Anthropogenic Factors in Singapore

Singapore experiences endemic dengue. Vector control remains the primary means to reduce transmission due to the lack of available therapeutics. Resource limitations mean that vector-control tools need to be optimized, which can be achieved by studying risk factors related to disease transmission. We developed a statistical modelling framework which can account for a high-resolution and high-dimensional set of covariates to delineate spatio-temporal characteristics that are associated with dengue transmission from 2014 to 2020 in Singapore. We applied the proposed framework to two distinct datasets, stratified based on the primary type of housing within each spatial unit. Generalized additive models reveal non-linear exposure responses between a large range of ecological and anthropogenic factors as well as dengue incidence rates. At values below their mean, lesser mean total daily rainfall (Incidence rate ratio (IRR): 3.75, 95% CI: 1.00-14.05, Mean: 4.40 mm), decreased mean windspeed (IRR: 3.65, 95% CI: 1.87-7.10, Mean: 4.53 km/h), and lower building heights (IRR: 2.62, 95% CI: 1.44-4.77, Mean: 6.5 m) displayed positive associations, while higher than average annual NO2 concentrations (IRR: 0.35, 95% CI: 0.18-0.66, Mean: 13.8 ppb) were estimated to be negatively associated with dengue incidence rates. Our study provides an understanding of associations between ecological and anthropogenic characteristics with dengue transmission. These findings help us understand high-risk areas of dengue transmission, and allows for land-use planning and formulation of vector control policies.

Environmental Change, Changing Biodiversity, and Infections-Lessons for Kidney Health Community

There is a direct and accelerating connection between ongoing environmental change, the unprecedented decline in biodiversity, and the increase in infectious disease epidemiology worldwide. Rising global temperatures are threatening the biodiversity that underpins the richness and diversity of flora and fauna species in our ecosystem. Anthropogenic activities such as burning fossil fuels, deforestation, rapid urbanization, and expanding population are the primary drivers of environmental change resulting in biodiversity collapse. Climate change is influencing the emergence, prevalence, and transmission of infectious diseases both directly and through its impact on biodiversity. The environment is gradually becoming more suitable for infectious diseases by affecting a variety of pathogens, hosts, and vectors and by favoring transmission rates in many parts of the world that were until recently free of these infections. The acute effects of these zoonotic, vector and waterborne diseases are well known; however, evidence is emerging about their role in the development of chronic kidney disease. The pathways linking environmental change and biodiversity loss to infections impacting kidney health are diverse and complex. Climate change and biodiversity loss disproportionately affect the vulnerable and limit their ability to access healthcare. The kidney health community needs to contribute to the issue of environmental change and biodiversity loss through multisectoral action alongside government, policymakers, advocates, businesses, and the general population. We describe various aspects of the environmental change effects on the transmission and emergence of infectious diseases particularly focusing on its potential impact on kidney health. We also discuss the adaptive and mitigation measures and the gaps in research and policy action.

Efficient Sex Separation by Exploiting Differential Alternative Splicing of a Dominant Marker in Aedes aegypti

Only female mosquitoes consume blood and transmit deadly human pathogens. Therefore, it is critical to remove females before conducting releases for genetic biocontrol interventions. Here we describe a robust sex-sorting approach termed SEPARATOR (Sexing Element Produced by Alternative RNA-splicing of A Transgenic Observable Reporter) that exploits sex-specific alternative splicing of an innocuous reporter to ensure exclusive dominant male-specific expression. Using SEPARATOR, we demonstrate reliable sex selection from larval and pupal stages in Aedes aegypti, and use a Complex Object Parametric Analyzer and Sorter (COPAS®) to demonstrate scalable high-throughput sex-selection of first instar larvae. Additionally, we use this approach to sequence the transcriptomes of early larval males and females and find several genes that are sex-specifically expressed in males. SEPARATOR can simplify mass production of males for release programs and is designed to be cross-species portable and should be instrumental for genetic biocontrol interventions.

Heatwave and mental health

Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.

Sociodemographic factors associated to knowledge and attitudes towards dengue prevention among the Peruvian population: findings from a national survey

OBJECTIVES

To evaluate the frequency of knowledge and attitudes towards dengue prevention among the Peruvian population, as well as the sociodemographic factors associated with reported knowledge and attitude outcomes.

DESIGN/SETTING

A cross-sectional study was conducted, based on information from the National Survey of Budget Programs of Peru, 2019.

PARTICIPANTS

We included 57 829 respondents with a mean age of 40.3±17.4 years, of whom 52.8% were women and 87.6% were from urban areas.

PRIMARY AND SECONDARY OUTCOMES

Knowledge about dengue infection (transmission, symptoms, importance of going to a health centre and not self-medicating) and preventive attitudes to avoid infection.

RESULTS

Of all the respondents, 36.2% (n=23 247) presented good knowledge about dengue and 11.6% (n=7890) had a higher number of preventive attitudes (≥3 attitudes). In the multivariate regression analysis, we found that being female (for knowledge: aPR (adjusted prevalence ratio): 1.03; 95% CI 1.02 to 1.03; and for attitude: aPR: 1.02; 95% CI 1.01 to 1.02), being married/cohabiting (for knowledge: aPR: 1.02; 95% CI 1.00 to 1.03; and for attitude: aPR: 1.01; 95% CI 1.00 to 1.02) and residing in the jungle (for knowledge: aPR: 1.14; 95% CI 1.12 to 1.16; and for attitude: aPR: 1.09; 95% CI 1.07 to 1.11) were associated with better knowledge and more preventive attitudes. In addition, we found that being an adolescent (for knowledge: aPR: 0.97; 95% CI 0.96 to 0.99; and for attitude: aPR: 0.99; 95% CI 0.97 to 0.99), and belonging to the Quechua ethnic group (for knowledge: aPR: 0.93; 95% CI 0.91 to 0.94; and for attitude: aPR: 0.98; 95% CI 0.97 to 0.99) were associated with a lower proportion of adequate knowledge and fewer preventive attitudes.

CONCLUSIONS

Our study found a high proportion of poor knowledge and few preventive attitudes towards dengue in the Peruvian population. That highlights the requirement to implement national strategies to educate people about dengue and promote preventive attitudes, considering the factors found.

Predicting Plasmodium knowlesi transmission risk across Peninsular Malaysia using machine learning-based ecological niche modeling approaches

The emergence of potentially life-threatening zoonotic malaria caused by Plasmodium knowlesi nearly two decades ago has continued to challenge Malaysia healthcare. With a total of 376 P. knowlesi infections notified in 2008, the number increased to 2,609 cases in 2020 nationwide. Numerous studies have been conducted in Malaysian Borneo to determine the association between environmental factors and knowlesi malaria transmission. However, there is still a lack of understanding of the environmental influence on knowlesi malaria transmission in Peninsular Malaysia. Therefore, our study aimed to investigate the ecological distribution of human P. knowlesi malaria in relation to environmental factors in Peninsular Malaysia. A total of 2,873 records of human P. knowlesi infections in Peninsular Malaysia from 1st January 2011 to 31st December 2019 were collated from the Ministry of Health Malaysia and geolocated. Three machine learning-based models, maximum entropy (MaxEnt), extreme gradient boosting (XGBoost), and ensemble modeling approach, were applied to predict the spatial variation of P. knowlesi disease risk. Multiple environmental parameters including climate factors, landscape characteristics, and anthropogenic factors were included as predictors in both predictive models. Subsequently, an ensemble model was developed based on the output of both MaxEnt and XGBoost. Comparison between models indicated that the XGBoost has higher performance as compared to MaxEnt and ensemble model, with AUC_ROC values of 0.933 ± 0.002 and 0.854 ± 0.007 for train and test datasets, respectively. Key environmental covariates affecting human P. knowlesi occurrence were distance to the coastline, elevation, tree cover, annual precipitation, tree loss, and distance to the forest. Our models indicated that the disease risk areas were mainly distributed in low elevation (75-345 m above mean sea level) areas along the Titiwangsa mountain range and inland central-northern region of Peninsular Malaysia. The high-resolution risk map of human knowlesi malaria constructed in this study can be further utilized for multi-pronged interventions targeting community at-risk, macaque populations, and mosquito vectors.

mHealth in Sub-Saharan Africa and Europe: Context of current health, healthcare status, and demographic structure

Introduction

The advent of digital systems and global mobile phone availability presents an opportunity for better healthcare access and equity. However, the disparity in the usage and availability of mHealth systems between Europe and Sub-Saharan Africa (SSA) has not been explored in relation to current health, healthcare status, and demographics.

Objective

This study aimed to compare mHealth system availability and use in SSA and Europe in the above-mentioned context.

Methods

The study analyzed health, healthcare status, and demographics in both regions. It assessed mortality, disease burden, and universal health coverage. A systematic narrative review was conducted to thoroughly assess available data on mHealth availability and use, guiding future research in the field.

Results

SSA is on the verge of stages 2 and 3 in the demographic transition with a youthful population and high birth rate. Communicable, maternal, neonatal, and nutritional diseases contribute to high mortality and disease burden, including child mortality. Europe is on the verge of stages 4 and 5 in the demographic transition with low birth and death rates. Europe's population is old, and non-communicable diseases (NCDs) pose major health challenges. The mHealth literature adequately covers cardiovascular disease/heart failure, and cancer. However, it lacks approaches for respiratory/enteric infections, malaria, and NCDs.

Conclusions

mHealth systems in SSA are underutilized than in Europe, despite alignment with the region's demographics and major health issues. Most initiatives in SSA lack implementation depth, with only pilot tests or small-scale implementations. Europe's reported cases highlight actual implementation and acceptability, indicating a strong implementation depth of mHealth systems.

Measuring efficiency of the global fight against the COVID-19 pandemic

Objectives

The ongoing COVID-19 pandemic has led to an unprecedented loss of life and a severe economic downturn across the globe. Countries have adopted various social distancing and vaccination policies to reduce the spread of the disease and lessen the impact on healthcare systems. The world should work together to confront the disaster and challenge of COVID-19.

Methods

This study uses stochastic frontier analysis to measure the efficiency and influencing factors of the global response to COVID-19 epidemics and to provide follow-up strategies and reference guidelines.

Results

The results of this study show that (1) the average efficiency of the global response to COVID-19 is not good, with significant space for improvement of up to 60%; (2) adequate medical supplies and equipment can reduce mortality; (3) the initial implementation of social distancing policies and wearing masks can effectively reduce the infection rate; and (4) as infection rates and vaccination rates increase so that most people have basic immunity to COVID-19, the epidemic will gradually be reduced.

Conclusions

As the world becomes more aware of the COVID-19 disease, humans will gradually return to normal social interaction and lifestyles. The results of this study are expected to provide a reference for the future direction of the global fight against epidemics and the improvement of public health policies.

Epidemiological, Entomological, and Climatological Investigation of the 2019 Dengue Fever Outbreak in Gewane District, Afar Region, North-East Ethiopia

Dengue Fever (DF) is an important arthropod-borne viral infection that has repeatedly occurred as outbreaks in eastern and northeastern Ethiopia since 2013. A cross-sectional epidemiological outbreak investigation was carried out from September to November 2019 on febrile patients (confirmed malaria negative) who presented with suspected and confirmed DF at both public and private health facilities in Gewane District, Afar Region, northeastern Ethiopia. Entomological investigation of containers found in randomly selected houses belonging to DF-positive patients was undertaken to survey for the presence of Aedes larvae/pupae. A total of 1185 DF cases were recorded from six health facilities during the 3-month study period. The mean age of DF cases was 27.2 years, and 42.7% of cases were female. The most affected age group was 15−49 years old (78.98%). The total case proportions differed significantly across age groups when compared to the population distribution; there were approximately 15% and 5% higher case proportions among those aged 15−49 years and 49+ years, respectively. A total of 162 artificial containers were inspected from 62 houses, with 49.4% found positive for Aedes aegypti larva/pupae. Aedes mosquitoes were most commonly observed breeding in plastic tanks, tires, and plastic or metal buckets/bowls. World Health Organization entomological indices classified the study site as high risk for dengue virus outbreaks (House Index = 45.2%, Container Index = 49.4%, and Breteau Index = 129). Time series climate data, specifically rainfall, were found to be significantly predictive of AR (p = 0.035). Study findings highlight the importance of vector control to prevent future DF outbreaks in the region. The scarcity of drinking water and microclimatic conditions may have also contributed to the occurrence of this outbreak.

A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment

Health-Care Risk Waste (HCRW) treatment protects the environment and lives. HCRW is waste from patient diagnostics, immunization, surgery, and therapy. HCRW must be treated before disposal since it pollutes, spreads illnesses, and causes harm. However, waste treatment increases the healthcare sector's carbon footprint, making the healthcare sector a major contributor to anthropogenic climate change. This is because treating HCRW pollutes the environment and requires a lot of energy. Treating HCRW is crucial, but its risks are not well-studied. Unintentionally, treating HCRW leads to climate change. Due to frequent climate-related disasters, present climate-change mitigation strategies are insufficient. All sectors, including healthcare, must act to mitigate and prevent future harms. Healthcare can reduce its carbon footprint to help the environment. All contributing elements must be investigated because healthcare facilities contribute to climate change. We start by evaluating the environmental impact of different HCRW treatment technologies and suggesting strategies to make treatments more sustainable, cost-effective, and reliable to lower the carbon footprint.

Engineering a sustainable future for point-of-care diagnostics and single-use microfluidic devices

Single-use, disposable, point-of-care diagnostic devices carry great promise for global health, including meeting urgent needs for testing and diagnosis in places with limited laboratory facilities. Unfortunately, the production and disposal of single-use devices, whether in lateral flow assay, cartridges, cassettes, or lab-on-chip microfluidic format, also poses significant challenges for environmental and human health. Point-of-care devices are commonly manufactured from unsustainable polymeric materials derived from fossil sources. Their disposal often necessitates incineration to reduce infection risk, thereby creating additional release of CO2. Many devices also contain toxic chemicals, such as cyanide derivatives, that are damaging to environmental and human health if not disposed of safely. Yet, in the absence of government regulatory frameworks, safe and sustainable waste management for these novel medical devices is often left unaddressed. There is an urgent need to find novel solutions to avert environmental and human harm from these devices, especially in low- and middle-income countries where waste management infrastructure is often weak and where the use of point-of-care tests is projected to rise in coming years. We review here common materials used in the manufacture of single-use point-of-care diagnostic tests, examine the risks they pose to environmental and human health, and investigate replacement materials that can potentially reduce the impact of microfluidic devices on the production of harmful waste. We propose solutions available to point-of-care test developers to start embedding sustainability at an early stage in their design, and to reduce their non-renewable plastic consumption in research and product development.