Reductions in development assistance for health funding threaten decades of progress in Africa.

Countries across Africa face health crises driven by aid cuts, shifting demography, and infectious and environmental threats. Renewed public health strategies, smarter investment, and stronger surveillance can help, but reversing funding cuts is vital.

Electroencephalogram Features Distinguish Cases of Cerebral Malaria Among Malawian Children With Fever and Coma.

Background: In febrile comatose patients living in malaria-endemic areas, overlapping symptoms and limited laboratory capacity make it difficult to distinguish parasitic, bacterial, and viral central nervous system infections. We evaluated electroencephalography (EEG) as a biomarker to differentiate the microbiologic etiology of pediatric febrile coma at a major referral center in Malawi.

Methods: This was a retrospective case-control study comparing EEG recordings of Malawian children with cerebral malaria to those with febrile coma of nonmalarial cause (bacterial meningitis, viral encephalitis, or unknown cause).

Costs and cost-effectiveness of integrated horizontal community health worker programmes in low- and middle-income countries (2015-2024): a scoping literature review.

Background: Community health workers (CHWs) play a vital role in delivering primary health care in low- and middle-income countries (LMICs), addressing multiple diseases through horizontal programmes. Despite their effectiveness, there is a US$4.4 billion annual funding gap for professional CHW programmes.

Using Electroencephalography to Assess Coma Etiology in Children with Retinopathy-Negative Cerebral Malaria.

Autopsy studies of children dying of cerebral malaria (CM) have revealed that those with malarial retinopathy exhibited high levels of sequestration in the cerebral vasculature, whereas children with retinopathy-negative CM exhibited lower sequestration levels and possible nonmalarial causes of death. This suggests that children dying of retinopathy-negative CM have nonmalarial coma etiologies with concomitant incidental parasitemia, which is common in high malaria transmission areas. Subsequent studies have challenged this assertion, positing that retinopathy-negative CM and retinopathy-positive CM are variants of the same disease pathophysiology or host biology, both caused by acute malaria infection.

Improved Speech Recognition in Adults With Conductive or Mixed Hearing Loss Using a Direct-to-Consumer Bone-Conduction Device: A Multiple Methods Intervention Study.

Background: Hearing loss affects 20% of the global population, including 250 million experiencing chronic suppurative otitis media, which can present challenges for conventional hearing aids due to ear discharge. Although assistive technology for hearing is available in high-income settings, provision is poor in low-income settings due to high costs and low availability of audiology services, reaching approximately 3% of those who could benefit from it.

Objective: This study aimed to evaluate the performance of a low-cost self-fitted direct-to-consumer bone-conduction headset for individuals with conductive or mixed hearing loss.

The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa.

Background: On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programs, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. A limited waiver option became available, but its implementation remains incomplete. We estimated the impact of these policy changes on HIV deaths and new infections in seven sub-Saharan African (SSA) countries-Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe -, which together account for about half of all people living with HIV in SSA.

How "Global" are Globally Oriented Pulmonary Rehabilitation Studies? Strategies to Promote Equitable Participation From Low- and Middle-Income Countries: A Systematic Review.

Purpose: To perform a systematic review of globally oriented pulmonary rehabilitation (PR) studies and describe low- and middle-income country (LMIC) participation including its enablers and barriers.

Review Methods: Systematic search of PubMed was performed on November 18, 2024 using a search string "pulmonary rehabilitation" AND ("global" OR "international" OR "consensus" OR "standards" OR "guidelines" OR "recommendations" OR "statement" OR "position") followed by citation searching. All PR publications from January 1, 2010 onwards were included if they were globally oriented, reported original research data, and targeted people with chronic respiratory disease (with or without comorbidity).

Lessons learnt during establishment of COVID-19 active vaccine safety surveillance in nine African countries.

Background: Globally, several gaps in vaccine safety surveillance exist, particularly in low- and middle- income countries (LMICs). Establishing and maintaining vaccine surveillance platforms in resource-constrained settings poses significant challenges. These countries often rely on paper-based medical records and immunization cards, lack unique patient identifiers across the healthcare systems, have limited electronic data capture capabilities, and face a shortage of clinical reviewers for case assessments.

Ficolin-1 in pediatric malaria and its possible role in parasite clearance and anemia.

malaria causes significant disease, especially in young children. A successful immune response to is a major determinant of clinical outcome. The ficolins are a family of lectins that act as pattern recognition molecules and can activate the lectin complement pathway and may promote inflammation and facilitate opsonization and lysis of pathogens.

Acceptability of pulmonary rehabilitation in Malawi: a qualitative study.

Background: Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.

Objectives: To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.

Methods: This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises.

Costs and cost-effectiveness of community health worker programs focussed on HIV, TB and malaria infectious diseases in low- and middle-income countries (2015-2024): A scoping literature review.

Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented. We performed a scoping review, searching ten databases and the grey literature for original studies published between August 2015 and July 2024.

Who has never tested for HIV following a community-based distribution of HIV self-test kits? Establishing associated predictors in rural Zimbabwe.

In 2023, Zimbabwe attained the 95-95-95 UNAIDS targets. However, some sub-populations are substantially less likely to have tested for HIV. Knowledge of characteristics of these groups is crucial in designing interventions that address their needs.

Coercing for public health: reflections on the role of coercion in public health emergencies.

The workshop, Coercing for Health: Transdisciplinary Approaches to the Ethics of Coercive Public Health Policies was held at the University of Oxford on July 3rd and 4th, 2024. This paper provides both a summary of the workshop proceedings and reflections and directions for future research on coercive public health measures. The workshop consisted of four key parts: defining coercion; history and legal analysis of coercion; public health ethics perspectives on coercion; experiences of coercive public health measures.

Personalised risk-prediction tools for cryptococcal meningitis mortality to guide treatment stratification in sub-Saharan Africa: a prognostic modelling study based on pooled analysis of two randomised controlled trials.

Background: Cryptococcal meningitis is a major driver of global HIV-related mortality, and validated approaches to stratify mortality risk could help to target effective treatment strategies. We aimed to develop and validate models to predict risk of all-cause mortality in people with HIV-associated cryptococcal meningitis in sub-Saharan African countries.

Methods: For this prediction modelling study, we pooled individual-level data from the ACTA (ISRCTN45035509) and AMBITION-cm (ISRCTN72509687) randomised controlled trials.

Aetiologies, neuroradiological features, and risk factors for mortality and long-term neurosequelae of febrile coma in Malawian children: a prospective cohort study.

Background: Children in febrile coma in Africa are frequently hospitalised, with poorer outcomes than those in high-income settings. Cerebral malaria is historically the most common cause of febrile coma. Due to limited diagnostic and radiological resources and a decrease in malaria prevalence, there might be under-recognition of non-malarial coma.

The aetiologies, mortality, and disability of non-traumatic coma in African children: a systematic review and meta-analysis.

Background: Non-traumatic coma in African children is a common life-threatening presentation often leading to hospital attendance. We aimed to estimate the distribution of non-traumatic coma causes and outcomes, including disease-specific outcomes, for which evidence is scarce.

Methods: We systematically reviewed MEDLINE, Embase, and Scopus databases from inception to Feb 6, 2024.

Do community-level factors play a role in HIV self-testing uptake, linkage to services and HIV-related outcomes? A mixed methods study of community-led HIV self-testing in rural Zimbabwe.

Community-led interventions, where communities plan and lead implementation, are increasingly being adopted within public health programmes. We explore factors associated with successful community-led distribution of HIV self-test (HIVST) kits to guide future service delivery. Twenty rural communities were supported to distribute HIVST kits for 1-month between January and September 2019.

Developing an intervention to improve early infant HIV diagnosis service uptake among postpartum women in Malawi's primary healthcare using a co-designing approach with stakeholders.

Low health service use by women and infants after birth limits early infant HIV diagnosis (EID). From August 2021 to December 2022, we collaborated with 44 healthcare workers (HCW), service users, and non-governmental organisation stakeholders from seven public facilities and five non-governmental organisations in Blantyre, building on a previous study. We analysed context-specific problems in EID services and co-designed a context-appropriate enhanced health system intervention to improve the uptake of six weeks' EID services in primary health facilities in Blantyre, Malawi, using qualitative methods and co-designing workshops.

Recruitment strategies used to enrol healthy volunteers in the first pneumococcal human infection study in Africa: Lessons from Blantyre, Malawi.

Background: Human Infection Studies (HIS) also known as Controlled Human Infection Models (CHIM) are a relatively new concept in African countries to clinicians, scientists, and communities alike. We have introduced HIS/CHIM studies to Malawi during the last four years by developing an experimental human pneumococcal carriage model. This CHIM was used to test the efficacy of a licensed 13-valent Pneumococcal Conjugate Vaccine (PCV13) against experimental nasal pneumococcal carriage.

Community-led strategies for communicable disease prevention and management in low- and middle- income countries: A mixed-methods systematic review of health, social, and economic impact.

Control of infectious diseases is a global health priority and a target of the 2015-2030 Sustainable Development Goals (SDGs). Community participation is fundamental to advancing primary health care and meeting SDGs. We conducted a mixed-methods systematic literature review of quantitative and qualitative evidence to understand the health, social, and economic impact of community-led strategies for communicable disease prevention and management in low- and middle- income countries.

A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: an international multicentre intervention study.

Background: Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi.

Methods: With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice.

A retrospective study to understand the differences in maternal mortality among women admitted in critical and stable conditions in Malawi.

Introduction: Addressing the burden of preventable maternal deaths remains a critical focus of global health efforts in countries like Malawi which still has a high maternal mortality ratio of 381 deaths per 100 000 live births. We investigated the differences in case characteristics, survival and causes of death between pregnant and recently pregnant women who died, following their admission in stable or critical conditions to healthcare facilities in Malawi.

Methods: We conducted a retrospective analysis of maternal deaths of women from all district and central hospitals of Malawi between August 2020 and August 2022.

A pilot study to explore utility of electronic informed consent in a low- income setting; the case of a Controlled human infection study in Blantyre, Malawi.

Background: Electronic informed consent can improve accuracy, workflow, and overall patient experience in clinical research but has not been used in Malawi, owing to uncertainty about availability, utility, patient data security and technical support.

Objectives: We aimed to explore the utility of electronic consent (e-consent) in an ongoing human infection study in Blantyre, Malawi.

Methods: The approved paper consent forms were digitized using Open Data Kit (ODK).