International Centre for Diarrhoeal Disease Research

BackgroundDespite a global decreasing trend in neglected tropical diseases (NTDs), progress is not on track to meet the Sustainable Development Goals by 2030. Evidence suggests a positive effect of conditional cash transfer programs on controlling NTDs. However, it remains to be evaluated whether other financial incentive programs exert similar effects on NTD-related service utilization and treatment outcomes in low- and middle-income countries (LMICs).ObjectiveThis systematic review aims to evaluate the effects of cash transfer and incentive programs on NTD-related service utilization and treatment outcomes in LMICs; to examine how covariates, program design, and implementation plan influence these outcomes; and to examine how NTD-related service utilization and treatment outcomes influence nutritional status and health in LMICs.MethodsThis review will follow the PICOS (Population, Interventions, Comparators, Outcomes, Study Design) framework. The population of this review will be restricted to adults and children of all ages in LMICs. For intervention selection, we will include any program or policies addressing socioeconomic disadvantage through the provision of cash transfers or incentive programs, including but not limited to in-kind transfers, food vouchers, free medicine vouchers, discount coupons, and microcredit to households or individuals. Eligible comparators will be the population who did not receive any intervention, recipients of interventions from before the intervention, and populations or areas exposed to different levels of intervention coverage. The primary outcomes will be service utilization and treatment outcomes related to any of the 21 NTDs prioritized by the World Health Organization. Studies without any financial incentive intervention will be excluded. Studies available in English between 2000 and 2024 will be searched in databases, including PubMed, Google Scholar, Scopus, Cochrane, Embase, and CINAHL. Screening, data extraction, and risk of bias assessment will be conducted independently by two reviewers, and discrepancies, if any, would be resolved by a third reviewer. Quality assessment will use the Revised Cochrane Risk of Bias for randomized trials (RoB 2), Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), the Joanna Briggs Institute (JBI) checklist for cross-sectional studies, and the Critical Appraisal Skills Programme (CASP) tool for qualitative studies. Data synthesis will involve narrative summaries by tables and figures, a meta-analysis will be undertaken, and subgroup analyses will be performed where feasible.ResultsThis project is supported by the Children’s Investment Fund Foundation and was funded in March 2024. As of January 15, 2026, article search and title-abstract screening have been completed, and full-text screening is expected to be completed by February 2026. Findings will then be synthesized and reported by the end of April 2026.ConclusionsThe limitations of the study may include potential language bias and methodological heterogeneity, which may limit the feasibility of meta-analysis. The findings of this review will inform policymakers in developing more effective strategic plans for controlling NTDs in LMICs.

Abstract In low- and middle-income countries, household floors made of soil remain common. Concrete floors are desirable household upgrades because they offer durability, improved hygiene, and flood resilience, and their prevalence is increasing. However, cement production is a substantial contributor to global anthropogenic carbon dioxide emissions. This study assessed the acceptability and feasibility of sustainable cement-based floors with lower embodied carbon; these floors replaced 20% of cement with fly ash, a byproduct of coal combustion. To assess whether low carbon cement floors are as acceptable as traditional cement-based floors, in-depth interviews were conducted with 30 respondents from 20 households in rural Bangladesh in which soil floors were replaced with either low carbon cement or traditional cement-based floors. Findings revealed that both flooring types were highly accepted due to ease of cleaning, health benefits, and protection from environmental hazards. Traditional cement floors were preferred in terms of repair and maintenance as the users were concerned about the availability of fly ash and concrete blocks in rural settings. Financial constraints emerged as a major barrier to cement-based floor adoption for both traditional and lower embodied carbon cement-based floors, with most respondents prioritizing roof and wall improvements over flooring. Subsidized housing programs were seen as a crucial enabler for cement-based floor installation, as self-financing was largely considered unattainable. This study demonstrates that in a rural, low-income population Bangladesh, cement-based floors with lower embodied carbon were as acceptable as traditional cement-based floors, but installation of either type of floor may require government subsidies.

While global estimates of SARS-CoV-2-infected mortality predominantly focus on in-hospital deaths, post-discharge mortality remains an overlooked contributor to the total disease burden, especially in low- and middle-income countries such as Bangladesh. This study aimed to estimate the 30-day post-discharge mortality rate among adult (≥ 18years) patients with severe acute respiratory infection (SARI) who were SARS-CoV-2-infected and to identify factors associated with these deaths. From March 2020-December 2023, we enrolled hospitalised adult meeting the World Health Organization defiend SARI case definationacross nine tertiary care hospitals in Bangladesh. We followed-up with patients or their family members 30-day post-discharge to ascertain survival status. We calculated the proportion of post-discharge deaths among SARS-CoV-2-infected patients and compared the demographic and clinical characteristics of decedents versus survivors. Data were summarised using descriptive statistics, t-test, Fisher's exact test, and Chi-square tests. We used multivariable Cox's regression models to calculate the adjusted hazard ratio (aHR) to identify factors associated with SARS-CoV-2-infected adult patient's deaths during 30-day post-discharge period. Among 7,816 patients enrolled [mean age 47years (± 47.7), 62% male], 1,280 (16.4%) were SARS-CoV-2-infected. Of them, 126 (9.8%) died during their hospital stay. Among the 1154 patients discharged alive, 1,108 (96%) were successfully followed up, and 111 (10%) died within 30 days post-discharge. The most frequently reported symptoms among post-discharge decedents included difficulty breathing (105; 94.6%), body ache (55; 49.6%), headache (44; 39.6%), with over half (59; 53.1%) having at least one pre-existing condition. Post-discharge mortality was approximately fourfold higher among prematurely discharged patients (aHR: 4.13; 95% CI 1.52-11.23), nearly fourfold higher in those with difficulty breathing (aHR: 3.69; 95% CI 1.62-8.43), and more than threefold higher among patients with kidney disease (aHR: 3.35; 95% CI 1.34-8.38) compared with their counterparts. Nearly one in five adult patients with SARS-CoV-2-infected SARI in Bangladesh died either during hospitalisation or within 30-day of post-discharge, with almost half of these deaths occurring after discharge. Study findings underscore the urgent need to strengthen discharge planning, such as developing and implementing standardised discharge guidelines, prioritising high-risk patients such as premature discharge for targeted post-discharge follow-up, and implementing structured post-discharge care interventions to reduce preventable mortality in resource-limited settings.

To describe (1) the proportion of deaths that were in recently hospitalised children and (2) causes of mortality among deceased children aged 0-59 months with preceding hospitalisations who enrolled in a mortality surveillance programme. Descriptive study using prospectively collected data. Eight Child Health and Mortality Prevention Surveillance (CHAMPS) community and healthcare sites in sub-Saharan Africa and South Asia. Deaths among children aged 0-59 months enrolled in CHAMPS 2016-2023. None. Deaths with antecedent hospitalisations within 180 days of death. Causes of death determined by expert panels who reviewed clinical data and histopathologic and microbiologic results from postmortem minimally invasive tissue sampling. CHAMPS enrolled 8548 deaths; we excluded 3688 neonates who died before discharge or ≤24 hours of birth and 482 with unclear information on antecedent hospitalisations. Out of the 4378 remaining deaths, 16.7% (95% CI 15.7% to 17.9%) were deaths that occurred within 180 days of a hospitalisation (n=733/4378). Of these, 55.7% (95% CI 52.0% to 59.3%) occurred outside healthcare facilities. Among included deaths with minimally invasive tissue sampling completed (n=337), lower respiratory tract infections (41.2%, 95% CI 36.0% to 46.7%), sepsis (39.8%, 95% CI 34.5% to 45.2%) and undernutrition (n=92, 27.3%, 95% CI 22.7% to 32.4%) were most common causes of death among cases with antecedent hospitalisations. The greatest proportion of deaths with antecedent hospital admissions occurred among cases aged 1-11 months (48.0%, 95% CI 44.4% to 51.7%), compared with those aged 0-1 months (21.7%, 95% CI 18.8% to 24.9%) and those aged 1-5 years (30.3%, 95% CI 27.0% to 33.8%). Moreover, the greatest proportion of deaths with antecedent hospital admissions occurred among infants/children with weight-for-age Z-score of <-3 (62.5%, 95% CI 56.5% to 68.0%) compared with those with weight-for-age Z-score of ≥-3 (37.5%, 95% CI 32.0% to 43.5%). We observed a high proportion of deaths with antecedent hospitalisations within 180 days among young children across eight sites in sub-Saharan Africa and Asia. Among those deaths, children aged 1-11 months and undernourished infants were over-represented, suggesting early follow-up as a potential point to focus targeted support and future research.

Candida auris is an emerging multidrug-resistant pathogen frequently misidentified by conventional methods, posing diagnostic and infection-control challenges, particularly in low- and middle-income countries. We report a 74-year-old male in Dhaka, Bangladesh, with multiple comorbidities who developed Candidemia. Blood culture yielded Gram-positive budding yeast with inconclusive conventional carbohydrate tests. The isolate was identified as C. auris using Vitek 2 (software v8.01) and confirmed by ITS sequencing (GenBank accession MZ323988). Phylogenetic analysis showed clustering with global strains. Antifungal susceptibility testing indicated resistance to fluconazole and amphotericin B, with susceptibility to echinocandins. Intravenous micafungin was started based on susceptibility results and guideline recommendations. The patient responded gradually to the treatment, recovered fully, and was discharged after 21 days of admission. This case highlights the importance of rapid species-level identification and access to confirmatory molecular testing to guide effective treatment and infection prevention in resource-limited settings.

Bifidobacterium longum and B. infantis are pioneer colonizers of the neonatal gut and are widely used as probiotics to support infant growth, development, and disease resistance. However, commercial strains derived largely from high-income countries (HICs) may be suboptimal for infants in low- and middle-income countries (LMICs). We assembled a global genomic atlas of more than 4,000 genomes from 48 countries, increasing representation from LMICs by 12- to 17-fold. High-resolution phylogenomic and functional analyses support delineating B. longum and B. infantis as distinct species with divergent functions and epidemiological patterns. B. infantis dominates early-life microbiota in LMICs but is rarely detected in HICs. Natural B. infantis strains show extreme biogeographic stratification and predicted adaptations to local plant-glycan-rich diets and breast-milk-derived substrates, including urea and B vitamins. This genomic resource enables genome-guided selection of geographically matched strains to inform more effective probiotics and precision microbiome therapeutics for diverse infant populations.

Background: Undernutrition among infants and young children in South Asia remains a major public health concern, contributing to high rates of morbidity and mortality. While quantitative systematic reviews have identified various risk factors for undernutrition, no review has focused on qualitative studies. This study aims to review published literature on family member and healthcare provider perceptions about influences on undernutrition among infants and young children in South Asia. Methods: We searched for qualitative research articles published from 2000 to 2026 in the PubMed, Scopus and CINAHL databases, and used the Critical Appraisal Skills Program (CASP) tool to assess the quality of selected articles. Selected articles were analyzed thematically. The PROSPERO registration number is CRD42022385382. Results: After screening 201 research articles, 19 articles were selected for inclusion in this review. Perceived influences of undernutrition among children were categorized into individual, socio-cultural, economic, environmental and system factors. Interconnected influences included maternal illness, single motherhood, mothers' knowledge and awareness, convenience of providing low-quality ready-made and junk food, spiritual beliefs and superstition, violence against women, financial constraints in a context of rising food prices and seasonal impacts on food production, and physical accessibility of healthcare services. Conclusions: This review emphasizes the complex interplay of influences on undernutrition among young children in South Asia. Potential interventions must be culturally tailored and gender-sensitive, with key strategies including nutrition education, community-based support, maternal health improvements, and policies addressing food insecurity and healthcare accessibility.