Johns Hopkins Center for Communication Programs

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

The application of human-centered design (HCD) is growing in global health, given its potential to generate innovative solutions to entrenched health problems by prioritizing human perspectives, needs, and desires. To address gaps in consolidated evidence on prior programs, we conducted a review of studies that applied a comprehensive HCD approach in low- and middle-income countries. A total of 535 articles were initially identified. Based on the inclusion and exclusion criteria, 22 articles were included. Most studies were conducted in sub-Saharan Africa and used qualitative or mixed methods throughout the HCD work. In the "discover and define" phase, user personas, journey maps, and interviews were commonly used to empathize with end users and key stakeholders. Studies used various strategies in the "ideation" phase, including idea generation based on feasibility and resource constraints. In the "testing" phase, low-fidelity prototypes were tested to obtain feedback from end users and stakeholders, enabling quick and cost-effective refinements. Prototype iterations occurred twice in most studies, but information about when iterations ceased was limited. Evaluations of design outcomes and health impacts were lacking. Studies cited multidisciplinary approaches, flexible methodology, and a sense of ownership among users and communities as strengths of HCD. Contrastingly, challenges in consistent participant engagement and limited scientific rigor were reported as weaknesses. Elements that enhanced program reporting included clear descriptions of HCD as cyclical, stakeholder maps (empathy tools), visual materials on design activities and prototypes, and transparency in failures. We recommend strengthening capacity among those applying HCD to optimize the effectiveness of the approach for global health. Although HCD is not inherently intended to serve as a rigorous research method, data triangulation and proper evaluations may ensure its usability as evidence in health research when appropriate. Also, a thorough reporting of design phases and providing detailed rationale behind design decisions can advance future HCD literature.

Myelomeningocele (MMC) is a severe form of spina bifida associated with substantial neurologic morbidity. In vitro modeling systems of human spinal cord development may help to elucidate the underlying pathophysiology of the MMC spinal cord. To that end, we developed spinal cord organoids (SCO), defined as self-organized, three-dimensional clusters of spinal tissue, that were derived from human amniotic fluid-induced pluripotent stem cells. Here, we used a variety of analyses, including immunofluorescent and single-cell transcriptomic approaches, to characterize SCOs from healthy and MMC fetuses. Organoids contained a diverse range of neural and mesodermal phenotypes when cultured for up to 130days in vitro. Multielectrode arrays revealed functional activity with evidence of emerging neuronal networks. Fetal spina bifida environment modeling was successfully established by culturing SCOs in second- and third-trimester amniotic fluid for 3weeks. Taken together, we show that functional SCOs can recapitulate the cellular identity of the fetal spinal cord and represent a novel research platform to study the interplay between cellular, biochemical, and mechanical cues during human MMC neural tube morphogenesis.

Nathaniel Romney Robinson, Niyati Bafna, Xiluo He, Tom Lupicki, Lavanya Shankar, Cihan Xiao, Qi Sun, Kenton Murray, David Yarowsky. Proceedings of the 22nd International Conference on Spoken Language Translation (IWSLT 2025). 2025.

Figure S1 Conjoined pair shared ventricle. Figure S2 Fetoscopic image of shared umbilical cord. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Understanding community health workers' (CHWs) experiences of sustaining routine health care promotion and provision activities as well as their challenges in adopting new responsibilities within a dynamic context is critical. This study explored the roles and perspectives of CHWs within the government-led coronavirus disease (COVID-19) community health response in Bangladesh. We conducted a mixed methods study to explore the government's response to COVID-19 and its association with community health programming through a telephone-based survey of 370 government-employed CHWs. We also conducted 28 in-depth interviews with policy makers, program managers, CHW supervisors, and CHWs. We conducted exploratory and regression analysis of survey data and qualitative analysis of interview data. The majority of CHWs reported receiving training related to COVID-19, including community-based prevention strategies from government and nongovernment stakeholders. Access to infection prevention supplies differed significantly by CHW cadre, and perspectives on the provision of adequate supplies varied qualitatively. CHWs reported slight decreases in routine work across all health areas early in the pandemic, and a majority reported added COVID-19-related responsibilities as the pandemic continued, including advising on signs/symptoms in their communities and referring suspected cases of COVID-19 for advanced facility care. Regression analyses showed that government support and integration of CHWs into their response-particularly being trained on COVID-19-predicted CHW capacity to advise communities on symptoms and provide routine services. Government-employed CHWs in Bangladesh continued to provide health education and routine services in their communities despite pandemic- and response-related challenges. Varied support and differential CHW cadre-specific effects on COVID-19 awareness building in the community, referral, and routine service provision merit attention in Bangladesh's pluralistic community health system. While COVID-19 infection and government-mandated lockdowns restricted CHW mobility, the workers' capacity to continue service provision and education can be leveraged in vaccination and surveillance efforts moving forward.

The World Malaria Report, released in December 2021, reflects the unique challenges currently facing the global malaria community. The report showed the devastating toll of malaria, with an estimated 627,000 people losing their lives to the disease in 2020. The improved methodological approach used for calculating cause of death for young children revealed a systematic underestimation of disease burden over the past two decades; and that Africa has an even greater malaria crisis than previously known. While countries were able to prevent the worst-case scenarios, the disruptions due to the COVID-19 pandemic revealed how weak health systems and inadequate financing can limit the capacity of the continent to address the malaria challenge. African countries also face a convergence of biological threats that could redefine malaria control, notably widespread pyrethroid resistance and emerging resistance to artemisinin. Despite these challenges, there is cause for optimism in lessons learned from the COVID-19 pandemic, recent acceleration of cutting edge research and development, and new partnerships that encourage leadership from and ownership by affected countries. This article presents key insights from the 2021 World Malaria Report and reflections on the future trajectories: it was informed by an in-depth discussion with leading malaria experts from the World Health Organization (WHO), the Bill & Melinda Gates Foundation, and the U.S. President’s Malaria Initiative (PMI). The discussion took place during the 34th edition of the Ifakara Master Classes, held virtually on December 15th, 2021.

Merci Mon Héros (MMH) is a youth-led multi-media campaign in Francophone West Africa seeking to improve reproductive health and family planning outcomes using radio, television, social media, and community events. One component to this project is the development of a series of youth-driven videos created to encourage both youth and adults to break taboos by talking to each other about reproductive health and family planning. A costing study was conducted to capture costs associated with the design, production, and dissemination of 11 MMH videos (in French) on social media in Côte d'Ivoire and Niger. The total costs to design, produce and disseminate 11 of the campaign videos for MMH in both Côte d'Ivoire and Niger were $44,981. Unit costs were calculated using three different denominators, resulting in average unit costs of $0.16 per reach, $1.29 per engagement, and $4.27 per video view. These findings can be useful for future studies of SBC interventions using social media for framing the analysis and selecting the appropriate metrics for the denominator, as well as for budgeting and planning SBC programs using social media.