Partners In Health

While higher pyrazinamide and isoniazid exposures and slow NAT2 acetylator status were each associated with increased hepatotoxicity, only pyrazinamide exposure was associated when considering pharmacokinetic variables together. Rifampin exposure was not associated with hepatotoxicity, supporting further evaluation of doses up to 20 mg/kg/day in a larger trial.

Silicosis is one of the most common forms of pneumoconiosis worldwide. In Rwanda, there is a lack of data on the silicosis burden and occupational risk among underground miners. We conducted a cross-sectional study among all miners from eight cassiterite (tin ore) mining sites in Kayonza district, eastern Rwanda. Questionnaire data and chest radiography were collected at Rwinkwavu District Hospital. Two radiologists reviewed all the chest radiographs using International Labour Organization (ILO) criteria, with a third radiologist reviewing films with ILO rating discrepancies. Logistic regression was performed to investigate risk factors associated with radiographic silicosis. In total, 1021 mine workers were included in the primary outcome (risk) analysis. The median age was 32 years (IQR 26-40), and 948 participants (93%) were male. Of all participants, 94 (9%) were diagnosed with silicosis in the primary analysis. Increased odds of silicosis were associated with working in a blasting station (adjusted OR (aOR) 3.30; 95% CI 1.68 to 6.45), excavation station (aOR 2.77; 95% CI 1.09 to 7.04), drilling station (aOR 2.51; 95% CI 1.34 to 4.70), exposure to tobacco (aOR 1.92; 95% CI 1.14 to 3.24) and increased time of working in mining (aOR 1.05 per year spent in mining; 95% CI 1.01 to 1.09). High-risk mining tasks, tobacco use and duration of mining employment were significantly associated with increased risk of having a silicosis diagnosis. Our results indicate that screening and preliminary occupational risk analysis in a rural mining cohort is technically feasible.

Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA. We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002-2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016-2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical-horizontal shares and the annual financing gap against published cost benchmarks. Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016-2019) to ~US$1.83 billion (2020-2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016-2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion. CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.

Mobile health (mHealth) apps are increasingly leveraged to support community health workers (CHWs) in delivering high-quality care, particularly in low- and middle-income countries. However, despite the proliferation of mHealth tools, few have been implemented at scale, partly due to limited attention to usability and acceptability among end users. In sub-Saharan Africa, mHealth tools designed for CHWs often lack systematic evaluation using validated instruments tailored to local contexts. Without such assessments, it is difficult to ensure that these tools can be integrated effectively into CHW workflows and scaled sustainably. This study aimed to adapt and validate existing mHealth usability and acceptability assessment tools to be contextually appropriate for CHWs in Rwanda. Specifically, we sought to ensure contextual appropriateness for CHWs supporting postoperative home follow-up for women after cesarean delivery. The resulting tool was designed for use in an implementation study of a novel CHW-led mHealth app. This study was conducted in the Kirehe district, Rwanda, from October 2022 to March 2023. We adapted 2 established tools-the mHealth App Usability Questionnaire and selected items from the Practitioner Opinion (Acceptability) Scale-and added new items that reflect core functions of the CHW-focused mHealth app. All items were translated into Kinyarwanda and simplified to align with CHWs' educational levels. We conducted a three-stage validation that consisted of (1) content validity testing with 8 local and international experts using a recommended content validity index threshold of >0.78; (2) face validity testing with 10 CHWs using a recommended face validity index threshold of ≥0.60; and (3) reliability testing using responses from 30 CHWs, with a Cronbach α coefficient of ≥0.70 indicating acceptable internal consistency. Of the 25 items assessed, 22 (88%) achieved a content validity index score of >0.78 for both clarity and relevance. The face validity index across all 22 items was 0.991, indicating strong comprehensibility and relevance to CHWs. Internal consistency was high: the Cronbach α was 0.86 for the mHealth App Usability Questionnaire items, 0.73 for the Practitioner Opinion (Acceptability) Scale items, and 0.87 for the newly developed questions. The final tool-named the Community Health Worker mHealth Usability and Acceptability Assessment Tool-included 22 items with strong content validity, face validity, and internal reliability. This study presents a rigorously adapted and validated tool for assessing mHealth usability and acceptability among CHWs in Rwanda. The Community Health Worker mHealth Usability and Acceptability Assessment Tool can guide future evaluations of mHealth interventions in similar contexts and serve as a model for localizing mHealth assessment tools in low- and middle-income country settings to ensure fit-for-purpose implementation.

Community-wide flooding in high HIV-burdened districts affects continuity of HIV care, especially in resource-limited countries in sub-Saharan Africa. We explored the lived experiences of antiretroviral therapy (ART) clients and health care workers (HCWs) in Malawi to understand challenges and potential solutions for ART delivery during floods. This was a mixed methods study. In quantitative analysis, we used routine program data from Partners in Hope (PIH) to compare interruption in treatment (IIT) (>28 days without medication) cases in months with and without flooding, October 2021 to December 2023, to understand how flooding influences IIT. In qualitative analysis, we conducted in-depth interviews (IDIs) with ART clients and focus group discussions (FGDs) with HCWs from from six health facilities impacted by flooding in Chikwawa, Nsanje and Mulanje districts. We analyzed data in Atlas.Ti. IIT was far higher in flooding periods. Across 49,152 IIT cases, IIT increased by 24% during the first flooding period and by 23% during the second flooding period. 23 ART clients completed IDIs between July and August 2024: 13 female, median age 40 years, predominantly subsistence farmers (n = 21). A total of 9/23 clients experienced IIT. Flooding negatively impacted nearly all IDI participants: 17/23 lost homes and had to relocate, mainly to government camps. Most clients lost crops, livestock, and ART medication. Many clients travelled to find income and despite uncertainties they were motivated to remain in care. In six FGDs with 34 HCWs, HCWs described facility-level ART stock-outs and loss of medical records, limited stakeholder coordination and the absence of guidelines for HIV services during emergencies. HCWs were also impacted but received little support. IIT cases greatly increased during flooding periods, with both clients and HCWs facing multiple challenges to ART service provision. National flooding guidelines, coordination of stakeholder response, adequate planning and seasonal six-month ART dispensing could improve retention.

Rates of drug-resistant tuberculosis (DR-TB) are increasing worldwide. Tuberculosis preventive treatment (TPT) for contacts of people with active TB is essential to halt infection progression and transmission. While newer TPT regimens for exposure to drug-susceptible and rifampin (R)-resistant strains (MDR-TB/RR-TB) are expanding, optimal treatment for contacts exposed to fluoroquinolone-resistant strains of TB (pre-XDR- or XDR-TB) remains unclear. In 2019-2020, Vladimir City, Russia, introduced moxifloxacin (Mfx)- and bedaquiline (Bdq)-based TPT regimens to prevent disease development in contacts exposed to MDR/RR-TB and pre-XDR-TB. We conducted a retrospective cohort study of adult TB contacts, people experiencing homelessness, and people with HIV who received TPT in Vladimir between 2019 and 2020. Those without TB disease but with indications for TPT were offered 1 of 6 regimens, based on drug-susceptibility testing results of the index patient: rifapentine/isoniazid (3HP), isoniazid (6H), rifabutin/isoniazid (3HRb), 4R, 4Mfx, or 3Bdq. Adverse drug reactions (ADRs) were monitored with monthly lab tests and electrocardiogram (ECGs). Outcome measures included ADRs, TPT completion, and TB disease incidence during the 12-month follow-up period. Over 24 months, 403 people started TPT. No life-threatening ADRs or deaths occurred. The lowest ADR rate and highest completion were seen with 3Bdq (95.2%) compared to 3HP (75.9%, Mid-P exact = .03). Tuberculosis incidence per 1000 person-years was 4 times higher among eligible individuals who declined TPT versus those initiating it. Preventive therapy for drug-resistant TB, including fluoroquinolone-resistant strains, is acceptable, safe, and effective. Implementation of comprehensive TPT programs in high-burden DR-TB settings can protect contacts and reduce transmission.

People living with insulin dependent diabetes (PLWIDD) in low and lower-middle income countries (LLMICs), specifically rural areas, face significant barriers to diabetes management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower people living with diabetes to improve self-management. This pilot study evaluates the feasibility and clinical impact of a DSME program in a rural Package of Essential Noncommunicable Disease-Plus (PEN-Plus) clinic in Liberia. This study was conducted at two sites in Harper, Liberia. After being trained on how to administer DSME, clinic providers delivered DSME to PLWIDD during routine monthly clinic visits. Primary outcomes included acceptability, adoption, fidelity and the frequency of self-management behaviors; secondary outcomes included knowledge change and Hemoglobin A1c (HbA1c). Three providers and twenty-six PLWIDD were enrolled. DSME was feasible and well accepted by providers and PLWIDD. Patient knowledge scores increased from 33% at baseline to 64.6% at month 12. Average weekly blood glucose checks increased from 4.0 (95% CI 1.93, 6.23) checks per week month one, to 7.2 (95% CI 3.56, 10.79) checks per week month 12. Average weekly missed insulin injections decreased from 3.9 (95% CI 2.51, 6.03) in month one, to 0.82 (95% CI -0.14, 1.79) in month 12. Mean HBA1C decreased from 12.0% (107.7 mmol/mol) at baseline to 10.9% (95.6 mmol/mol) month 12, (modeled mean reduction of 1.1%,95% CI 0.0 to 2.0). This study adds to the growing body of literature showing that DSME can address many barriers faced by PLWIDD in LLMICs. Further research is warranted to expand the scope of self-management education to other noncommunicable conditions in the context of integrated PEN-Plus strategies.

Integrated One Health surveillance is pivotal to Africa's future health security, particularly in preventing and managing zoonotic and environmental health threats. The One Health strategy recognizes the interconnectedness of human, animal, and environmental health, allowing a holistic framework for tracking and responding to emerging and re-emerging pathogens. The One Health approach facilitates cross-sectoral data sharing and enhances surveillance, enabling the early detection and response to potential outbreaks. This proactive approach shifts the paradigm from reactive crisis management to preventive containment strategies. However, challenges such as funding gaps, limited infrastructure, limited diagnostic capacity, and weak multi-sectoral and cross-border collaborations remain. This perspective paper aims to 1) explore the effectiveness of integrated One Health surveillance in early detection and response to zoonotic diseases and environmental threats in Sub-Saharan Africa (SSA), and 2) identify key challenges and proposed solutions to strengthen regional health security. A multisectoral laboratory working group (MLWG) emerged as a pillar to enable active surveillance targeting humans, animals, and the environment. This paper highlighted essential strategies for enhancing One Health surveillance in SSA in light of the recent Marburg virus disease in Rwanda. It emphasizes environmental sampling through animal excreta and wastewater surveillance for early zoonotic detection, advocates for point-of-care polymerase chain reaction (PCR) testing platforms, and multiplex models to improve decentralized diagnostics. With 48% of African nations incorporating One Health in national agendas, a unified continental framework is needed to support broader adoption and advance regional health security.

BackgroundThe Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH-MH) program supports mental health care delivery by non-specialist, primary care providers in Rwanda to improve access to quality mental health care. After an initial pilot in one rural district, the program was scaled to support service delivery across two additional districts. We aimed to assess changes in symptoms and functioning outcomes among patients who received treatment at selected health centers supported by MESH-MH. We compare them with patient outcomes from the original pilot district.MethodsWe conducted a prospective cohort study among patients with mental health conditions and epilepsy who started treatment at ten health centers in the Rwinkwavu and Kirehe Hospital catchment areas between November 2020 and December 2021. We assessed patients’ symptoms using the 12-item General Health Questionnaire (GHQ-12) and daily functioning using the 12-item World Health Organization Disability Assessment Scale (WHO-DAS 2.0 Brief). We collected data at baseline, midline (on average, 71 days from treatment initiation), and endline (on average, 197 days from treatment initiation). We measured changes over time in outcomes and associations with the duration of treatment using Wilcoxon signed rank tests and linear mixed models. We compared findings with those of our previous study in the Burera district using linear mixed models and adjusting for possible confounding factors.ResultsOf 151 participants enrolled, primary diagnoses were epilepsy (n = 45, 29.8%), depression (n = 36, 23.8%), brief psychosis (n = 26, 17.2%), and schizophrenia (n = 20, 13.2%). The median GHQ-12 score improved from 24 (IQR: 18–30) at baseline to 11 (IQR: 5–17) at endline (median change: -12 [IQR: -19, -6], p < 0.001). The median WHO-DAS Brief score improved from 21.8 (IQR: 13–30) to 6 (IQR: 3–15) (median change: -13 [IQR: -22, -4], p < 0.001). The median number of days with having difficulties to carry out regular activities declined from 20 (IQR: 7–20) at baseline to 5 (IQR: 2–15) at endline (median change: -10 [IQR: -21, 0], p < 0.001) with comparable significant reductions in the number of days where patients were less able to engage in usual activities. We consistently observed significant improvements when using linear mixed models and across patient diagnoses. The scale-up sites revealed slightly greater reductions in symptoms relative to Burera, the pilot site study, while they showed comparable improvements in functioning.ConclusionsOur findings indicate that patients with mental health conditions and epilepsy who received treatment at health centers newly supported by MESH-MH experienced significant improvements in symptoms and functioning. These improvements were comparable to the outcomes seen in the initial pilot of MESH-MH. Scaling-up interventions like the MESH-MH model could help to decentralize and increase access to mental health services in Rwanda and other similar settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07610-9.

The main question and context of the discussion is whether the concept of impoverishment through asset confiscation in corruption cases in Indonesia fulfills the aspect of justice for defendants. This research will play a role in providing legal boundaries and certainty regarding the concept of impoverishment. This research used normative legal research. Normative legal research focuses on analyzing legal rules, principles, and doctrines to understand how the law should be, rather than how it is practiced. This research showed that the concept of impoverishing perpetrators of corruption crimes is interpreted as the confiscation of wealth/assets belonging to perpetrators of corruption crimes, which are the proceeds of corruption, and carried out in accordance with applicable regulations. Asset confiscation from perpetrators of corruption crimes must be implemented with legal measures that do not disregard the sense of justice and without disregarding or respecting the rights of the defendants and the property rights of others unrelated to the corruption case being handled, so the execution in the form of asset confiscation that can provide a sense of justice as it is conducted in a civilized manner and based on humanitarian values. Confiscating the wealth of defendants in corruption cases must be carried out proportionally, and the confiscation of individuals suspected of committing criminal acts of corruption must be upheld and must not violate constitutional principles.