SETTINGSierra Leone, using data from the District Health Information System 2 (DHIS2) database.OBJECTIVEThis study examined the spatial and spatio-temporal distribution of malaria incidence, and the relationship between malaria incidence and rainfall in surrounding areas in Sierra Leone from 2021 to 2024.METHODA cross-sectional geospatial study was conducted using malaria case data, mean rainfall data, population estimates, and chiefdom-level geographic coordinates. Spatial clustering was evaluated using Moran’s I, significant district-level clusters were identified through space–time Poisson models (α = 0.05; 999 permutations), and the relationship between malaria incidence and rainfall in surrounding areas was assessed using bivariate Moran’s I, implemented in Python.RESULTSBetween 2021 and 2024, 7.4 million malaria cases were reported. Chiefdom-level incidence ranged from 21.2 to >750 per 1,000 population. Significant spatial clustering was observed (Moran’s I > 0; P < 0.01). Persistent high–high clusters (P < 0.05) and low–low clusters (P < 0.05) were identified across the country. Space–time analysis identified both high-risk (relative risk [RR] = 1.2–1.9; P < 0.01) and low-risk districts (RR = 0.5–0.9; P < 0.01). There was no significant association between malaria incidence and rainfall in surrounding areas at the national level.CONCLUSIONMalaria transmission remains spatially and temporally heterogeneous, with persistent hotspots that require tailored subnational interventions to accelerate progress towards elimination.

Tobacco consumption has long been implicated in several lethal diseases. However, the tobacco industry has continued to develop new products and marketing schemes to attract new generations of customers and sustain its market share and sales. This year’s World No-Tobacco Day theme zeroes in on the driving force behind the global tobacco epidemic – the tobacco industry and its relentless pursuit of new victims.

This issue of Public Health Action (PHA) includes the first of a series of articles that provide evidence-based answers to questions raised by health workers on addressing HIV, TB and malaria on the frontlines in Sierra Leone. The research was conducted as part of a SORT IT course, which is a partnership-based initiative led by TDR and implemented with various partners. SORT IT aims to make countries ‘data rich, information rich and action rich’ to improve health care delivery and outcomes. The course in Sierra Leone brought together 19 institutions to foster global engagement, partnerships and communities of practice, and highlighted the convening power of SORT IT towards galvanizing research capacity strengthening at the country level.

SETTINGFive districts with large coalmining workforces in Pakistan.OBJECTIVETo assess the burden of TB among returnee coalminers (RCMs) and associated community members (ACMs) in their home districts through active case finding (ACF).DESIGNThis cross-sectional study (October 2020–September 2021) used portable chest X-ray (CXR) with artificial intelligence (AI) in camps and verbal screening in camps and communities. Individuals screening positive were tested with GeneXpert, and those diagnosed were initiated on TB treatment.RESULTSA total of 150,242 individuals were screened, including 44% RCMs. Of these, 8.3% underwent CXR, 10% verbal screening in camps, and 81% verbal screening in communities. Symptoms were reported by 45% of RCMs and 15% of ACMs, while CXR abnormalities were comparable. TB was diagnosed in 226 RCMs and 204 ACMs, with overall prevalence per 100,000 of 341 (95% confidence interval [CI]: 296–385) and 243 (95% CI: 209–276), respectively. TB prevalence varied by screening strategy and was significantly higher among those screened with CXR: 1,156 in RCMs and 497 in ACMs.CONCLUSIONAI-assisted CXR was substantially more effective than verbal screening, detecting significantly higher numbers of TB cases among RCMs and ACMs, supporting its use for targeted ACF in high-risk populations.

In India, tobacco products are a leading cause of preventable diseases, including cancer. Because of the health risks to children, we explored compliance and implementation of tobacco control law in relation to educational institutes (EIs). We discuss an issue of accountability by an EI in relation to compliance regarding the prohibition of tobacco vendors in close proximity to the EI. We also discuss various studies highlighting poor implementation of the law prohibiting tobacco sales near to EIs. It is our recommendation that the tobacco control law in India should be strengthened to reduce preventable diseases, including cancer.

BACKGROUNDTB continues to pose significant public health challenges in high-burden regions such as Kano State, Nigeria, where private health sector engagement in TB control is notably lacking. The Social Franchising for TB Contact Investigation (SOFT) model was introduced to leverage private healthcare to increase the reach and efficacy of TB control efforts.METHODSThis nine-month project supported mapping health facilities, training of community health workers and systematic TB contact screening. The SOFT model aimed to enhance TB control by integrating private healthcare facilities and community-based organisations to improve TB yield, contact investigation and uptake of TB Preventive Therapy (TPT).RESULTSThe project showed a consistent increase in TB case detection, with a significant rise in index TB cases identified and their contacts screened each quarter. There was also a marked increase in the number of household contacts screened and initiated on TPT, demonstrating the model’s effectiveness in enhancing TB control efforts.CONCLUSIONThe integration of social franchising with community and private healthcare engagement presents a scalable and innovative approach to improving TB control in high-burden settings. This model contributes significantly to global TB elimination efforts by improving detection rates and TPT uptake.

SETTINGFive major coal mining districts in Balochistan, Pakistan.OBJECTIVESTo assess burden of TB among coal miners and their associated communities and establish linkages with TB care services.DESIGNA cross-sectional study was conducted to find TB cases through active case finding. The target population included people working at coal mining sites and surrounding communities residing within 10 km, including coal miners’ families and other individuals. Verbal symptom screening was carried out via mobile camps and community outreach. Sputum was collected from screened positive individuals and tested for TB on GeneXpert. TB cases diagnosed were linked with TB care services.RESULTSA total of 14,541 individuals including 8,149 (56%) coal miners were screened. Of the people screened, 81% were male, median age was 31 years, 2,274 (15.6%) had TB symptoms, and 34 confirmed TB cases were diagnosed. All 34 TB patients were linked to care and 32 completed treatments successfully. The estimated TB prevalence was 234 cases per 100,000 population (95% confidence interval: 150.6–316.5), with no significant difference between coal miners and associated communities.CONCLUSIONSimilar TB prevalence among coal miners and associated communities reflects shared vulnerability. Use of more sensitive screening tools is recommended to validate prevalence estimates in future studies.

Despite recent progress in TB notification rates, 6.2% of the 3.1 million 'missing' people with TB globally are from Nigeria. Identifying these 'missing' cases will improve TB control efforts in Nigeria. This paper aims to describe the outcome of an intensified TB case-finding strategy in northern Nigeria. An intensified TB case-finding strategy was implemented in four states in northern Nigeria from October 2021 to September 2022. Trained ad-hoc staff screened hospital attendees and linked identified persons with presumptive TB to diagnosis using a hub and spoke approach. People with confirmed TB were linked to treatment. Contributions of the strategy to the national TB notification rates for each state were assessed. A total of 1.17 million individuals were screened for TB across the four project States. 64,079 people with presumptive TB were identified, of which 10.1% were diagnosed with TB and 97% of those diagnosed were placed on treatment. Averagely, 33.3% of the TB cases notified from each state were contributions from the hospital-based Intensified TB case-finding intervention. Facility-based intensified TB case-finding results in significant improvement in TB notification rates and a good strategy to improve the identification of missing TB cases in Nigeria.

In sub-Saharan Africa, the syndemic of HIV and non-communicable diseases (NCDs) poses a significant challenge. To address this, leading global think tanks like the WHO advocate for integrated HIV/NCD care at primary healthcare levels. However, comparative empirical data on the costs of integrated care are limited. South Africa, with the largest HIV programme globally, was purposively selected for our comparative case study. To determine the cost of integrated HIV/NCD care from the providers' perspective at two 'ideal status' public healthcare facilities in South Africa as case studies. A multi-pronged methodology was used to collect provider cost data via retrospective documentary sources or records and a question-and-answer session with facility managers who provided key information on cost-related data. Data analysis utilised an activity-based costing (ABC) method. Despite the difference in the size of the clinics, the cost per patient in terms of ABC is similar between the two primary healthcare facilities, USD261.60 and USD226.30, respectively. The ABC method can be utilised to cost integrated care, foster health economic data availability for future research, and inform health policymakers.

Multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) is now endemic in the National Capital District (NCD), Papua New Guinea. Loss to follow-up (LTFU) is a challenge. To evaluate and identify risk factors for LTFU, including pre-treatment LTFU, in adults with MDR/RR-TB at Port Moresby General Hospital (PMGH). A retrospective analysis of treatment initiation in adults diagnosed with MDR/RR-TB (2018-2022) and outcomes for a cohort treated for MDR/RR-TB (2014-2019). We assessed the factors associated with LTFU using multivariate logistic regression. Of 95 patients diagnosed with MDR/RR-TB at PMGH from 2018 to 2022, 21 (22%) were lost to follow-up before treatment. Of the 658 adults who initiated treatment for MDR/RR-TB at PMGH from 2014 to 2019, 161 (24%) were lost to follow-up during treatment. A higher proportion of patients on injectable-containing long regimens (110/404, 27%) were lost to follow-up than those on the all-oral regimen containing bedaquiline (13/66, 12%). Treatment loss to follow-up was associated with age (35-54 years age group: aOR 0.49, 95% CI 0.32-0.77; 55-75 years age group: aOR 0.42, 95% CI 0.19-0.90; compared to the 15-34 years age group), residence outside of NCD (aOR 1.79, 95% CI 1.04-3.06), and year of treatment initiation. Pre-treatment LTFU requires programmatic focus. Shorter oral regimens and decentralised services may address the reasons for higher LTFU in younger people and people living outside NCD.