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☐ ☆ ✇ BMJ Open

Multicentric longitudinal study on malaria burden, vector bionomics and health system assessment in diverse eco-epidemiological settings in the context of malaria elimination in India: study protocol

Por: Rahul · A. · Thiruvengadam · K. · Sharma · R. · Jabir · M. · Viswan · A. · Jency · P. J. · Bharadwaj · N. · Muthukumaravel · S. · Shriram · A. N. · Raju · H. K. · Kannan · S. · Singh · M. · Bhuyan · P. J. · Jain · T. · Rahi · M. — Febrero 9th 2026 at 15:19
Introduction

Malaria remains a major public health challenge in India, with transmission dynamics varying widely across ecological, epidemiological, sociobehavioural and health system contexts. Achieving the national malaria elimination target by 2030 requires integrated, context-specific evidence to design effective interventions. This study aims to generate a comprehensive understanding of malaria transmission and factors surrounding it across diverse eco-epidemiological settings in India by assessing malaria burden, identifying determinants of transmission, evaluating health system performance and equity, characterising vector bionomics and insecticide resistance, and examining the influence of environmental drivers.

Methods and analysis

This longitudinal, multicentric study will be conducted in collaboration with the national programme in 12 districts spanning 10 states in India, covering a population of around 25 000 individuals representing varied ecological contexts (urban, periurban, rural, forest-foothill and coastal) and malaria endemicity levels. In each district, two clusters (villages) with a population of 1000 individuals will be included. A baseline mass survey will estimate malaria prevalence using bivalent rapid diagnostic tests (RDTs) and blood smear microscopy, with low-density parasitaemia detected by PCR in a subset of RDT-negative samples. Participants will be followed for 1 year, with monthly screening of symptomatic individuals using RDT and microscopy, and testing a subset of asymptomatic individuals to detect subclinical infections. Sociobehavioural data will be collected through structured interviews and household observations, with purposive inclusion of vulnerable groups, pregnant women, migrants, elderly persons, individuals with disabilities and tribal populations to assess equity dimensions through mixed-methods approaches. Health system performance will be evaluated through key informant interviews with programme officials, health workers, patients, private practitioners and traditional healers. Entomological surveillance will document vector species composition, density, infection rates and assessment of susceptibility status and intensity of insecticide resistance to commonly used public health insecticides. Environmental variables, including temperature, rainfall and humidity, will be linked with entomological and epidemiological data to explore spatiotemporal relationships.

Ethics and dissemination

The protocol was approved by the Institute Human Ethics Committee of ICMR-Vector Control Research Centre (IHEC 03-0125/N/F). All standard ethical practices will be adhered to. The findings will be shared with stakeholders and published in reputed open-access journals.

☐ ☆ ✇ BMJ Open

Prevalence and associated factors of undernutrition among children under the age of 5 years: a cross-sectional study in riverbank erosion areas of Bangladesh

Por: Rahman · T. · Rashid · M. · Arafat · Y. · Fahim · M. · Sultana · P. · Merajul Islam · M. — Febrero 5th 2026 at 13:02
Objectives

The study aimed to determine the prevalence and identify the associated factors of undernutrition among children under 5 years of age living in riverbank erosion areas in Bangladesh.

Study design

A community-based cross-sectional study.

Setting

The study was carried out in riverbank erosion-prone areas of the Tangail and Kushtia districts of Bangladesh, which were selected because they are highly vulnerable to riverbank erosion and related livelihood disruptions.

Participants

Participants were selected using a two-stage cluster sampling technique based on the criterion that mothers had at least one child under the age of 5 years.

Outcomes

Stunting, wasting and underweight were considered independently as outcome variables to assess nutritional status.

Methods

Descriptive analysis was performed to determine the prevalence of undernutrition, while the ² test and multivariable Poisson regression model were used to identify significantly associated factors with undernutrition among children under 5 years of age in riverbank erosion areas.

Results

The average prevalence of stunting, wasting and underweight was 37.74%, 22.64% and 9.81%, respectively. Results from the Poisson regression model showed that children who were average or large in size at birth had a much lower prevalence of all forms of undernutrition compared with those born very small. Female children had a 30% lower prevalence of stunting compared with male children. In addition, having educated parents, receiving four or more antenatal care visits and household livestock ownership were each associated with a lower prevalence of undernutrition.

Conclusion

The prevalence of stunting in this study was higher than that reported in the most recent Bangladesh Demographic and Health Survey 2022. Child size at birth, sex, parental education, antenatal care visits and household livestock ownership were identified as significantly associated factors with undernutrition in riverbank erosion areas of Bangladesh.

☐ ☆ ✇ BMJ Open

Predictors of healthcare seeking for tuberculosis symptoms in the private healthcare facilities: findings from a cross-sectional population-based survey in Tamil Nadu

Por: Giridharan · P. · Arangba · S. · Nagarajan · K. · Frederick · A. · Thiruvengadam · K. · Selvaraju · S. — Enero 14th 2026 at 15:37
Objectives

To identify the factors influencing the choice of private healthcare facilities among individuals experiencing tuberculosis (TB) symptoms.

Design

Cross-sectional study.

Setting

The data for this study were obtained from a cross-sectional population-based TB prevalence survey conducted in 33 districts of Tamil Nadu, a state in southern India, between February 2021 to July 2022.

Participants

130 932 individuals, 15 years and above, residents of the selected cluster for the past 1 month, were included. Hospitalised patients, sick/morbid individuals and the institutional population were excluded.

Results

Of 143 005 eligible individuals, 130 932 (91.6%) participated. Among them, 9540 individuals were found to have at least one TB symptom. Of these symptomatic individuals, 2678 sought healthcare, with 62.7% in the public facilities and 37.3% in private facilities. Factors associated with seeking care in the private healthcare facilities included working in organised sector (aOR: 1.3; 95% CI 1.0 to 1.7; p

Conversely, individual with symptom of weight loss (aOR: 0.4; 95% CI 00.3 to 00.6; p25 years (aOR: 0.6; 95% CI 0.4 to 0.9; p

Conclusion

The study highlights the distinct factors that could affect healthcare seeking for TB symptoms in the public and private healthcare settings for TB and the need for tailored interventions and customised healthcare policies to address such gaps and distinctions in care seeking.

☐ ☆ ✇ Evidence-Based Nursing

How can we improve low-volume paediatric emergency departments to enhance readiness?

Por: Goparaju · N. · Pines · J. M. — Diciembre 15th 2025 at 09:45

Commentary on:Michelson KA, Rees CA, Florin TA, et al. Emergency department volume and delayed diagnosis of serious pediatric conditions. JAMA Pediatr. 2024;178:362–8. doi:10.1001/jamapediatrics.2023.6672

Implications for practice and research

  • Low-paediatric-volume emergency departments (EDs) can increase paediatric readiness by improving diagnostic tools, expanding paediatric expertise (eg teleconsultation) and using electronic clinical decision support.

  • Further research is needed to examine the costs and effectiveness of specific interventions to improve readiness in low-volume paediatric EDs.

  • Context

    Children sometimes have subtle illness presentations and symptom overlap with non-serious conditions.1 Young age also presents a communication barrier. The combination of these factors can lead to diagnostic delays and sometimes misdiagnosis, particularly in emergency department (EDs) that do not see high volumes of children. In the USA, one in three EDs sees fewer than five children daily. A prior study linked low-paediatric ED volume to diagnostic delays in...

    ☐ ☆ ✇ BMJ Open

    Evaluating economic outcomes in the management of temporomandibular disorders: a protocol for a systematic review of randomised controlled trials

    Por: Komarraju · P. · AlSabbagh · B. · Ohinmaa · A. · Armijo-Olivo · S. · Morris · M. · Li · J. · Major · P. W. · Goldberg · M. · Naik · A. · Abdelkarim · A. · Velly · A. M. — Noviembre 4th 2025 at 13:13
    Introduction

    Systematic reviews (SRs) on the management of temporomandibular disorders (TMDs) have predominantly focused on evaluating the effectiveness of various treatments, identifying those that provide the greatest benefits. However, the economic evaluation of these treatments has not been systematically explored. This SR aims to address this gap by evaluating the economic outcomes of the most common treatment modalities for TMDs, including cost-effectiveness, cost-utility, cost-benefit, cost-minimisation and the burden of illness.

    Methods and analysis

    This SR will be conducted using the following electronic databases Business Source Complete, CINAHL, EconLit (ProQuest), Embase (Ovid), MEDLINE (PubMed), MEDLINE (Ovid) and Scopus to identify studies evaluating the economic outcomes of treatments for TMDs. The eligibility criteria are as follows: (1) studies examining the costs and/or impact of treatments for TMDs and (2) articles published between 2000 and 2025. The primary outcomes of interest are the economic findings outlined earlier. Data extraction will include the following: author(s), year of publication, country, study objectives, study design, eligibility criteria, TMD diagnosis and screening, study groups, randomisation, blinding, sample size, number of participants invited, enrolled and completed, duration of treatment, follow-up, study duration, settings, assessment instruments, study outcomes, statistical analyses, results, limitations, strengths and funding sources. The quality of studies will be evaluated using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist, with risk of bias assessed using the Cochrane Effective Practice and Organization of Care’s risk-of-bias tool; where applicable, the Outcome Reporting Bias in Trials will be used to detect reporting biases. A narrative synthesis and summary tables will outline study characteristics, economic outcomes and the overall quality of evidence. We will conduct qualitative secondary and sensitivity analyses.

    Ethics and dissemination

    This SR does not require an ethics approval. The results will be disseminated through international and national conferences and peer-reviewed journals.

    PROSPERO registration number

    CRD42024613553.

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