Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities. Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years. The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9–7.0%) and TB deaths by 10.4% (9.5–11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy. Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.

The Snakebite Treatment and Research Hospital (SBTRH) is a leading centre for snakebite envenoming care and research in sub-Saharan Africa, treating over 2500 snakebite patients annually. Despite routine data collection, routine analyses are seldom conducted to identify trends or guide clinical practices. This study retrospectively analyzes 1022 snakebite cases at SBTRH from January to June 2024. Most patients were adults (62%) and were predominantly male (72%). Key factors such as age, sex, and time between bite and hospital presentation were associated with outcomes, including recovery, amputation, debridement, and death. Adult males who took more than four hours to arrive to hospital were identified as a high-risk group for poor outcomes. Using patient characteristics, an XGBoost model was developed and was compared to Random Forest and logistic regression models. In general, all models had high positive predictive value and low sensitivity, meaning that if they predicted a patient to experience amputation, debridement, or death, that patient almost always actually experienced amputation, debridement, or death; however, most models rarely made this prediction. The XGBoost model with all features was optimal, given that it had both a high positive predictive value and relatively high sensitivity. This may be of significance to resource-limited settings like SBTRH, where antivenoms can be scarce; however, more research is needed to build better predictive models. These findings underscore the need for targeted interventions for high-risk groups, and further research and integration of machine-learning-driven decision support tools in low-resource-limited clinical settings.

Background: There is vast global inequality regarding where health research happens, who leads the research, and who benefits from the evidence. Globally, wealthier nations drive and influence data-driven research and how it is structured institutionally. Key barriers to high-quality research being undertaken in and led by low-resource settings are well reported. These barriers persist, thereby perpetuating a lack of locally generated data and/or evidence to tackle diseases that bring the greatest burden. Our aim was to design a tool to capture best practices in the production of data-driven health research, to advance both quality and quantity of research being conducted where it is needed most. Methods: An expert group of senior global health researchers from Asia, Africa, Europe, and Latin America and the Caribbean (LAC) convened to discuss potential solutions to addressing this imbalance in both quality and quantity of global health research. This study documents how a novel approach was developed, informed by this discussion, to support research teams in low-resource settings. The new approach, called “Pathfinder”, is a process-mapping tool wherein teams document key steps of their research projects flow to produce quality data and subsequent studies. Results: The Pathfinder methodology is a novel tool to be used alongside planned studies to guide teams through each step of their research, from setting their research question, to identifying the best methods needed to complete each step, to translating research outputs into impactful policy and practice. It is a standardized framework, which can be applied or adapted to specific settings for research teams track to key steps, challenges, solutions, and tools throughout their planned study’s process. Pathfinders can also be applied to studies that have already been completed, retroactively documenting their key components. Several global research institutes are piloting the Pathfinder methodology. Conclusions: Pathfinders can help inform future studies by capturing best practices, thereby removing barriers to research, and addressing global inequality in this domain. Specifically, Pathfinders can help identify the methods and skills needed for teams to produce safe, ethical, and accurate data-driven health research.

Background: Nigeria remains one of the highest burden bearers of snakebite envenoming in sub-Saharan Africa. In Northeastern Nigeria, where agricultural practice, livestock herding and outdoor play—especially during the dark hours—are common, children are frequently exposed to snakes. Due to the unique challenges posed by paediatric snakebite envenoming and the paucity of data on paediatric snakebites, there is need for local research on this subject. The study aims to bridge this knowledge gap by examining the characteristics and outcomes of paediatric snakebites in our setting. Methods: This was a retrospective study conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Medical records of 723 patients aged 0 to 17 years treated at this facility between 1 January to 31 December 2024 were retrieved. Socio-demographic information and key clinical data were extracted from paper-based records and recorded in a Microsoft Excel document. The association between patient characteristics and likelihood of recovery without complications like amputation, debridement or death, was assessed using univariate and multivariable regression analyses. Results: There were 480 male patients (66%) and the median age of patients was 12 (range 1 to 17). Within the study period, snakebites in children were most common in April ( n = 102, 14%). Nearly two-thirds of the participants ( n = 468, 65%) took four hours or more to present to hospital after being bitten. Indeed, patients who took four hours or more to arrive to hospital were less likely to recover without complications (Unadjusted odds ratio (OR) = 0.24, 95% confidence interval (CI) = 0.12–0.43). A sub-analysis among patients who received antivenom revealed that antivenom dose, time to antivenom administration, and antivenom cost were all significantly associated with likelihood of recovery without complications. Conclusions: This study found that some patient characteristics may contribute to poor outcomes among paediatric snakebite patients in Northeastern Nigeria. It demonstrated the increased risk of complications among those presenting to hospital more than four hours after being bitten, those without timely antivenom administration, and those who paid for antivenom. We hereby recommend increased awareness and health education on early presentation after snakebites.

Introduction: Pregnant women with neglected tropical diseases like snakebites are considered doubly neglected due to the intersection of multiple vulnerabilities, including compounded challenges stemming from socio-economic marginalization, inadequate healthcare access and most importantly, the lack of targeted public health interventions. Despite these concerns, there is a substantial gap in the literature regarding the presentation, management and outcomes of snakebites among pregnant women, especially in low-resource settings like northeastern Nigeria.Methods: Consequently, a retrospective observational study was conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Six years of patient folders were searched to identify patients of all ages that were pregnant at the time of presentation.Results: Between 2019 and 2024, 77 pregnant women presented to SBTRH with snakebites. The median age among pregnant women presenting with snakebite was 26 [interquartile range (IQR) 20–30], and most had not completed any level of education (n = 70, 91%). On average, patients were not experiencing their first pregnancy (median gravidity 3, IQR 1–5), and the median gestational age at admission was 22 weeks (IQR 16–28 weeks). Most patients (n = 73, 95%) visited a traditional healer prior to arriving at SBTRH. All patients recovered from snakebite. Of the two women that gave birth prior to discharge, one underwent spontaneous vaginal delivery followed by neonatal death, and one underwent caesarean section, where both mother and child survived.Discussion: These findings underscore the urgent need to recognize and respond to the unique vulnerabilities of pregnant women affected by snakebite in northeastern Nigeria. There is a need to integrate snakebite education during antenatal care period, engaging traditional healers in referral networks, developing pregnancy-specific clinical protocols and strengthening surveillance systems to capture maternal and foetal outcomes comprehensively.

Background: Snakebite envenoming (SBE) is a neglected tropical disease and a major public health crisis in Africa. We integrated a maximum difference experimental design and machine learning (ML) models to predict challenges and opportunities for improving SBE management in Ghana. Methods: This cross-sectional study included 137 healthcare workers, identified through multistage sampling, from August to December 2024 in two districts of the Eastern Region, Ghana. We employed five-fold cross-validation and analysed the dataset using 12 ML models. Results: The most significant obstacle to managing SBE was ‘delayed health-seeking behaviour by patients’, followed by ‘high cost of treatment’ and ‘inadequacy/shortage of antivenom’. On the opportunity side, ‘increasing public awareness and knowledge about snakebite prevention and initial management before reaching a healthcare facility’ was deemed crucial. Other opportunities such as ‘conducting research into alternative management for snakebite to complement or replace antivenoms’ and ‘increasing awareness and knowledge about snakebite management among healthcare workers’ were also recognized as trade-offs. Conclusions: This study significantly contributes to the existing research on artificial intelligence/ML, as previous studies have not quantified the challenges and opportunities in managing SBE. Policymakers and healthcare providers can use these findings to implement strategies such as promoting better health-seeking behaviours, subsidizing treatment costs, ensuring access to effective antivenom and raising public awareness about snakebite prevention and initial care.