BackgroundPneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers.Methods and FindingsWe conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low.ConclusionsGiven the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes.

Trinidad and Tobago TT: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 9.000 % in 2016. This records a decrease from the previous number of 9.100 % for 2015. Trinidad and Tobago TT: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 9.100 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 14.400 % in 2000 and a record low of 9.000 % in 2016. Trinidad and Tobago TT: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Trinidad and Tobago – Table TT.World Bank: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Intestinal parasitic infections caused by helminths are globally distributed and are a major cause of morbidity worldwide. Parasites may modulate the virulence, gut microbiota diversity and host responses during infection. Despite numerous works, little is known about the complex interaction between parasites and the gut microbiota. In the present study, the complex interplay between parasites and the gut microbiota was investigated. A total of 12 bacterial strains across four major families, including Enterobacteriaceae, Morganellaceae, Flavobacteriaceae, and Pseudomonadaceae, were isolated from Channa punctata, infected with the nematode species Aporcella sp., Axonchium sp., Tylencholaimus mirabilis, and Dioctophyme renale. The findings revealed that nematode infection shaped the fish gut bacterial microbiota and significantly affected their virulence levels. Nematode-infected fish bacterial isolates are more likely to be pathogenic, with elevated hemolytic activity and biofilm formation, causing high fish mortality. In contrast, isolates recovered further from non-parasitised C. punctata were observed to be non-pathogenic and had negligible hemolytic activity and biofilm formation. Antibiogram analysis of the bacterial isolates revealed a disproportionately high percentage of bacteria that were either marginally or multidrug resistant, suggesting that parasitic infection-induced stress modulates the gut microenvironment and enables colonization by antibiotic-resistant strains. This isolation-based study provides an avenue to unravel the influence of parasitic infection on gut bacterial characteristics, which is valuable for understanding the infection mechanism and designing further studies aimed at optimizing treatment strategies. In addition, the cultured isolates can supplement future gut microbiome studies by providing wet lab specimens to compare (meta)genomic information discovered within the gut microenvironment of fish.

Mali ML: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 60.600 % in 2016. This records a decrease from the previous number of 61.500 % for 2015. Mali ML: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 63.150 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 70.600 % in 2000 and a record low of 60.600 % in 2016. Mali ML: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Mali – Table ML.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Venezuela VE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 11.300 % in 2016. This records a decrease from the previous number of 11.500 % for 2015. Venezuela VE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 11.650 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 14.900 % in 2000 and a record low of 11.300 % in 2016. Venezuela VE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Venezuela – Table VE.World Bank: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

aAverage annual number of deaths and cases. Range: Annual variation in the number of deaths and cases - minimum and maximum value in the period.bVL cases data for sex and age available for period 2001–2011.cAverage annual incidence or mortality rates, calculated using the average number of cases or deaths due to VL as a numerator and population size in the middle of period as a denominator.dAge-standardized (Brazilian Census 2010 population) and age-specific mortality rates.

Abstract: Aim Oomycetes are one of the most widespread and destructive parasitic groups in the world. The first infection of oomycetes on copepod Parabroteas sarsi Daday 1901 was recently recorded in America. Oomycetes infection on this species makes their eggs unviable and could differentially affect the survival of females. The aim of this study was to track the incidence of oomycetes in two populations of P. sarsi. Methods Two Patagonian ponds were monitored during spring-summer of 2014-2018, measuring environmental variables and the prevalence of oomycete infections on P. sarsi populations. Taxonomic determination of the oomycetes was performed in laboratory. Sex ratios also were recorded in each survey. Results The presence of Aphanomyces ovidestruens Gicklhorn 1923 and Pythium flevoense Van der Plaats-Niterink 1972 was detected in females of P. sarsi in both ponds. We observed a decrease in the parasite prevalence over time, from ~25% (assessed on the total number of adults) to almost disappear completely. Besides, a lower proportion of females than males were observed in samples with high prevalence of parasitism. No temperature differences were found during the sampling years and the monthly temperatures between the maximum and minimum prevalences were similar. Conclusions Our study presents a new record of oomycetes parasitizing copepods in America. Temperature can play a key role in the dynamics of parasite species, but in our study this variable not affected the incidence of the infection. However, other variables could be affect the pattern of the infection such as the presence of predators of oomycetes spores (cladocerans). The lower females proportion when the infection was higher, could support the idea of differential sex/mortality induced by the infection. Recording and identification of parasites is a critical starting point for wildlife management, which will provide an early warning to prevent the spread of harmful parasites such as oomycetes.

Finland FI: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 1.300 % in 2016. This records an increase from the previous number of 1.200 % for 2015. Finland FI: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 1.600 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 6.900 % in 2000 and a record low of 1.200 % in 2015. Finland FI: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Finland – Table FI.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Abstract Trypanosoma cruzi is the etiological agent of Chagas disease, a public health challenge due to its morbidity and mortality rates, which affects around 6-7 million people worldwide. Symptoms, response to chemotherapy, and the course of Chagas disease are greatly influenced by T. cruzi‘s intra-specific variability. Thus, DNA mutations in this parasite possibly play a key role in the wide range of clinical manifestations and in drug sensitivity. Indeed, the environmental conditions of oxidative stress faced by T. cruzi during its life cycle can generate genetic mutations. However, the lack of an established experimental design to assess mutation rates in T. cruzi precludes the study of conditions and mechanisms that potentially produce genomic variability in this parasite. We developed an assay that employs a reporter gene that, once mutated in specific positions, convert G418-sensitive into G418-insenstitive T. cruzi. We were able to determine the frequency of DNA mutations in T. cruzi exposed and non-exposed to oxidative insults assessing the number of colony-forming units in solid selective media after plating a defined number of cells. We verified that T. cruzi‘s spontaneous mutation frequency was comparable to those found in other eukaryotes, and that exposure to hydrogen peroxide promoted a two-fold increase in T. cruzi‘s mutation frequency. We hypothesize that genetic mutations in T. cruzi can arise from oxidative insults faced by this parasite during its life cycle.

BackgroundEncephalitis, an inflammatory central nervous system disease causing significant morbidity and mortality, disproportionately affects low- and middle-income countries (LMICs) due to healthcare disparities. Encephalitis has diverse etiologies—viral, autoimmune, bacterial, parasitic—each with distinct clinical and epidemiological features. Despite declining global age-standardized rates since 1990, inequities in diagnostics, vaccine coverage, and critical care persist, worsened by COVID-19 pandemic, which delayed diagnoses and disrupted vaccinations.MethodsUsing Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) across 204 countries (1990–2021). We used the Bayesian Age-Period-Cohort model with integrated nested Laplace approximation to predict encephalitis’ future trends, through 2040, enhancing the study’s predictive value. Sociodemographic Index (SDI) stratification and Bayesian meta-regression models assessed trends, with significance determined via 95% uncertainty intervals and estimated annual percentage change (EAPC).ResultsIn 2021, 4.64 million individuals worldwide were affected by encephalitis (1.49 million new cases; 92,000 deaths), encompassing cases spanning acute, subacute, and chronic stages of the disease. Low-middle SDI regions bore 3–5 times higher burdens than high-SDI regions. South Asia had the highest burden (age-standardized prevalence rate [ASPR]: 140.9/100,000; incidence [ASIR]: 51.3/100,000), while Australasia reported the lowest (ASPR: 1.94/100,000). High-SDI countries showed distinct patterns, such as rising incidence in Australia. COVID-19 was associated with an 18% increase in DALYs in high-burden regions. National disparities were stark: Pakistan, India, and Nepal had the highest burdens; Canada, the lowest. The encephalitis burden was greater in children than in other age groups.ConclusionThis analysis advances prior GBD research by integrating post-COVID-19 insights and future burden forecasts, filling pre-pandemic study gaps. GBD dataset does not differentiate etiological subtypes, limiting our analysis granularity given encephalitis’ clinical and epidemiological heterogeneity. Socioeconomic inequities drive encephalitis burden, necessitating targeted interventions: scaling Japanese encephalitis vaccination in South Asia, strengthening African diagnostic hubs, and integrating climate-resilient surveillance. Post-pandemic recovery must prioritize healthcare infrastructure, telehealth, and policies addressing poverty and education. Global collaboration is critical to mitigate disparities and optimize region-specific strategies.

Jamaica JM: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 11.200 % in 2016. This records an increase from the previous number of 11.000 % for 2015. Jamaica JM: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 12.050 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 17.700 % in 2000 and a record low of 11.000 % in 2015. Jamaica JM: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Jamaica – Table JM.World Bank: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Ranked mortality rate by cause of death at health facilities Ghana, 2017 and 2018.

Israel IL: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 10.000 % in 2016. This stayed constant from the previous number of 10.000 % for 2015. Israel IL: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 8.850 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 10.000 % in 2016 and a record low of 6.700 % in 2000. Israel IL: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Israel – Table IL.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Paraguay PY: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 13.700 % in 2016. This records a decrease from the previous number of 13.900 % for 2015. Paraguay PY: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 14.750 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 21.600 % in 2000 and a record low of 13.700 % in 2016. Paraguay PY: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Paraguay – Table PY.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Sweden SE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 5.200 % in 2016. This records a decrease from the previous number of 5.800 % for 2015. Sweden SE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 5.350 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 5.800 % in 2015 and a record low of 4.500 % in 2010. Sweden SE: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Sweden – Table SE.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

List of marker genes that were identified using the FindAllMarkers function for all non-immune clusters as shown in Fig 5. Table contains the gene name (rowname and gene), the p-value (p_val), the average log2 fold change compared to all other clusters (avg_log2FC), percent of cells expressing the gene in cluster of interest (pct.1), percent of cells expressing the genes in all other clusters (pct. 2), adjusted p-value (p_val_adj) and the cluster to which the gene belongs (cluster). (XLSX)

Norway NO: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 7.300 % in 2016. This records a decrease from the previous number of 7.400 % for 2015. Norway NO: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 7.350 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 7.400 % in 2015 and a record low of 6.800 % in 2010. Norway NO: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Norway – Table NO.World Bank: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Summary of national mass drug administration (MDA) implementation years, implementation units (IUs), populations, and reported coverage rates between 2008 and 2014.

Mexico MX: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data was reported at 9.800 % in 2016. This records an increase from the previous number of 9.700 % for 2015. Mexico MX: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data is updated yearly, averaging 10.450 % from Dec 2000 (Median) to 2016, with 4 observations. The data reached an all-time high of 17.700 % in 2000 and a record low of 9.700 % in 2015. Mexico MX: Cause of Death: by Communicable Diseases & Maternal, Prenatal & Nutrition Conditions: % of Total data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Mexico – Table MX.World Bank.WDI: Health Statistics. Cause of death refers to the share of all deaths for all ages by underlying causes. Communicable diseases and maternal, prenatal and nutrition conditions include infectious and parasitic diseases, respiratory infections, and nutritional deficiencies such as underweight and stunting.; ; Derived based on the data from WHO's Global Health Estimates.; Weighted average;

Enteric and parasitic infections such as soil-transmitted helminths cause considerable mortality and morbidity in low- and middle-income settings. Earthen household floors are common in many of these settings and could serve as a reservoir for enteric and parasitic pathogens, which can easily be transmitted to new hosts through direct or indirect contact. We conducted a systematic review and meta-analysis to establish whether and to what extent improved household floors decrease the odds of enteric and parasitic infections among occupants compared with occupants living in households with unimproved floors. Following the PRISMA guidelines, we comprehensively searched four electronic databases for studies in low- and middle-income settings measuring household flooring as an exposure and self-reported diarrhoea or any type of enteric or intestinal-parasitic infection as an outcome. Metadata from eligible studies were extracted and transposed on to a study database before being imported into the R software platform for analysis. Study quality was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. In total 110 studies were eligible for inclusion in the systematic review, of which 65 were eligible for inclusion in the meta-analysis after applying study quality cut-offs. Random-effects meta-analysis suggested that households with improved floors had 0.75 times (95CI: 0.67–0.83) the odds of infection with any type of enteric or parasitic infection compared with household with unimproved floors. Improved floors gave a pooled protective OR of 0.68 (95CI: 0.58–0.8) for helminthic infections and 0.82 OR (95CI: 0.75–0.9) for bacterial or protozoan infections. Overall study quality was poor and there is an urgent need for high-quality experimental studies investigating this relationship. Nevertheless, this study indicates that household flooring may meaningfully contribute towards a substantial portion of the burden of disease for enteric and parasitic infections in low- and middle-income settings.