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Background Growing evidence suggests a link between helminth infections and cardiometabolic diseases, but their relationships have not been reviewed systematically. Further, the possibility that helminth eradication could increase the risk of cardiometabolic diseases has not been comprehensively investigated. Methods We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development or severity of cardiometabolic diseases and risk factors. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and updated on March 1, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently. Results Eighty-three studies were included in the final analysis (Figure). Most studies reported on lipids (44), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and cardiomyopathy (4) (Table). Fifteen different helminth infections were represented. Helminth-infected subjects were less frequently reported to have dyslipidemia, metabolic syndrome, diabetes, and atherosclerosis, including coronary artery disease. Only 11 studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment adverse increases in lipids, diabetes or glucose levels, and/or metabolic syndrome. Figure.PRISMA Flow Diagram of Systematic ReviewTable.Trends of Cardiometabolic Diseases and Risk Factors Reported in All Included Studies Conclusion Animal and human reports consistently indicate that helminth infection may offer protection against dyslipidemia, metabolic syndrome, diabetes, and cardiovascular disease, and this protection may lessen after anthelmintic treatment. Our findings highlight the need for further cross-disciplinary research, which would have implications for both individual and population health, including mass drug administration, and could point towards ground-breaking new strategies to address the challenges of non-communicable diseases worldwide. Disclosures All Authors: No reported disclosures.

Background Hypertension is a growing public health emergency in rural sub-Saharan Africa. Based on the known influence of religious leaders in rural sub-Saharan Africa and our prior research, we explored perspectives of religious leaders on hypertension and potential strategies to improve hypertension control in their communities. Methods We conducted 31 in-depth interviews with Christian (n = 17) and Muslim (n = 14) religious leaders in rural Tanzania. Interviews focused on religious leaders’ perceptions of hypertension and how they could play a role in promoting blood pressure reduction. We used interpretative phenomenological analysis, a qualitative research method, to understand religious leaders’ perspectives on, and experiences with, hypertension. Results Three main themes emerged during analysis. First, we found that perceptions about causes, treatment, and complications of hypertension are influenced by religious beliefs. Second, religious beliefs can enable engagement with hypertension care through religious texts that support the use of biomedical care. Third, religious leaders are enthusiastic potential partners for promoting hypertension control in their communities. These themes were consistent between religion and gender of the religious leaders. Conclusions Religious leaders are eager to learn about hypertension, to share this knowledge with others and to contribute to improved health in their communities.

Elevated circulating endotoxin levels in the plasma of patients with advanced hepatosplenic schistosomiasis caused by Schistosoma mansoni have been reported, possibly caused by parasite egg-induced intestinal mucosal breaches facilitating bacterial access to the bloodstream. Neither endotoxin levels in people with S. mansoni but without hepatosplenic disease nor the impact of treatment on endotoxin levels have been described. We used a methodically optimized Limulus amebocyte lysate assay to measure plasma endotoxin in community-dwelling women from an S. mansoni-endemic area without clinical hepatosplenic disease. We found no difference in baseline mean plasma endotoxin levels between those with (n = 22) and without (n = 31) infection (1.001 versus 0.949 EU/mL, P = 0.61). Endotoxin levels did not change in schistosome-infected women after successful treatment (1.001 versus 1.093 EU/mL, P = 0.45) and were not correlated with circulating anodic antigen or stool egg burden. Our findings do not support the hypothesis that translocating eggs in S. mansoni infection introduce bacterial sources of endotoxin to the circulation.

PROBLEM: Women comprise 7 out of every 10 health care workers globally yet are significantly underrepresented in leadership positions. The COVID-19 pandemic has exacerbated underlying gender disparities, placing additional burdens on many female global health professionals. APPROACH: The authors describe the development of a novel, low-cost pilot program-the Female Global Scholars Program (Weill Cornell Medicine)-established in April 2018 to promote the advancement of female global health research professionals and prepare them for leadership positions in this field. Using a logic model, the program was informed by discussion with peers at scientific symposia, qualitative research examining the barriers women experience in global health, discussions with experts in the fields of global health and medical education, and a literature review of other initiatives focused on fostering female advancement. The program provides opportunities to learn leadership skills and peer mentoring to female junior investigators in global health research over the course of 2 years through attendance of a symposium and skill-building workshop, skill-building webinars, and the building of a peer mentor group. OUTCOMES: The inaugural cohort of the Female Global Scholars Program (April 2018-March 2020) included 10 female global health researchers from 6 countries (Haiti, India, Kenya, Tanzania, Uganda, and the United States) across 3 continents. By the end of year 1, 6 participants received academic promotions. Additionally, the inaugural 10 scholars collectively presented at 11 international conferences and submitted 22 abstracts and 19 manuscripts. NEXT STEPS: The authors hope to provide additional support and guidance to scholars as they become leaders of their own versions of this program at their home sites and plan to expand the faculty group to further lessen the time burden, while enabling the program to provide additional research mentorship to scholars.

BackgroundUse of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided.MethodsWe performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar.ResultsKey interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members.ConclusionsAddressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

We examined the HIV care cascade in a community-based cohort study in Kisesa, Magu, Tanzania. We analyzed the proportion achieving each stage of the cascade - Seroconversion, Awareness of HIV status, Enrollment in Care and Antiretroviral therapy (ART) initiation - and estimated the median and interquartile range for the time for progression to the next stage. Modified Poisson regression was used to estimate prevalence risk ratios for enrollment in care and initiation of ART. From 2006 to 2017, 175 HIV-seroconverters were identified. 140 (80%) knew their HIV status, of whom 97 (69.3%) were enrolled in HIV care, and 87 (49.7%) had initiated ART. Time from seroconversion to awareness of HIV status was 731.3 [475.5-1345.8] days. Time from awareness to enrollment was 7 [0-64] days, and from enrollment to ART initiation was 19 [3-248] days. There were no demographic differences in enrollment in care or ART initiation. Efforts have been focusing on shortening time from seroconversion to diagnosis, mostly by increasing the number of testing clinics available. We recommend increased systematic testing to reduce time from seroconversion to awareness of status, and by doing so speed up enrollment into care. Interventions that increase enrollment are likely to have the most impact in achieving UNAIDS targets.

Although a growing number of studies suggest interactions between Schistosoma parasites and viral infections, the effects of schistosome infections on the host response to viruses have not been evaluated comprehensively. In this systematic review, we investigated how schistosomes impact incidence, virulence, and prevention of viral infections in humans and animals. We also evaluated immune effects of schistosomes in those coinfected with viruses. We screened 4,730 studies and included 103. Schistosomes may increase susceptibility to some viruses, including HIV and Kaposi’s sarcoma-associated herpesvirus, and virulence of hepatitis B and C viruses. In contrast, schistosome infection may be protective in chronic HIV, Human T-cell Lymphotropic Virus-Type 1, and respiratory viruses, though further research is needed. Schistosome infections were consistently reported to impair immune responses to hepatitis B and possibly measles vaccines. Understanding the interplay between schistosomes and viruses has ramifications for anti-viral vaccination strategies and global control of viral infections., Author summary Many studies have described the effects of parasitic Schistosoma worm infections on the way that humans and animals respond to a variety of viral infections. Our goal was to evaluate, in a systematic manner, how having a schistosome parasitic infection affects a host’s susceptibility to viral infections, the clinical disease course of viral infections, and prevention of viral infections by vaccines. We also assessed the effects of schistosome infection on the host immune response to viruses. We screened 4,730 studies for potential relevance and included 103 of them in this review. Overall, our analysis showed that schistosome infection impairs the host response to many viruses. This includes increasing host susceptibility to HIV and possibly Kaposi’s sarcoma-associated herpesvirus, worsening the severity of clinical disease in hepatitis B and C infections, and decreasing immune responses to vaccines for hepatitis B and possibly measles. The studies that we analyzed also suggested that schistosome infection may protect the host against poor clinical outcomes from some viral infections including Human T-cell Lymphotropic Virus-Type 1, respiratory viruses, and chronic HIV. We discuss how these findings might be interpreted, and the additional research needed, in order to improve anti-viral vaccination strategies and control of viral infections globally.

To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania.Cross-sectional study conducted between 2015 and 2016 in the selected communities. In each community, we randomly selected a sample of adults from the general population and from three putative risk groups including the following: (i) fishermen, (ii) fish processors and traders, and (iii) women working in the recreational facilities. Participants were interviewed to obtain information about potential risk factors, and venous blood was collected for detection of HIV, syphilis and schistosome infections. We used logistic regression models to quantify the associations between potential risk factors and HIV, and also between schistosome infection and HIV.We enrolled 1128 people from selected fishing communities. The overall prevalence of HIV, syphilis and schistosome infection was 14.2%, 15.6% and 83.1%, respectively. Female recreational facility workers had the highest prevalence of HIV (30.4%) and syphilis (24%). The odds of being HIV infected were generally higher in all age categories. Transactional sex was commonly reported and especially receiving gifts for sex was found to be strongly associated with HIV (adjusted OR = 2.50; 95% CI: 1.44-4.34, P = 0.008). Confirmed serological syphilis was associated with increased odds of having HIV infection. HIV was not associated with schistosome infection in a combined dataset and when we examined this separately for men and women alone.We observed a high burden of HIV, syphilis and schistosome infections in the fishing communities. Targeted efforts to treat and control infections have the potential to improve health among their residents.Quantifier la charge du VIH, de la syphilis et de l’infection à schistosomes et les facteurs de risque associés chez les adultes vivant dans sept communautés de pêcheurs du lac Victoria dans le nord-ouest de la Tanzanie. MÉTHODES: Etude transversale menée entre 2015-2016 dans les communautés sélectionnées. Dans chaque communauté, nous avons sélectionné aléatoirement un échantillon d'adultes de la population générale et de trois groupes à risque présumés, notamment: 1) les pêcheurs, 2) les transformateurs et commerçants de poisson et 3) les femmes travaillant dans les établissements de loisirs. Les participants ont été interrogés pour obtenir des informations sur les facteurs de risque potentiels, et du sang veineux a été collecté pour la détection du VIH, de la syphilis et des infections à schistosome. Nous avons utilisé des modèles de régression logistique pour quantifier les associations entre les facteurs de risque potentiels et le VIH, ainsi qu'entre l'infection à schistosome et le VIH. RÉSULTATS: Nous avons recruté 1.128 personnes dans une sélection de communautés de pêcheurs. La prévalence globale de l'infection par le VIH, la syphilis et les schistosomes était de 14,2%, 15,6% et 83,1% respectivement. Les travailleuses des établissements de loisirs avaient la prévalence la plus élevée du VIH (30,4%) et de la syphilis (24%). Les chances d'être infecté par le VIH étaient généralement plus élevées dans toutes les catégories d'âge. Les rapports sexuels transactionnels étaient fréquemment rapportés et surtout le fait de recevoir des cadeaux pour le sexe était fortement associé au VIH (OR ajusté = 2,50; IC95%: 1,44-4,34 ; P = 0,008). La syphilis sérologique confirmée était associée à une probabilité accrue d'être infecté par le VIH. Le VIH n'était pas associé à une infection à schistosome dans un ensemble de données combinées et lorsque nous avons examiné cela séparément pour les hommes et les femmes.Nous avons observé une charge élevée d'infections par le VIH, la syphilis et les schistosomes dans les communautés de pêcheurs. Des efforts ciblés pour traiter et contrôler les infections ont le potentiel d'améliorer la santé des résidents.

Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.

Elevated circulating endotoxin levels in the plasma of patients with advanced hepatosplenic schistosomiasis caused by Schistosoma mansoni have been reported, possibly caused by parasite egg–induced intestinal mucosal breaches facilitating bacterial access to the bloodstream. Neither endotoxin levels in people with S. mansoni but without hepatosplenic disease nor the impact of treatment on endotoxin levels have been described. We used a methodically optimized Limulus amebocyte lysate assay to measure plasma endotoxin in community-dwelling women from an S. mansoni–endemic area without clinical hepatosplenic disease. We found no difference in baseline mean plasma endotoxin levels between those with (n = 22) and without (n = 31) infection (1.001 versus 0.949 EU/mL, P = 0.61). Endotoxin levels did not change in schistosome-infected women after successful treatment (1.001 versus 1.093 EU/mL, P = 0.45) and were not correlated with circulating anodic antigen or stool egg burden. Our findings do not support the hypothesis that translocating eggs in S. mansoni infection introduce bacterial sources of endotoxin to the circulation.

Background Schistosomiasis increases the risk of human immunodeficiency virus (HIV) acquisition in women by mechanisms that are incompletely defined. Our objective was to determine how the cervical environment is impacted by Schistosoma haematobium or Schistosoma mansoni infection by quantifying gene expression in the cervical mucosa and cytokine levels in cervicovaginal lavage fluid. Methods We recruited women with and those without S. haematobium infection and women with and those without S. mansoni infection from separate villages in rural Tanzania with high prevalences of S. haematobium and S. mansoni, respectively. Infection status was determined by urine and stool microscopy and testing for serum circulating anodic antigen. RNA was extracted from cervical cytobrush samples for transcriptome analysis. Cytokine levels were measured by magnetic bead immunoassay. Results In the village where S. haematobium was prevalent, 110 genes were differentially expressed in the cervical mucosa of 18 women with versus 39 without S. haematobium infection. Among the 27 cytokines analyzed in cervicovaginal lavage fluid from women in this village, the level of interleukin 15 was lower in the S. haematobium-infected group (62.8 vs 102.9 pg/mL; adjusted P = .0013). Differences were not observed in the S. mansoni-prevalent villages between 11 women with and 29 without S. mansoni infection. Conclusions We demonstrate altered cervical mucosal gene expression and lower interleukin 15 levels in women with S. haematobium infection as compared to those with S. mansoni infection, which may influence HIV acquisition and cancer risks. Studies to determine the effects of antischistosome treatment on these mucosal alterations are needed.

Obtaining RNA from clinical samples collected in resource-limited settings can be costly and challenging. The goals of this study were to 1) optimize messenger RNA extraction from dried blood spots (DBS) and 2) determine how transcriptomes generated from DBS RNA compared with RNA isolated from blood collected in Tempus tubes. We studied paired samples collected from eight adults in rural Tanzania. Venous blood was collected on Whatman 903 Protein Saver cards and in tubes with RNA preservation solution. Our optimal DBS RNA extraction used 8 × 3-mm DBS punches as the starting material, bead beater disruption at maximum speed for 60 seconds, extraction with Illustra RNAspin Mini RNA Isolation kit, and purification with Zymo RNA Concentrator kit. Spearman correlations of normalized gene counts in DBS versus whole blood ranged from 0.887 to 0.941. Bland-Altman plots did not show a trend toward over- or under-counting at any gene size. We report a method to obtain sufficient RNA from DBS to generate a transcriptome. The DBS transcriptome gene counts correlated well with whole blood transcriptome gene counts. Dried blood spots for transcriptome studies could be an option when field conditions preclude appropriate collection, storage, or transport of whole blood for RNA studies.

Objectives Schistosome infections can damage organs important for water homeostasis, especially the kidneys. Urogenital schistosomiasis (caused by Schistosoma haematobium) increases protein and blood in urine and intestinal schistosomiasis (caused by S. mansoni) affects total body water. However, no data exist on how different schistosome species affect urine specific gravity (USG), a hydration biomarker. Therefore, we assessed the relationship between S. haematobium- and S. mansoni-infected and uninfected women and USG in rural Tanzania. Materials and methods Surveys were conducted and stool and urine samples were collected among 211 nonpregnant women aged 18-50. S. haematobium eggs were detected using the urine filtration method. S. mansoni eggs were detected using the Kato Katz method. USG was measured using a refractometer and analyzed as both a continuous and dichotomous variable. Regression (linear/logistic) models were estimated to test the relationship between infection and hydration status. Results The prevalence of S. haematobium was 5.9% and S. mansoni was 5.4% with no coinfections. In regression models, S. haematobium-infected women had significantly higher USG (Beta = 0.007 g mL-1 ; standard error = 0.002; p = 0.001) and odds (Odds ratio: 7.76, 95% CI: 1.21-49.5) of elevated USG (>1.020 g mL-1 ) than uninfected women, whereas S. mansoni-infected women did not. Discussion Schistosoma haematobium, but not S. mansoni, infection is associated with higher USG and risk of inadequate hydration. Future work should determine whether findings are attributable to parasite-induced debris in urine or urinary tract pathologies and signs of renal damage. Human and non-human primate studies using USG in schistosome-endemic areas should account for schistosomiasis.

In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported.We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016.Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women.From our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme - e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital - all of overwhelming sepsis.Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.En République-Unie de Tanzanie, l'incidence du tétanos non néonatal lié à la circoncision est probablement sous-estimée.Nous avons analysé des tableaux et extrait des informations concernant les suites et l'emplacement de la plaie des cas de tétanos non néonatal admis dans le service de soins intensifs du centre médical Bugando entre 2001 et 2016.Le centre médical Bugando, l'un des quatre hôpitaux centraux d'enseignement de la République-Unie de Tanzanie, dispose d'un service de soins intensifs doté de 13 lits qui prend en charge tous les patients admis avec le tétanos. Dans la République-Unie de Tanzanie, les programmes formels de vaccination contre le tétanos ciblent les nourrissons ou les femmes.Nous avons relevé, dans nos registres d'hospitalisation, six patients atteints de tétanos non néonatal parmi les patients masculins ayant récemment subi une circoncision. Seul un de ces patients avait été circoncis dans le cadre d'un programme infranational de circoncision masculine médicale volontaire. Les cinq autres avaient été circoncis en-dehors de ce programme, par exemple dans de petits dispensaires ruraux ou par un praticien traditionnel sans formation médicale formelle. Ces six patients étaient âgés de 11 à 55 ans et cinq (83%) d'entre eux sont décédés à l'hôpital, tous de septicémie.Dans le cadre du programme tanzanien de circoncision masculine médicale volontaire, l'éducation à l'hygiène de la plaie contribue probablement à réduire l'incidence du tétanos non néonatal lié à la circoncision. L'incidence correspondante chez les garçons et les hommes qui sont circoncis en-dehors de ce programme infranational est probablement plus importante. La formation en matière de soin des plaies de toutes les personnes qui pratiquent des circoncisions et la mise en place d'un programme de vaccination permettant aux Tanzaniens de bénéficier de vaccins contre le tétanos après la petite enfance sont recommandées.En la República Unida de Tanzania, es posible que no se comunique la incidencia del tétanos relacionado con la circuncisión no neonatal.Hemos analizado gráficos y extraído información sobre las consecuencias y la localización de la herida para los casos no neonatales de tétanos ingresados en la unidad de cuidados intensivos del Bugando Medical Centre entre 2001 y 2016.El Bugando Medical Centre, uno de los cuatro hospitales de referencia en la República Unida de Tanzania, cuenta con una unidad de cuidados intensivos de 13 camas que se ocupa de todos los pacientes ingresados con tétanos. En la República Unida de Tanzania, los programas oficiales de vacunación contra el tétanos están orientados a infantes o mujeres.A partir de los registros de pacientes hospitalizados, se identificaron a seis pacientes con tétanos no neonatal entre los pacientes varones con un historial reciente de circuncisión. Solo uno de estos pacientes había sido circuncidado dentro de un programa subnacional para la circuncisión masculina voluntaria médica. Los otros cinco habían sido circuncidados fuera del programa, por ejemplo, en pequeños dispensarios rurales o atendidos por un proveedor tradicional sin formación médica oficial. Los seis pacientes tenían entre 11 y 55 años de edad y cinco (83%) de ellos murieron en el hospital, todos a causa de una sepsis incontenible.Dentro del programa de Tanzania para la circuncisión masculina voluntaria médica, probablemente la educación sobre la higiene de las heridas ayude a reducir la incidencia del tétanos relacionado con la circuncisión no neonatal. Es probable que la incidencia correspondiente entre los niños y hombres circuncidados fuera de este programa subnacional sea mayor. Se recomienda la formación de todos los proveedores de circuncisión en el cuidado de heridas y un programa de vacunación para asegurar que los varones de Tanzania sean vacunados contra el tétanos después de la infancia.من المرجح وجود قصور في الإبلاغ عن حدوث الإصابة بالكزاز (التيتانوس) غير المرتبط بالولادة في جمهورية تنزانيا المتحدة.قمنا بتحليل الرسوم البيانية واستخلاص المعلومات المتعلقة بنتائج ومواقع الجروح الخاصة بحالات الإصابة بالكزاز في غير حالات الأطفال حديثي الولادة الخاضعة للعناية المركزة في مركز بوغاندو الطبي بين عامي 2001 و2016.يُعد مركز بوغاندو الطبي واحدًا من أربع مستشفيات جامعية تستقبل التحويلات الطبية في جمهورية تنزانيا المتحدة، كما أنه مجهز بوحدة للعناية المركزة تشتمل على 13 سريرًا للتعامل مع جميع حالات الإصابة بالكزاز التي يتم قبولها. وفي جمهورية تنزانيا المتحدة، تستهدف البرامج الرسمية لتمنيع الكزاز الرضع أو النساء.حددنا من بين سجلات المرضى الداخليين لدينا ستة حالات إصابة بالكزاز من غير الحالات المرتبطة بالأطفال حديثي الولادة وذلك بين المرضى الذكور الذين خضعوا مؤخرًا للختان. ولم يخضع سوى مريض فقط من بين هؤلاء المرضى للختان في إطار برنامج دون وطني لختان الذكور التطوعي. وقد تم ختان الخمسة الآخرين خارج نطاق البرنامج – على سبيل المثال في المستوصفات الريفية الصغيرة أو من قبل مقدم تقليدي للخدمات الطبية دون تدريب طبي رسمي. وتتراوح أعمار المرضى الستة ما بين 11 إلى 55 عامًا، وتوفي خمسة منهم (‏83‏%) في المستشفى بسبب الإنتان الشديد.من المرجح أن تفيد التوعية بشأن نظافة الجروح في الحد من الإصابة بالكزاز الناتج عن الختان وغير المرتبط بحديثي الولادة، وذلك في إطار البرنامج التنزاني للختان الطبي التطوعي للذكور. ومن المرجح أن تكون النسبة المقابلة بين الأولاد والرجال الذين يتم ختانهم خارج هذا نطاق البرنامج دون الوطني أعلى. ويوصى بتدريب جميع القائمين على إجراء الختان على كيفية العناية بالجروح وبرنامج التطعيم لضمان حصول الذكور التنزانيين على التمنيع ضد الكزاز بعد مرحلة الطفولة.在坦桑尼亚联合共和国,与非新生儿割礼相关的破伤风发病率可能少报了。.我们分析了关于 2001 年至 2016 年间入住布坎多医疗中心 (Bugando Medical Centre) 重症监护病房的非新生儿破伤风病例的治疗效果和伤口位置的图表,并提取了信息。.作为坦桑尼亚联合共和国四家教学类转诊医院之一的布坎多医疗中心 (Bugando Medical Centre) 拥有 13 个床位的重症监护病房,管理所有入院的破伤风患者。坦桑尼亚联合共和国正式的破伤风免疫计划目标人群是婴儿或女性。.根据我们住院患者记录,我们在近期进行过割礼的男性患者中确定了六位非新生儿破伤风患者。其中只有一名患者是通过地方性自愿医疗男性割礼计划实施割礼的。其余五人均非通过该计划实施割礼 – 例如:通过小型的农村诊疗所,或通过没有经过正式医疗培训的传统提供者。这六位患者年龄在 11–55 岁之间,其中五人 (83%) 在医院死亡——全部为爆发性败血症。.坦桑尼亚联合共和国自愿医疗男性割礼计划以及伤口卫生教育可能有助于降低非新生儿与割礼相关的破伤风患病率。未通过这项地方性计划实施割礼的男孩和男性的相应患病率可能会增加。应面向所有割礼提供者进行关于伤口护理的培训,并推荐实施一项可确保坦桑尼亚男性居民在婴儿期之后的阶段接受破伤风免疫的免疫接种计划。.Показатели заболеваемости столбняком, связанным с обрезанием крайней плоти, проводимым не над младенцами, в Объединенной Республике Танзания, вероятно, являются заниженными.Мы проанализировали графики и получили данные об исходах и местоположении раны для случаев заболеваемости столбняком у пациентов старше младенческого возраста, поступивших в отделение интенсивной терапии Медицинского центра Бугандо в период с 2001 по 2016 год.Медицинский центр Бугандо, который является одной из четырех учебных многопрофильных больниц в Объединенной Республике Танзания, располагает отделением интенсивной терапии на 13 койко-мест, куда поступают все пациенты со столбняком. Официальные программы иммунизации против столбняка, действующие на территории Объединенной Республики Танзания, нацелены на детей или женщин.На основе информации, полученной из наших стационарных журналов, мы выявили шесть пациентов старше младенческого возраста со столбняком среди пациентов мужского пола с обрезанием в недавнем анамнезе. Только один из этих пациентов был обрезан в рамках субнациональной программы добровольного мужского медицинского обрезания. Остальные пять были обрезаны вне программы, например в небольших сельских диспансерах или традиционными специалистами по обрезанию крайней плоти без официального медицинского образования. Шесть пациентов были в возрасте 11–55 лет, из них пять (83%) умерли в больнице — все по причине развития генерализованного сепсиса.Проведение обучения по обработке и гигиене раны в рамках танзанийской программы добровольного медицинского обрезания крайней плоти у мужчин, вероятно, способствует снижению заболеваемости столбняком в возрасте старше младенческого, связанным с проведением обрезания. Соответствующая заболеваемость среди мальчиков и мужчин, прошедших обрезание вне этой субнациональной программы, вероятно, выше. Рекомендуется обучать всех специалистов по обрезанию крайней плоти у мужчин надлежащей обработке и лечению ран, а также соблюдать программы вакцинации для обеспечения того, чтобы мужчины Танзании в раннем детстве проходили иммунизацию от столбняка.

Schistosomiasis is a parasitic worm infection that affects over 260 million individuals worldwide. Women with schistosome infections have been demonstrated to have a 4-fold increase in the odds of human immunodeficiency virus (HIV) infection compared with women without schistosome infections. A relationship between schistosome and HIV infections has not been clearly defined in men. Among 674 men aged 18-50 years living in rural Tanzania, we identified 429 (63.6%) who had a schistosome infection as defined by serum positivity for schistosome circulating anodic antigen, visualization of parasite eggs in urine or stool, or both. HIV infection was identified in 38 (5.6%). The odds of HIV infection was 1.3 [95% confidence interval = 0.6-2.5] (P = 0.53) among men with any schistosome infection (Schistosoma haematobium or Schistosoma mansoni), and it was 1.4 [0.6-3.3] (P = 0.43) among men with S. haematobium infection. Men with S. haematobium infection were significantly more likely to report the symptom of hemospermia than men without S. haematobium infection. We conclude that schistosome infections appear to have little to no association with HIV infection in men.

Background Current World Health Organization (WHO) guidelines recommend annual mass drug administration using praziquantel in areas with high schistosome endemicity. Yet little is known about incidence and reinfection rates after treatment in women with frequent exposure to schistosomes. We sought to quantify response to anti-schistosome treatment and incident S. mansoni infections in a cohort of rural women living in a schistosome-endemic area of northwest Tanzania. Methods and principal findings We enrolled women with and without S. mansoni infection into a 12-month longitudinal cohort. Every 3 months, women were tested for schistosome infection using microscopic examinations for ova on filtered urine, Kato Katz slides, and serum Circulating Anodic Antigen (CAA). Those with schistosome infection received treatment with praziquantel 40 mg/kg according to the standard of care. We studied 35 women who were S. mansoni positive by stool microscopy and 46 women without schistosome infection who returned for at least one follow-up. Of the women who were initially infected, 14 (40%) were schistosome-positive at a follow-up visit. Four women developed incident infections, for a cumulative incidence of 8.7% and incidence rate of 0.99 per 100 person-months throughout the year among initially uninfected women. Only 3 women were egg-positive at any follow-up. Women with persistent, recurrent, or incident infection during the study period were significantly younger (p = 0.032) and had fewer children than women who remained uninfected or those who cleared the infection and did not experience recurrence (p = 0.003). Having fewer children remained significant after controlling for age (p = 0.023). There was no difference in initial intensity of infection by CAA or stool egg count, HIV status, or socioeconomic status. Although most water contact behaviors were comparable between the two groups, women with recurrent or incident schistosome infections were significantly more likely to have recently swum in the lake (p = 0.023). Conclusions Our data suggests that annual praziquantel treatment reduces intensity of schistosome infections but is insufficient in providing stable parasite eradication in over a third of women in endemic communities. Furthermore, microscopy lacks adequate sensitivity to evaluate efficacy of treatment in this population. Our work demonstrates that further investigation into treatment efficacy and reinfection rates is warranted and suggests that increased frequency of praziquantel treatment is needed to improve cure rates in high-risk populations., Author summary Schistosomiasis is a parasitic infection transmitted through contaminated water that primarily affects the gastrointestinal and urogenital tracts. Previous studies in Tanzania have shown that adult women infected with schistosomes also have a higher risk of contracting HIV. Although it is recommended that people living in areas where they are exposed to schistosomes be treated with praziquantel once a year, the rate of new infections or reinfection after treatment in adult women is not known. We followed a group of schistosome-infected women and an uninfected control group for 12 months. They were tested for schistosomes every 3 months, and treated with praziquantel if they were infected. Over 40% of the women tested positive for schistosome infection at some point during the follow-up period, and the majority of them were from the group that was infected at the beginning of the study. These women may not have fully cleared the infection after one treatment, or they may be more susceptible to reinfection due to variations in their immune systems. Further studies are recommended to investigate whether a higher frequency of treatment is needed to control schistosome infection in adult women, especially given that reducing schistosome infection may help to reduce HIV risk in populations similar to ours.

Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic areas.

Background Schistosoma sp. infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. infection on the efficiency of antiretroviral treatment (ART) in HIV-1 infected individuals. One study suggested increased immunological failure in patients infected with schistosomes compared to those uninfected. To our knowledge, no report exists on the virological response to ART in schistosome-infected individuals. In addition, viral load in HIV-1 infected individuals changes over the course of the HIV infection. This study assessed the impact of HIV-1/Schistosoma sp. co-infections on viral load in people with immunological failure on ART, taking into account the duration of HIV-1 infection. Methods We enrolled HIV-1 infected Tanzanian adults over 18 years of age who had used first line ART for more than 6 months and were identified to have immunological failure by the WHO criteria (50% drop from peak CD4 count, or CD4 count equal to or below baseline after 6 months of ART, or CD4 count below 100cells/mm3 after 1 year of ART). Patients were also tested for schistosome infection by microscopy for ova in urine and stool and by circulating anodic antigen (CAA) levels in serum. The duration of HIV-1 infection was calculated using baseline CD4+ T-cell (CD4) counts determined at enrollment. Univariable and multivariable analyses were conducted to compare viral loads in schistosome infected and uninfected patients. Results A total of 188 patients were enrolled. After univariable analysis, female sex, lower peak CD4 counts, lower current CD4 counts, anemia, and shorter time infected with HIV-1 were all significantly associated with higher viral load. Schistosome infection was not associated with viral load even after adjusting for sex, current CD4 counts and duration of HIV-1 infection. Conclusions The current study of HIV-infected patients with immunological failure on ART suggests that once ART is introduced, ART is the dominant driver of viral load and schistosome infection may no longer have an impact.

Summary Background Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. Methods In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (

Malaria remains common in sub-Saharan Africa, but it is frequently over-diagnosed and over-treated in hospitalized children. HIV is prevalent in many malaria endemic areas and may delay parasite clearance and increase mortality among children with malaria. This prospective cohort study enrolled children with suspected malaria between 3 months and 12 years of age hospitalized at two referral hospitals in Tanzania. Both a thick blood smear (BS) and a malaria rapid diagnostic test (mRDT) were performed. If discordant results were obtained, PCR was performed for Plasmodium falciparum. Malaria was confirmed if two out of three tests were positive. Malaria parasite densities were determined for two consecutive days after diagnosis and treatment of malaria. All participants were tested for HIV. Among 1492 hospitalized children, 400 (26.8%) were enrolled with suspected malaria infection. There were 196/400 (49.0%) males, and the median age was 18 [9-36] months. BS was positive in 95/400 (23.8%), and mRDT was positive in 70/400 (17.5%), with moderate agreement (Kappa=0.598). Concordant results excluded malaria in 291/400 (72.8%) and confirmed malaria in 56/400 (14.0%). PCR performed on 53 discordant results confirmed malaria in 1/39 of the BS-positive/mRDT-negative cases, and 6/14 of the BS-negative/mRDT-positive cases. The prevalence of confirmed malaria was 63/400 (15.8%). In multivariable logistic regression, malaria was associated with HIV (OR 3.45 [1.65-7.20], p=0.001). Current breastfeeding (OR 0.25 [0.11-0.56], p=0.001) and higher hemoglobin (OR 0.70 [0.60-0.81], p

Schistosome worms infect over 200 million people worldwide. They live in the host’s bloodstream and alter host immunity. Epidemiological data suggest that males and females have different responses to schistosome infection, but the effect of sex on systemic response is undetermined. Our objective was to characterize differences in peripheral blood transcriptional profiles in people with or without active S. haematobium infection, and to determine whether this signature differs between males and females. Messenger RNA was isolated using poly(A) selection and sequenced on an Illumina Hi-Seq4000 platform. Transcripts were aligned to the human hg19 reference genome and counted with the HTSeq package. Genes were compared for differential expression using DESeq2. Ingenuity Pathway Analysis was used to identify gene networks altered in the presence of S. haematobium . We enrolled 33 participants from villages in rural Tanzania where S. haematobium is endemic. After correction for multiple comparisons, we observed 383 differentially-expressed genes between those with and without S. haematobium infection when sex was included as a covariate. Heat-mapping of the genes with greater than 1.5-fold differences in gene expression revealed clustering by S. haematobium infection status. Top networks included development, cell death and survival, cell signaling, and immunologic disease pathways. We observed a distinct whole blood transcriptional profile, as well as differences in men and women, with S. haematobium infection. Additional studies are needed to determine the clinical effects of these divergent responses. Attention to sex-based differences should be included in studies of human schistosome infection.

Background: Traditional microscopic examination of urine or stool for schistosome eggs lacks sensitivity compared to measurement of schistosome worm-derived circulating antigens in serum or urine. The ease and non-invasiveness of urine collection makes urine an ideal sample for schistosome antigen detection. In this study several user-friendly, lateral-flow (LF) based urine assays were evaluated against a composite reference that defined infection as detection of either eggs in urine or anodic antigen in serum. Method: In a Tanzanian population with a S. haematobium prevalence of 40–50% (S. mansoni prevalence

Background Africa bears the burden of approximately 70% of global HIV infections and 90% of global schistosome infections. We sought to investigate the impact of schistosome infection at the time of HIV-1 seroconversion on the speed of HIV-1 disease progression, as measured by the outcome CD4+ T-cell (CD4) counts, Author summary Several studies had shown that people infected with schistosome parasites were at risk of getting HIV and that they may have higher HIV viral concentrations in their blood as well. The authors explored the impact of the parasite on HIV disease after infection, expecting that people co-infected with the parasite at time of HIV-infection would develop worse HIV outcomes than people who did not have the parasite. HIV seroconverters were identified among a large cohort tested regularly for HIV in northwest Tanzania and were followed-up in clinics to determine their CD4 + T-cells counts and mortality. The seroconverters’ stored blood samples were tested for infection with the parasite and outcomes were compared between seroconverters who were and were not infected with the parasites at the time that they became HIV-infected. The authors surprisingly found that people with the parasite experienced fewer negative outcomes of HIV than people who did not have the parasite. To the investigators’ knowledge, this is the first longitudinal study to find this result. Long-term immunological changes may explain this protective effect and more studies are recommended to explore this research question.

Schistosome worms infect over 200 million people worldwide. They live in the host’s bloodstream and alter host immunity. Epidemiological data suggest that males and females have different responses to schistosome infection, but the effect of sex on systemic response is undetermined. Our objective was to characterize differences in peripheral blood transcriptional profiles in people with or without active Schistosoma haematobium infection and to determine whether this signature differs between males and females. mRNA was isolated using poly(A) selection and sequenced on an Illumina Hi-Seq4000 platform. Transcripts were aligned to the human hg19 reference genome and counted with the HTSeq package. Genes were compared for differential expression using DESeq2. Ingenuity Pathway Analysis (IPA) was used to identify gene networks altered in the presence of S. haematobium. We enrolled 33 participants from villages in rural Tanzania where S. haematobium is endemic. After correction for multiple comparisons, we observed 383 differentially expressed genes between those with or without S. haematobium infection when sex was included as a covariate. Heat-mapping of the genes with >1.5-fold differences in gene expression revealed clustering by S. haematobium infection status. The top networks included development, cell death and survival, cell signaling, and immunologic disease pathways. We observed a distinct whole blood transcriptional profile, as well as differences in men and women, with S. haematobium infection. Additional studies are needed to determine the clinical effects of these divergent responses. Attention to sex-based differences should be included in studies of human schistosome infection.

Background Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]. In response to these recommendations, our tertiary referral hospital in Tanzania implemented a standardized clinical protocol for care of patients with tetanus in 2006 and a subsequent modification in 2012. In this study we aimed to assess the impact of the protocol on clinical care of tetanus patients and their outcomes. Methods and findings We examined provision of care and outcomes among all patients admitted with non-neonatal tetanus to the ICU at Bugando Medical Centre between 2001 and 2016 in this retrospective cohort study. We compared three groups: the pre-protocol group (2001–2005), the Early protocol group (2006–2011), and the Late protocol group (2012–2016) and determined associations with mortality by univariable logistic regression. We observed a significant increase in provision of care as per protocol between the Early and Late groups. Patients in the Late group had a significantly higher utilization of mechanical ventilation (69.9% vs 22.0%, p< 0.0001), provision of surgical wound care (39.8% vs 20.3%, p = 0.011), and performance of tracheostomies (36.8% vs 6.7%, 40%). Institution of a standardized tetanus management protocol, in accordance with WHO recommendations, decreased immediate mortality related to primary causes of death after tetanus. However, this was offset by an increase in death due to later ICU complications such as sepsis. Our results illustrate the complexity in achieving mortality reduction even in illnesses thought to require few critical care interventions. Improving basic ICU care and strengthening vaccination programs to prevent tetanus altogether are essential components of efforts to decrease the mortality caused by this lethal, neglected disease.

It has been postulated that impaired host immunity due to HIV infection reduces parasite egg excretion. Schistosoma/HIV interactions have also been shown to differ by sex. We hypothesized that egg excretion would vary based on both HIV status and sex. We examined data from more than 1,700 participants in eight studies conducted in northwest Tanzania between 2010 and 2016. Schistosoma infection was defined by circulating anodic antigen (CAA) serum levels ≥ 30 pg/mL and/or egg positivity in either stool by Kato Katz method or urine by filtration. We used multivariable analyses to determine the impact of confounding factors such as sex, age, previous praziquantel treatment, and worm burden as measured by serum CAA level, on the relationship between egg excretion and HIV status. HIV-infected individuals were significantly less likely to excrete schistosome eggs than HIV-uninfected individuals, even after controlling for worm burden and sex (OR = 0.6 [0.4, 0.9], P = 0.005). Furthermore, after controlling for worm burden and HIV status, women had lower odds of egg excretion than men (OR = 0.4 [0.3, 0.5], P < 0.001). Sensitivity of egg microscopy was lower in HIV-infected women than HIV-uninfected men (41% versus 61%, P < 0.001), whereas sensitivity in women remained low in both groups (33% versus 37%, P = 0.664). Our study is the first to report that women with Schistosoma infection excrete fewer eggs than men for a given worm burden, regardless of HIV the status. These findings suggest that guidelines for use of microscopy to diagnose Schistosoma infections in HIV-infected individuals and in women merit reconsideration.

Circulating anodic antigen (CAA) testing is a powerful, increasingly-used tool for diagnosis of active schistosome infection. We sought to determine the feasibility and reliability of measuring CAA in blood spots collected on Whatman 903 protein saver cards, which are the predominant filter papers used worldwide for dried blood spot (DBS) research and clinical care. CAA was eluted from blood spots collected from 19 individuals onto Whatman 903 cards in Mwanza, Tanzania, and the assay was optimized to achieve CAA ratios comparable to those obtained from the spots' corresponding serum samples. The optimized assay was then used to determine the correlation of serum samples (n=16) with DBS from cards that had been stored for 8 years at ambient temperature. Using a DBS volume equivalent to approximately four times the quantity of serum, CAA testing in DBS had a sensitivity of 76% and a specificity of 79% compared to CAA testing in serum. CAA testing was reliable in samples eluted from Whatman 903 cards that had been stored for 8 years at ambient temperature. The overall kappa coefficient was 0.53 (standard error 0.17, p

Introduction Little is known about hepatotoxicity in patients with schistosome and HIV co-infections. Several studies have reported increased liver enzymes and bilirubin levels associated with schistosome infection. We investigated whether HIV-infected adults on antiretroviral therapy who had S. mansoni co-infection had a higher prevalence of hepatotoxicity than those without. Methodology/Principal findings We determined the presence and grade of hepatotoxicity among 305 HIV-infected outpatients who had been on medium-term (3–6 months) and long-term (>36 months) antiretroviral therapy in a region of northwest Tanzania where S. mansoni is hyperendemic. We used the AIDS Clinical Trial Group definition to define mild to moderate hepatotoxicity as alanine aminotransferase, alanine aminotransferase, and/or bilirubin elevations of grade 1 or 2, and severe hepatotoxicity as any elevation of grade 3 or 4. We determined schistosome infection status using the serum circulating cathodic antigen rapid test and used logistic regression to determine factors associated with hepatotoxicity. The prevalence of mild-moderate and severe hepatotoxicity was 29.6% (45/152) and 2.0% (3/152) in patients on medium-term antiretroviral therapy and 19.6% (30/153) and 3.3% (5/153) in the patients on long-term antiretroviral therapy. S. mansoni infection was significantly associated with hepatotoxicity on univariable analysis and after controlling for other factors associated with hepatotoxicity including hepatitis B or C and anti-tuberculosis medication use (adjusted odds ratio = 3.0 [1.6–5.8], p = 0.001). Conclusions/Significance Our work demonstrates a strong association between S. mansoni infection and hepatotoxicity among HIV-infected patients on antiretroviral therapy. Our study highlights the importance of schistosome screening and treatment for patients starting antiretroviral therapy in schistosome-endemic settings. Additional studies to determine the effects of schistosome-HIV co-infections are warranted., Author summary Schistosoma sp. are parasitic worms that infect at least 218 million people worldwide. Over 90% of these individuals live in Africa, where HIV infection is also endemic. Schistosome worms lay eggs that damage the gastrointestinal and genitourinary tracts, causing extensive morbidity and mortality. Patients who have HIV and Schistosoma mansoni co-infections are at risk for damage to the liver due to both the effects of the schistosome parasite and the side-effects of antiretroviral therapy. However, little is known about the additional liver effects of schistosome infection in patients already taking antiretroviral therapy. Therefore, we conducted a study in northwest Tanzania, where our prior work has shown that approximately one-third of HIV-infected patients also have schistosome infections, to investigate the effect of co-infection with Schistosoma mansoni on liver damage in patients taking antiretroviral therapy. We studied 305 HIV-infected outpatients on medium and long-term antiretroviral therapy and determined both liver damage and S.mansoni infection in those patients. We found that among patients on antiretroviral therapy, those with HIV-schistosome co-infection were 3 times more likely to have liver damage than those with HIV infection alone. Our work shows the importance of screening and treating for Schistosoma mansoni to decrease the risk of liver damage in patients infected with HIV.

Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies than men and that these policies are more supportive of women and children. Other studies show that proactive interventions to increase the proportion of women in leadership positions within businesses or government can be successful. Therefore, the authors assert that increasing female leadership in global health is both feasible and a fundamental step towards addressing the problem of women's health. In this Perspective, the authors contrast the high proportion of young female trainees who are interested in academic global health early in their careers with the low numbers of women successfully rising to global health leadership roles. The authors subsequently explore reasons for female attrition from the field of global health and offer practical strategies for closing the gender gap in global health leadership. The authors propose solutions aimed to promote female leaders from both resource-wealthy and resource-poor countries, including leadership training grants, mentorship from female leaders in global professions, strengthening health education in resource-poor countries, research-enabling grants, and altering institutional policies to support women choosing a global health career path.