Asset Publisher

Pneumonia contributes to 40.6% of deaths in children under five, says a study by the CHAMPS network

Another study by CHAMPS concludes that 98.9% of malaria deaths could be prevented through enhanced access to malaria control measures

Photo: ISGlobal (M Solano)

We now have detailed information on two major killers in children under five years of age – pneumonia and malaria - thanks to two new studies by the CHAMPS network, in which the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, participated. This information, published in Lancet Child Adolescent Health and the Journal of Infection, will help to design evidence-based interventions and guide research efforts to reduce childhood mortality in high-burden regions. 

Despite major progress in improving child survival in recent decades, nearly 14,000 children under five die every day, mostly in low-income countries. The Child Health and Mortality Prevention Surveillance (CHAMPS), led by Emory University, was launched in 2015 to track causes of death in children aged under five, across multiple sites in sub-Saharan Africa and Asia. To establish the cause of death, CHAMPS uses an innovative technique called minimally invasive tissue sampling (MITS), which was developed and validated by ISGlobal researchers.

Two new CHAMPS studies have focused on two of the leading killers in children under five - pneumonia and malaria - to better estimate the real contribution of these diseases to child mortality and to improve prevention and treatment strategies.

Pneumonia: high prevalence of co-infections

Pneumonia is the leading infectious cause of death in children under five, but identifying the cause (whether it’s bacterial or viral) is challenging. In this study, CHAMPS researchers analysed 1120 under-five deaths that occurred between December 2016 and December 2022 in six sub-Saharan countries (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in Asia (Bangladesh). Using MITS and clinical data, the researchers found that pneumonia was involved in up to 40.6% of all childhood deaths. More than one pathogen (bacterial, viral and/or fungal) was behind 57.8% of pneumonia deaths. The most common bacteria were Streptococcus pneumoniae, Klebsiella pneumoniae and Heamophilus influenzae, while cytomegalovirus was the most common viral pathogen. In about two-thirds of the cases, pneumonia was most likely acquired in the community, while about one-third of cases were hospital-acquired. 

Despite widespread use of the pneumococcal conjugate vaccine in all participating countries, S pneumoniae remained the leading cause of community-acquired pneumonia. “This means that the pneumococcal deaths were caused by serotypes not included in the current vaccine formulation or in children not fully vaccinated,” says ICREA researcher Quique Bassat, General Director of ISGlobal and co-author of the study.

The findings highlight the complexity of severe pneumonia cases, with a high prevalence of co-infections involving both bacterial and viral pathogens. The authors point to the need to review the clinical management of very severe pneumonia in low- and middle-income settings. For example, the currently recommended empirical treatment for community-acquired pneumonia in children would be inadequate for treating K pneumoniae. The resultss also highlight the need for research into new or improved vaccines against these pathogens.

Malaria remains a significant cause of childhood mortality

In another study conducted in the same seven countries, CHAMPS researchers led by Bassat focused on investigating malaria-related deaths. While the disease remains a major cause of death, particularly in children under five who are no longer protected by maternal antibodies but have not yet developed natural immunity to the disease, there is still much uncertainty about the true burden of malaria-associated mortality in endemic areas.

The researchers used MITS together with socio-demographic, clinical, laboratory and verbal autopsy data to determine the causes of death in 858 children aged 1-59 months. The proportion of malaria-associated deaths varied between countries: from 43% in Sierra Leone to 18% in Mozambique or 0.3% in Mali. Malaria was the sole infectious agent in 70% of these deaths, while bacterial and viral co-infections were identified in 24% and 12% of cases, respectively. “This high percentage of bacterial co-infections points to the potential benefits of giving antibiotics to patients with severe malaria,” says Rosauro Varo, co-primary author of the study.

Most child deaths could be avoided

The authors estimate that almost all malaria-related deaths (98.9%) could have been prevented. “Compared to non-malaria deaths, many of the malaria deaths are easily preventable through access to malaria control measures,” says Bassat. For instance, only 63% of children had received antimalarial drugs prior to death. In the pneumonia study, the authors estimate that two-thirds of the pneumonia deaths were potentially preventable. This confirms previous CHAMPS estimates that 82% of child deaths in low-income countries could be prevented. Notably, malnutrition was a dominant factor in pneumonia-related deaths and was present in one third of malaria and non-malaria deaths. 

In addition to advancing research efforts, CHAMPS researchers hope that the findings of these studies will help guide global health agendas, policies and evidence-based interventions to reduce child mortality in these high-burden regions.



Mahtab S, Blau DM, Madewell ZJ et al. Post-mortem investigation of deaths due to pneumonia in children aged 1–59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. Lancet Child Adolesc Health. 2024. Doi: 10.1016/S2352-4642(23)00328-0.

Ogbuanu IU, Otieno K, Varo R et al. Burden of child mortality from malaria in high endemic areas: results from the CHAMPS Network using minimally invasive tissue sampling. Journal of Infection. 2024. Doi: 10.1016/j.jinf.2024.01.006


Conditional Cash Transfers Significantly Reduce HIV/AIDS Cases and Deaths in Highly Vulnerable Populations

New study using data from more than 22 million beneficiaries of the Programa Bolsa Familia in Brazil shows that the effect is concentrated among the very poor, women and adolescents

Photo: Ministério do Desenvolvimento Social

The Brazilian cash transfer programme has reduced by more than half the number of new cases and deaths from HIV/AIDS among the very poor, according to a large cohort study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, in collaboration with the Institute of Collective Health of the Federal University of Bahia, Brazil. The results, published in Nature Communications, show that these programmes are essential for reaching the AIDS-related targets by 2030.

Living with very little money puts people at greater risk of contracting many different diseases, including HIV/AIDS, a pandemic that has caused more than 30 million deaths worldwide. Poverty not only increases the risk of contracting HIV, it also makes it harder to get appropriate and timely care.

But fighting diseases like HIV/AIDS is not just about health care. It’s also about improving the conditions in which people live (the social determinants of health). One way to help families with low incomes is through programmes that give them money if they meet certain conditions, such as making sure their children go to school and get medical check-ups. These programmes have been used in many low- and middle-income countries (LMICs) and have helped improve health in many ways. One of the world’s largest such programmes is the Programa Bolsa Família (PBF), which was launched in Brazil two decades ago.

 “Conditional cash transfer (CCT) programmes are among the most effective and widely used interventions to address the social determinants of health, but the magnitude of its impact on HIV/AIDS was not clear,” says Davide Rasella, ISGlobal researcher and study coordinator.

In this study, Rasella and colleagues looked at data from more than 22 million PBF beneficiaries over 9 years (between 2007 and 2015) to find out.

Effect according to income, sex and age

The results of the analysis show a strong effect of the PBF on all disease-related outcomes. But this effect depended on the baseline income of the beneficiaries. Among people with extremely low income, the number of new AIDS cases and deaths was reduced by more than half (55% and 54% respectively), and the case-fatality rate of the disease was also reduced (by 37%). The programme had almost no effect on people with higher incomes.

The impact was also stronger in women and adolescents, showing that this programme helps to reduce inequalities based not only on income but also on sex and age.

Conditional cash transfers can help prevent HIV/AIDS through several mechanisms. For example, by reducing the likelihood that women will resort to sex to meet basic needs, or by providing access to health education and information, or by reducing malnutrition and other co-morbidities that exacerbate the disease.

“This is the largest evaluation of the impact of CCTs on an infectious disease, in particular on HIV/AIDS,” says Andréa F. da Silva, researcher at the Institute of Collective Health of the Federal University of Bahia, and first author of the study.

As Rasella points out, these are “very strong results.” They show that CCTs significantly reduce AIDS cases and deaths in extremely vulnerable populations and should be considered an essential intervention to achieve the AIDS-related Sustainable Development Goals by 2030.



Silva, A.F., Dourado, I., Lua, I. et al. Los ingresos determinan el impacto de las transferencias de efectivo sobre el VIH/SIDA: estudio de cohortes de 22,7 millones de brasileños. Nat Commun 15, 1307 (2024).

Policy & Global Development

ISGlobal Launches a Series of Documents Analyzing Issues Related to COVID-19

The collection, authored by a team of 23 experts, deals with the key components of a safe and phased reopening of society


ISGlobal is launching a new series of analytical documents aimed at contributing to the fight against COVID-19 and orienting the strategy for lifting mitigation and confinement measures. The collection will, initially, comprise 17 documents in which 23 experts will endeavour, from the standpoint of research, to identify and respond to some of the major challenges posed by the current crisis. The aim of this collection, coordinated by ISGlobal’s Policy team, is to contribute evidence-based information and the answers to questions about the main topics involved in the management of the COVID-19 crisis. It is possible that further documents will be added depending on the issues and questions that arise as the pandemic continues.

The main focus of the analysis will be on the scientific and epidemiological aspects of the crisis, but considerations related to economic, social, public health and communication aspects will also be included. The final output will make up a guide to the concept of what the authors are calling ‘precision public health’. “To date, the mitigation measures have succeeded in slowing down transmission of the virus and preventing the collapse of our health care system,” says Antoni Plasència, Director of ISGlobal. “As an institute committed to working for the health of all people, ISGlobal’s current mission must be to contribute to ensuring a controlled exit from the containment phase”.

This project is being coordinated by the ISGlobal Policy team. At this time, the authors on the team are as follows: Josep M. Antó, Joan Ballester, Quique Bassat, Elisabeth Cardis, Carlos Chaccour, Carolyn Daher, Carlota Dobaño, Gonzalo Fanjul, Alberto García-Basteiro, Raquel González, Caterina Guinovart, Manolis Kogevinas, Jeffrey Lazarus, Jill Litt, Anna Llupiá, Denise Naniche, Mark Nieuwenhuijsen, Cristina O’Callaghan, Antoni Plasència, Adelaida Sarukhan, Elisa Sicuri, Jordi Sunyer and Rafa Vilasanjuan.

Read the published documents here:

57. The Economic Fallacy of Improving Air Quality in Europe: the Social and Economic Costs of Inaction Are Far Greater than Taking Ambitious Action

56. What Is Universal Health Coverage and Why Is It Important for Spain?

55. How Can We Prepare for and Respond to Radiological Incidents During Armed Conflicts?

54. Health and Climate: Briefing Notes Ahead of COP28

53. Towards Clean Air in the EU: the Need for a Bold Step Forward

52. How Can We Address the Effects of Economic Downturns on Systemic Health Crises?

51. What Opportunities and Challenges Does the EU Global Health Strategy Present?

50. The All-Hazards Preparedness Approach: How Can We Be Better Prepared for the Next Public Health Crisis?

49. Childhood Pneumonia: The Impact of the Pandemic and What Needs to Be Done Now

48. The International Pandemic Treaty: What is at Stake?

47. What impact has the COVID-19 pandemic had on the fight against malaria?

46. What Impact has COVID-19 had on Childhood Immunization Programs?

45. Could COVID-19 Present an Opportunity in the Fight Against HIV?

44. How Has COVID-19 Affected the Global Fight Against Tuberculosis?

43. COVID-19 and Other Pandemics: Indirect Effects in Low- and Middle-Income Countries

41. COVID-19: When and How Will the Pandemic End?

39. COVID-19 Vaccines: What Are the Global Health Consequences of a Third Dose?

38. How to Respond to COVID-19 in a Small Island State. The Experience of the English-Speaking Caribbean and the Importance of International Cooperation

37. The Chilean Paradox: Why Are Cases Rising Despite High Levels of Vaccination?

36. What Is Long COVID and What Can We Do to Address the Problem?

35. Will We Be Able to Achieve Herd Immunity Against COVID-19?

34. What Can We Expect From the G20 and EU Global Health Summit?

33. COVID-19, Global Cooperation and Reigniting the Economy: Do we Need Vaccine Certificates?

32. Will We See a Wave of Mental Health Problems After the COVID-19 Pandemic?

31. Ivermectin and COVID: What's Going On?

30. Biomedical R&D and Innovation: How Can We Protect the Public Interest After COVID-19?

29. How Is COVID-19 Affecting Pregnant Women?

28. What Are the Main Challenges That Global COVID-19 Immunisation Efforts Must Now Overcome?

27. Who Should Receive the First Doses of COVID-19 Vaccine?

26. What Is a Zero-COVID Strategy and How Can It Help Us Minimise the Impact of the Pandemic?

25. The G20, Vaccines and COVID-19: Why is the Success of the COVAX Iniciative Vital?

24. COVID-19: What Can Past Nuclear Accidents Teach Us?

23. Is COVID-19 Threatening the Success of the Sustainable Development Goals in Spain?

22. Should We Be Concerned About SARS-CoV-2 Reinfections?

21. How Should We Handle the Influenza Epidemic During the Coronavirus Pandemic?

20. Infodemic: How Has the Epidemic of Misinformation Affected the Response to COVID-19?

19. What Are the Health Priorities of Older Adults During a Pandemic?

18. COVID-19 in Latin America: What does it take to go from a highly-vulnerable region to a pandemic-ready region?

17. How Should We Deal With New Outbreaks of COVID-19?

16. What Do We Know About the Impact of Gender on the COVID-19 Pandemic?

15. How Can We Prevent COVID-19 from Exacerbating Other Epidemics in Low- and Middle-Income Countries?

14. What Role Can Spanish Cooperation Play in the Response to COVID-19 and the Prevention of Future Crises?

13. How Can We Resume International Travel During the COVID-19 Pandemic?

12. What Are the Barriers to Achieving Universal Immunisation Against COVID-19?

11. Improving Case and Contacts Tracing During the COVID-19 Pandemic

10. How Should Work Environments Adapt During the COVID-19 Epidemic?

9. Is an Immunity Passport an Option as Part of a Deconfinement Strategy?

8. How Can we Ensure a Socially Equitable Approach to Deconfinement during the COVID-19 Pandemic?

7. COVID-19: How to Manage the Reopening of Schools?

6. Mobility & COVID-19: How Should We Redesign Transport for a New Future?

5. Should We Go Outside During the COVID-19 Confinement and Beyond?

4. Should We Allow Physical Activity During The Coronavirus Disease Pandemic?

3. What Are the Main Research Gaps for Lifting Confinement Measures? 

2. Can We Meet Children’s Needs During Home Confinement and Relaxation of Restrictions?

1. Components of a Safe and Phased Reopening of Society


14 of the 20 Countries Most Affected by Viral Hepatitis Have Made Progress Towards its Elimination, Says Lancet Commission

Key actions to accelerate progress in all countries include simplifying models of care, ensuring access to appropriate diagnostics, funding hepatitis care, and learning from the COVID-19 pandemic

Photo: Image by jcomp on Freepik

14 of the 20 countries with the highest burden of viral hepatitis have made progress towards its elimination, according to a policy index score developed by the Lancet Commission on Elimination of Viral Hepatitis, co-led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by “la Caixa” Foundation. However, further investment is needed to support local clinicians, scientists, advocates, and activists to implement and monitor national plans across all countries.

Most of the burden is concentrated in 20 countries

Twenty countries account for more than 75% of the global burden of viral hepatitis (HBV and HBC). This means that the global elimination targets set for 2030 (a 90% reduction in incidence and a 65% reduction in mortality) cannot be achieved without an effective response in these 20 countries.

“By burden we mean not only the number of infections in these countries, but also the years lived with disability due to these infections,” says ISGlobal researcher Jeffrey V. Lazarus who, together with three other world experts, has led the Lancet Commission on Progress towards Elimination of Viral Hepatitis for the past three years.

To track a country’s progress towards hepatitis elimination, the Commission designed an index based on 11 key policies for elimination. A first assessment was carried out in 2018, followed by another in 2023. The analysis, conducted with national experts from each of the 20 countries, shows that countries with the strongest policy responses in 2018 (Brazil, Egypt, and the USA) have continued to make progress. Egypt remains an example of what can be achieved in settings with limited resources, with one of the most ambitious testing programmes in the world and free provision of HBV vaccination at birth. Similarly, Brazil has championed free, sustainable access to HCV therapy since 2015.

National plans, screening and antivirals

Overall, 14 of the 20 countries have made progress since 2018, largely thanks to national action plans, publicly funded screening and subsidised of antiviral treatment. The most substantial progress has been made in Bangladesh, India, Indonesia, Japan and Russia. Little or no progress has been made in Ukraine, Myanmar and Ethiopia, due to political unrest and war. And in some countries, such as Pakistan and the Philippines, the policy index scores have decreased.

Some key themes emerged from discussions with national experts, including a greater emphasis on simplified models of care, access to appropriate diagnostics, and funding of hepatitis care. Some lessons from the COVID-19 pandemic, such as use of telemedicine, self-testing and decentralisation of care, were also identified. Other relevant measures include global pricing of antivirals and the decriminalisation of drug use in many of these countries.

 “The work of our Commission shows that while progress has been made in these high-burden countries, there is still a long way to go to reach the WHO elimination targets,” says Lazarus, head of the Health Systems Research group at ISGlobal.

He and colleague Camila Picchio participated recently in the week of liver disease in Catalonia (January 15-18), a region committed to eliminate viral hepatitis by 2030. They also lead COMSAVAC , a European project aimed at scaling-up and adapting community-based viral hepatitis testing and vaccination strategies among migrant and refugee populations from high-burden countries. This project is being conducted in Italy, Greece, and Spain.

Lazarus and colleagues also authored a study in Lancet Gastroenterology and Hepatology analysing hepatitis C antiviral reimbursement policies in 160 countries.

You can see here a webinar on the global launch of “The Lancet Gastroenterology and Hepatology Commission on viral hepatitis”, on Thursday, February 15, 2024, 1:00 pm GMT.


Infographic on WHO targets to eliminate viral hepatitis as a global public health threat by 2030.



Cooke GS, Flower B, Cunningham E et al. Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update. The Lancet Gastro Hepat. Doi: 10.1016/S2468-1253(23)00321-7


Study Shows How Air Pollution and Weather Influence Daily Physical Activity in People with COPD

Exposure to air pollutants is associated with low physical activity, while higher temperatures and less precipitation are associated with increased physical activity

Photo: Canva

People with chronic obstructive pulmonary disease (COPD) have low levels of physical activity. However, there is little scientific evidence on how environmental factors affect their physical activity in the short term. A study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, investigated the effects of air pollution and weather conditions on daily physical activity levels in people with COPD.

The study, conducted over two 7-day periods separated by one year, involved 408 people with COPD in Catalonia, 85% of whom were men. The research team analysed the relationship between air pollution, mean and maximum temperature and rainfall with the amount and intensity of daily physical activity. Levels of air pollutants, including nitrogen dioxide (NO2), PM10 and PM2.5 particles, were estimated up to five days before each assessment.

The results of the study showed that air pollution was associated with a significant decrease in physical activity up to four days after exposure to particulate matter. Pollution had a greater impact on people with severe COPD and those with higher levels of regular physical activity. In contrast, higher temperatures and less precipitation were associated with an increase in the amount of physical activity on the same day, as well as a decrease in sedentary time.

Contrary to the research team's hypothesis, there was no threshold for ambient temperature above which a negative effect on physical activity levels would be expected. This may be explained by the lack of data collected during the hottest months of the year. "Future studies should include measures of physical activity during the hottest period of the year to determine whether a temperature threshold really exists, especially in the context of climate change and in anticipation of more frequent, extreme and longer-lasting, heat waves," says Judith Garcia-Aymerich, ISGlobal researcher and senior author of the study.

Clinical and public health implications

This is the first study to show that exposure to levels of air pollution, even below current World Health Organisation recommendations, can lead to a reduction in the amount and intensity of physical activity in people with COPD. The findings have important implications for formulating treatment strategies to ensure the health and well-being of people with COPD.

"Our findings provide evidence that air pollution and climatic factors must be considered when making physical activity recommendations or when assessing physical activity outcomes in people with COPD. The impact of these factors on people's health needs to be considered when planning and redesigning cities," says Alícia Josa-Culleré, ISGlobal researcher and first author of the study.

"Regular physical activity is a key pillar in the treatment and rehabilitation of COPD. Daily physical activity routines depend on daily decisions, so it is important to identify the factors that influence these choices. Our findings suggest that air pollution and weather factors play an important role when deciding whether to engage or not in physical activity," adds Garcia-Aymerich.

Research, Antimicrobial Resistance

An Easy and Rapid Test to Detect Infections Caused by Antibiotic-Resistant Bacteria in the Clinic

A European multicentre study shows that the BL-DetecTool is highly sensitive in detecting two families of enzymes associated with antibiotic resistance directly from clinical samples


The BL-DetecTool is a rapid and reliable diagnostic test for the detection of antibiotic resistance mechanisms directly from clinical samples, according to a multicentre study in which the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation, participated together with the Hospital Clínic de Barcelona. This test will make it possible to rapidly identify and treat multidrug-resistant infections, thus preventing them from spreading.

Antibiotic resistance is one of the world's most worrying public health problems, with significant clinical and economic implications. Tackling this problem requires the development of strategies at different levels (e.g. increasing surveillance, speeding up diagnosis and/or finding new treatments). The BL-DetecTool project, funded by the European Institute of Innovation and Technology (EIT-Health) and in which ISGlobal participated, was launched four years ago with the aim of validating a rapid test to detect two types of molecules that cause antibiotic resistance: extended-spectrum beta-lactamases (bacterial enzymes capable of degrading cephalosporins) and carbapenemases (capable of degrading last-line carbapenem antibiotics). The emergence and spread of multi-resistant bacteria carrying multiple carbapenemases in recent years is a cause for concern.

 "Early detection of these enzymes would help to improve the treatment of patients with infections caused by multi-resistant bacteria and thus prevent their spread," says Jordi Vila, Director of the Antimicrobial Resistance Initiative at ISGlobal and coordinator of the study.

One test, two resistance mechanisms, nine European centres and more than 20,000 clinical specimens

BL-DetecTool is a rapid and simple test based on a lateral flow immunoassay (similar to pregnancy or COVID-19 tests) to detect a range of extended-spectrum beta-lactamases (ESBL) and/or five of the major carbapenemases produced by multi-resistant bacteria (enterobacteria such as Escherichia coli or Klebsiella pneumoniae, as well as Pseudomona aeruginosa). The test provides results in 35 minutes, directly from positive blood cultures or urine, as well as from rectal swabs.

Nine European centres - in Spain (including Hospital Clínic), France, Hungary, Greece, Italy and Germany - participated in this study to evaluate the test on a total of 22,010 biological specimens.

High sensitivity directly from urine and blood

The prevalence of BLEE-producing bacteria ranged from 6% to 29%, depending on the hospital, and the test proved to be highly sensitive for positive blood culture samples (sensitivity over 90%) and urine (over 94%, with the exception of one hospital where eight samples were false positives). For rectal specimens, specificity was more variable but increased to over 75% if the sample was pre-treated with an enrichment step.

As expected, the prevalence of carbapenemase-producing bacteria was lower: between 1.9 and 20% in five hospitals, while none were detected in the other four. Excluding the hospital with the lowest prevalence, the sensitivity of the test was 75-100% for blood or urine samples. Again, rectal samples required pre-treatment to increase sensitivity above 66%. 

"The sensitivity observed is slightly lower than previously reported for the BL-DetecTool, but this is due to the high number of samples in our cohort and the multicentre study design," says Mariana Fernandez-Pittol, researcher at the Hospital Clínic and first author of the study. 

The results confirm that the BL-DetecTool allows rapid and reliable detection of extended-spectrum beta-lactamases and carbapenemases directly from positive blood cultures or urine, as well as from enriched rectal specimens. "This technique is easy to implement and will greatly facilitate work in clinical microbiology laboratories," he adds.



Fernandez-Pittol M, Bosch J, Ballesté-Delpierre C et al. Multicentre study to assess the use of BL-DetecTool for the detection of CTX-M-type ESBLs and carbapenemases directly from clinical specimens. JCM. DOI: 10.1128/jcm.01136-23


The high burden of 'P. vivax' infections in children contributes to the rapid acquisition of immunity to malaria

Study published in PLoS Neglected Tropical Diseases

An international research team led by Ivo Mueller from the CRESIB, research centre of ISGlobal, has found that the high number of Plasmodium vivax infection that children experience in the first five years of life contributes to the rapid acquisition of immunity to malaria caused by this parasite. This study has been published in PLoS Neglected Tropical Diseases.

When both parasite species are co-endemic, P.vivax incidence peaks in younger children compared to P. falciparum. To identify differences in the number of blood stage infections of these species and its potential link to acquisition of immunity, we have estimated the molecular force of blood-stage infection of P. vivax (molFOB, i.e. the number of genetically distinct blood-stage infections over time), and compared it to previously reported values for P. falciparum.

P. vivax molFOB was estimated by high resolution genotyping parasites in samples collected over 16 months in a cohort of 264 Papua New Guinean children living in an area highly endemic for P. falciparum and P. vivax. In this cohort, P. vivax episodes decreased three-fold over the age range of 1-4.5 years.

While the incidence of clinical P. vivax illness was strongly associated with molFOB, molFOB itself did not change with age. The incidence of P. vivax showed a faster decrease with age in children with high compared to those with low exposure.

Ivo Mueller, researcher at CRESIB, research centre of ISGlobal (Spain), and Walter and Eliza Hall Institute (Australia), concludes that "the high number of P. vivax clones that infect children in early childhood are a major contributor to the very rapid acquisition of immunity against clinical P. vivax malaria".


Koepfli C, Colborn KL, Kiniboro B, Lin E, Speed TP, Siba PM, Felger I, Mueller I. A High Force of Plasmodium vivax Blood-Stage Infection Drives the Rapid Acquisition of Immunity in Papua New Guinean Children. PLoS Negl Trop Dis. 2013 Sep 5;7(9).

Quique Bassat Will Be the New Director General of the Barcelona Institute for Global Health

Bassat will succeed Antoni Plasència, who has held this position since October 2014.


The Board of Trustees of the Barcelona Institute for Global Health (ISGlobal) has appointed Quique Bassat as the new Director General of the institution. Bassat will succeed Antoni Plasència, who has led the institution since October 2014. 

A paediatrician and epidemiologist, Quique Bassat is ICREA Research Professor and Director of the Malaria and Neglected Parasitic Diseases programme at ISGlobal, as well as Associate Professor at the University of Barcelona and researcher at Hospital Sant Joan de Déu. Throughout his professional career, which has included long stays in the Manhiça Health Research Centre (CISM), in Mozambique, he has combined his clinical work with biomedical research on infectious diseases affecting the poorest and most vulnerable populations, with his two main areas of interest being childhood malaria and respiratory infections (bacterial or viral). 

"I am honoured and thrilled by this opportunity that the Board of Trustees has given me," says Bassat. "ISGlobal plays a critical role in advancing global health and equity, and I look forward to continuing to work with the incredible team of professionals that make up ISGlobal in my new role to further our positive impact around the world.

A rigorous selection process 

On behalf of the Executive Committee of ISGlobal's Board of Trustees, a selection committee made up of experts appointed by the Board of Trustees, with the support of the CERCA system of the Generalitat de Catalunya, carried out the selection process for the new director through a public and international call for applications. From the list of applications received, a group of highly qualified candidates were interviewed to assess their scientific solvency, management skills and strategic proposals for ISGlobal. Quique Bassat was the unanimous choice because of his proven scientific, clinical and translational track record and his commitment to ISGlobal's mission and values. His experience in the field, his ability to lead multidisciplinary teams and his innovative vision were key aspects in the Committee's final assessment. 

In relation to the change of Director, the Board of Trustees expresses its deep gratitude to the outgoing director, Antoni Plasència, for his strong commitment and exemplary leadership, and expresses its full confidence in his successor, Quique Bassat. "Through a rigorous selection process we have chosen the best candidate to lead this new cycle. The "la Caixa" Foundation is proud to continue to support ISGlobal in its strategy to address the major global health challenges and promote equity in health through excellence in research and the transfer and application of knowledge", said Javier Solana, Chairman of the Executive Committee of ISGlobal.

A cycle marked by institutional growth 

Antoni Plasència, with a distinguished professional career in public health, has led ISGlobal for the past nine years. Under his leadership, the three pre-existing institutions were integrated, contributing to ISGlobal's remarkable growth and achieving a level of institutional excellence that, together with its recognition as a Severo Ochoa centre, consolidates it as an international benchmark in global health research and translation. It has also strengthened strategic alliances with national and international institutions, thus broadening the impact of its research and programmes. 

Last June, Plasència informed the Board of Trustees that he wished to complete his mandate and renew the executive leadership of ISGlobal, contributing to its institutional strengthening. The transition process between the two directors will take place in the coming weeks, to ensure a smooth transfer of responsibilities, and is expected to be completed by 31 December 2023. Plasència will remain associated with the Institute and will take on new responsibilities, thus maintaining his valuable link with the institution he has helped to strengthen. 

"I am deeply grateful to have enjoyed the trust of ISGlobal's Board of Trustees and professionals in this collective success of construction and consolidation of which we should all feel very proud," says Antoni Plasència. "It is a unique privilege - in Spain, in Catalonia, in Barcelona and on the international scene - that institutions of such prestige and diversity in their visions and missions agree on the importance of continuously supporting excellent research in global health, research that pursues 'health and equity without borders'. I am confident that with the commitment and cooperation of the entire ISGlobal community, the new leadership that now begins will contribute to a period of new progress and recognition while keeping with the centre’s 'science with heart'. 

In his new role as General Director of ISGlobal from January, Bassat will be responsible for leading ISGlobal into a new strategic cycle, maintaining its commitment to excellence in research, training and translation to promote health equity worldwide, especially among the most disadvantaged populations.


Study Uncovers Environmental Risk Factors that Influence Vitamin D Deficiency in Pregnant Women

Being younger, having a higher body mass index, living in polluted areas, as well as being exposed to less ultraviolet radiation and living in less humid areas are risk factors.

Imagen de una mujer embarazada.
Photo: Canva

A scientific team led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has studied the determinants that influence vitamin D levels in pregnant women. After analysing more than 100 environmental, behavioural and socio-demographic factors, they found that younger women with a higher body mass index and who live in areas with more pollution and lower levels of humidity and ultraviolet radiation are at greater risk of vitamin D insufficiency.

Vitamin D deficiency has been linked to cancer, cardiovascular and autoimmune diseases, diabetes and adverse birth and delivery outcomes, such as pre-eclampsia or gestational diabetes. During pregnancy, the mother is the only source of vitamin D for the foetus, so a lack of vitamin D has been associated with later consequences, such as childhood asthma, skeletal abnormalities and impaired neurodevelopment .

The study included data from more than 2,000 women participating in the cohorts of Gipuzkoa, Sabadell and Valencia (Spain) of the INMA Project . Fifty-one percent of the participants showed vitamin D levels below the Endocrine Society recommendation (30 ng/mL). This is a higher percentage than in other European countries, such as the Netherlands, where in another study the percentage of women with vitamin D insufficiency was 33%.

The aim of the research was to assess the determinants of vitamin D levels during pregnancy by analysing more than 100 socio-demographic, lifestyle or environmental factors . To determine the level of vitamin D in the plasma of the participants, a blood sample was taken and, together with a urine sample, was also used to measure the presence of endocrine disruptors and other chemical pollutants. Socio-demographic (age, education, socio-economic status, etc.) and lifestyle data (diet, work exposure, physical activity) were obtained through questionnaires. Parameters of different environmental determinants, such as air pollution, temperature and humidity, ultraviolet radiation and exposure to green spaces, were obtained from the address of residence.

More vitamin D at older ages

Statistical analysis revealed that older pregnant women had higher vitamin D levels than younger women, which the team attributed to the likelihood that older women are more aware of the risks and adopt healthier lifestyles, in line with previous hypotheses by other authors.

Similarly, women with higher socioeconomic status also had higher levels of the vitamin, which may be attributed to factors such as a higher quality diet or more outdoor physical activity.

Regarding the association between higher body mass index and lower vitamin D levels , the research team's hypothesis, in line with the assumptions of other authors, is that more adipose tissue may cause the vitamin to be stored there, lowering the levels of available vitamin.

Sun and vitamin D

Most vitamin D is synthesised through the endogenous process of photosynthesis, which explains why UV exposure was associated with higher levels of vitamin D in the participants. In addition, women residing in more humid regions were also found to have higher levels of vitamin D, suggesting greater exposure to sunlight.

A similar mechanism may explain other associations found. Participants who were more exposed to air pollution had lower vitamin D levels. According to the team's hypothesis, air pollutants such as particulate matter can absorb and diffuse ultraviolet photons, thus impairing the internal production of the vitamin.

"Our results highlight the influence of socio-demographic, environmental and lifestyle-related factors on vitamin D levels in pregnant women", says Maria Llopis, ISGlobal researcher and first author of the study.

Role of vitamin D supplementation

Analyses of this study indicate that supplementation improves maternal vitamin D levels. However, Paula Sol Ventura, a paediatrician on the research team, stresses: "Excess vitamin D can be toxic to the mother and foetus. Its generalised supplementation is not recommended and should only be done under medical supervision".

Predictive techniques using machine learning

The research included a machine learning component, by which data from participants was used to try to predict vitamin D insufficiency before it occurs. "This study shows the potential of machine learning techniques for screening women at risk of vitamin D insufficiency, suggesting that it could be a relevant tool for public health policy", concludes Paula Petrone, ISGlobal researcher and one of the senior authors of the study. In this analysis, ambient humidity and the concentration of PM2.5 particles in the air emerged as two of the most relevant determinants of vitamin D levels.


Llopis M, Ventura PS, Brachowicz N, Sangüesa J, Murcia M, Lopez-Espinosa MJ, García-Baquero G, Lertxundi A, Vrijheid M, Casas M, Petrone P. Sociodemographic, lifestyle, and environmental determinants of vitamin D levels in pregnant women in Spain. Environ Int. 2023 Dec;182:108293. doi: 10.1016/j.envint.2023.108293 . Epub 2023 Nov 4. PMID: 37984291.

Research, Maternal, Child and Reproductive Health

African Women Living with HIV Have an Effective Option to Prevent Malaria During Pregnancy

The combination of two antimalarial drugs (DHA-PPQ) reduces the risk of malaria infection and disease in pregnant women on HIV treatment, according to results from the MAMAH trial

Photo: Raquel González

In women living with HIV, preventive treatment with DHA-PPQ is a safe and effective strategy to prevent malaria during pregnancy, according to the final results of MAMAH, a clinical trial funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) and coordinated by the Barcelona Institute for Global Health (ISGlobal), an institution supported by “la Caixa” Foundation. The study, published in the Lancet Infectious Diseases, could help protect the health of the estimated one million pregnant women who suffer from a double infection with malaria and HIV every year.

Pregnant women are particularly vulnerable to malaria infection. Hence the recommendation to offer preventive treatment (IPTp) based on sulphadoxine and pyrimethamine (SP) to pregnant women living in malaria-endemic areas. The problem is that these drugs are incompatible with co-trimoxazole (CTX), an antibiotic given to people with HIV to prevent bacterial infections.

“This means that the population most vulnerable to malaria infection and its consequences, namely pregnant women living with HIV, are also the least protected,” explains ISGlobal researcher Raquel González, technical coordinator of the MAMAH project, led by Clara Menéndez, director of ISGlobal’s Maternal, Child and Reproductive Health Initiative

The aim of the project was to evaluate the safety and efficacy of two other drugs: dihydroartemisinin and piperaquine (DHA-PPQ) to prevent malaria during pregnancy in women living with HIV. The research team conducted the trial in Gabon and Mozambique with more than 600 pregnant women taking CTX in addition to antiretroviral treatment for HIV. One group of pregnant women received DHA-PPQ and the other group received a placebo.

Lower risk of malaria infection and disease

Although there was no significant difference in malaria infection at the time of delivery, women in the DHA-PPQ group had a significantly lower risk of developing clinical malaria throughout pregnancy (almost eight times lower than the placebo group) and also a lower risk (almost half) of becoming infected. DHA-PPQ was effective in women taking different antiretroviral treatments. No serious side effects were observed, and DHA-PPQ had no effect on mother-to-child transmission of HIV.

"We show that preventive treatment with DHA-PPQ is effective even in low malaria transmission settings," says Gonzalez. "Adding this strategy to malaria control tools could significantly improve the health of thousands of mothers and their babies, especially in sub-Saharan Africa, a region where an estimated one million women living with HIV are infected with malaria during pregnancy every year," she adds.

“We congratulate the MAMAH team on these important results in the field of malaria research, and in particular, in providing better health to pregnant women living with HIV in malaria-endemic areas,” says Montserrat Blázquez-Domingo, EDCTP Senior Project Officer. “This study underlines the value of collaborative research that EDCTP supports and our focus on priority infectious disease affecting sub-Saharan Africa in populations often excluded from clinical trials – such as pregnant women.”

The MAMAH study is part of the EDCTP2 Programme supported by the European Union (grant number RIA2016MC-1613-MAMAH).


González R, Nhampossa T, Mombo-Ngoma G, et al. Safety and efficacy of dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria in HIV-infected pregnant women from Gabon and Mozambique: a randomised, double-blind, placebo-controlled clinical trial. Lancet Infect Dis. 2024. doi: 10.1016/S1473-3099(23)00808-3

e-QuoL Kicks Off with the Aim of Promoting Equality in Quality of Life for Childhood to Young Adulthood Cancer Patients, Survivors and their Families

The European project will provide children and young adults who have survived cancer with e-health tools designed specifically for and with them to help them manage their health

Kick-off of the e-QuoL project at the University Hospital Centre of Angers (CHU Angers), France. Credit : Catherine Jouannet – CHU d’Angers
Photo: Catherine Jouannet – CHU d’Angers

The European Commission-funded e-QuoL project kicked off with the aim of using e-health tools to promote equality in quality of life for children, adolescents and young adults cancer survivors in Europe. The kick-off meeting organised by GCS Hôpitaux Universitaires Grand Ouest (HUGO), the coordinator of the project, was held from January 24th to January 26th in Angers, France, with the participation of all the partners including ISGlobal who is leading the Work Package (WP7) on communication.

Cancer affects 35,000 children, adolescents and young adults in Europe each year. Currently 80% of them survive at least 5 years but the intensive oncological treatments leave these survivors with late-health effects and reduced quality of life.

“The project will identify children, adolescents and young adults survivors (CAYACS) unmet needs and those of their families, and adapt accessible and affordable tools to address these needs”, says Charlotte Demoor-Goldschmidt, principal investigator of the project based at HUGO. “Ultimately, e-QuoL will improve their quality of life by enabling them to actively engage in their care and better self-manage their health and well-being”, she adds.

e-QuoL: 30 partners, 16 countries

The e-QuoL project brings together 30 partners from 16 European countries (France, Hungary, Norway, Italy, Denmark, Finland, Spain, Croatia, Germany, Bosnia and Herzegovina, UK, Slovenia, Romania, Belgium, The Netherlands and Switzerland). It’s a PanEuropean project supported by the PanCare and Harmonic consortia.

“There are several challenges providing follow-up care for CAYACS,” says Demoor-Goldschmidt. “It is resource-demanding in an overburdened healthcare system; psychosocial and supportive care needs are often unmet, and access is unequal between European countries,” she adds. As she pointed out during the first day of the meeting, the overall goal of the project is to “use e-health tools to promote equality in quality of life for CAYACS and their families”.

E-QuoL will adapt specifically for young survivors, an existing interoperable personalized e-health tool focusing on supportive care and quality of life that can be used alone or as an add-on module to existing tools such as digital survivorship care plans already used in several European countries for preventive medicine based on personalized screening recommendations. Through participatory research, involving CAYACS, families, associations, networks, health institutes, social sciences and humanities researchers and industrial partners with different backgrounds, it will identify the unmet needs of CAYACS and their families. The developed e-health tools will be accessible and affordable to address these needs on a person-centered approach providing medical follow-up, guidance on preventive behaviours (e.g. physical activity nutrition) and psychological and social support (e.g. education, employment).

During the three-day meeting and the general assembly, the researchers discussed how they plan to carry out the different tasks described in the project. The project has received a funding of 5.9 million euros from the Horizon Europe programme.

e-QuoL project:

  • GCS HUGO, France
  • Magyar Gyermekonkologiai Halozat -Magyar GYE, Hungary
  • Universitetet I Oslo, Norway
  • Centre Hospitalier Universitaire Saint Étienne - CHUSE, France
  • Istituto Giannina Gaslini, Italy
  • Resilience, France
  • Oslo Universitetssykehus HF, Norway
  • Aarhus Universitetshospital, Denmark
  • Aarhus Universitet, Denmark
  • Varsinais-Suomen Sairaanhoitopiirin Kuntayhtym, Finland
  • HUS-YHTYMA, Finland
  • ISGlobal, Spain
  • Klinicki Bolnicki Centar Rijeka, Croatia
  • Centre de Lutte Contre le Cancer Léon Bérard, France
  • Cineca Consorzio Interuniversitario, Italy
  • Universitaetsklinikum Essen, Germany
  • Javna zdravstvena ustanova Univerzitetski klinicki centar, Bosnia and Herzegovina
  • The Royal Marsden National Health Service Trust, UK
  • Onkoloski Institut Ljubljana, Slovenia
  • Epiconcept, France
  • Asociatia Little People Romania, Romania
  • Clinique Universitaire Saint-Luc ASBL, Belgium
  • Hôpital Robert Debré, France
  • Universitaestsmedizin der Johannes Guterberg-UN, Germany
  • Pancare, The Netherlands
  • Universitat Luzern, Switzerland
  • Institut Gustave Roussy, France
  • Érintettek Egyesület, Hungary
  • Association Les Aguerris, France
  • Fundatia Youth Cancer Europe, Romania


The project e-Quol, number 101136549, is funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or Horizon Europe, granting authority. Neither the European Union nor the granting authority can be held responsible for them.

ISGlobal, Awarded for its Institutional Culture in Data Protection

The AEPD has recognised the institution's good practices in biomedical research and its comprehensive approach to data protection

People and representatives of the entities awarded in the 'Data Protection Awards 2023', including ISGlobal (Photo: Spanish Data Protection Agency).
Photo: Agencia Española de Protección de Datos (AEPD)

With the aim of recognising and publicising actions that promote the dissemination and knowledge of the right to data protection and its practical application, the Spanish Data Protection Agency (AEPD, by its acronym in Spanish) has this week awarded the 'Data Protection Awards 2023'. The Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, was one of the 15 winners in the category of Proactivity and Good Practice in Compliance with the European Data Protection Regulation and the Organic Law on the Protection of Personal Data and Guarantee of Digital Rights.

Under the theme ‘Institutional culture in the field of personal data protection. An Integrative Approach', ISGlobal was highlighted for its exemplary exercise in good practice in biomedical research and for its global approach, which translates into the development of dissemination tools, complemented by training, thus contributing to the knowledge and effective application of data protection regulations.

Mar España, the director of the Spanish Data Protection Agency (AEPD), awards the 2023 Data Protection Prize to Joana Porcel and Ramon Cifuentes, who receive it on behalf of ISGlobal
Mar España, the director of the Spanish Data Protection Agency (AEPD), awards the 2023 Data Protection Prize to Joana Porcel and Ramon Cifuentes, who receive it on behalf of ISGlobal (Photo: Spanish Data Protection Agency).


Recognising the Work, Commitment and Responsibility of All Staff

ISGlobal has created an institutional culture towards data protection over the last few years through an integrated approach involving both research staff and other departments. The strategy is based on four pillars. Firstly, a global approach to personal data protection that goes beyond the regulations, closely linked to the ethical aspects of research. Secondly, an understanding that data protection is the responsibility of all members of the institution. Thirdly, data protection as an element of institutional governance. Finally, continuous training and the design of communication tools.

"At ISGlobal, we see the protection of personal data and related activities as a central element, linked to reputation and compliance, but which transcends both aspects and has as main priority the respect for the rights and freedoms of those who generously share their most sensitive data, their health data, for the advancement of science," said Joana Porcel, Research Manager, Project Unit Manager and Data Protection Officer at ISGlobal, during the award ceremony, which took place at the headquarters of the National Commission for Markets and Competition in Madrid last Monday. “It is a recognition of the collective work that we have been doing for some time. It also encourages us to continue in this direction".

Training and Innovation: Defining a Data Protection Culture

ISGlobal's ultimate goal is to create an institutional culture towards the protection of personal data. Every member of the institution, regardless of their position and function, incorporates data protection as an essential element in their daily activities.

"It is a question of raising awareness, generating commitment and shared responsibility in everything related to the protection of the personal data we process in this institution," adds Porcel. Continuous training, tailored to project needs and different groups within the institution, has been key. This goes beyond the mere transmission of concepts, definitions and regulations.


EPICOH Early Conference

EPICOH Early Conference.jpg
04/11/2024 - 05/11/2024
PRBB - Barcelona Biomedical Research Park (C/ del Dr. Aiguader, 88, Barcelona)

The EPICOH Early Career Conference 2024 will be held on 4-5 November at the Barcelona Biomedical Research Park (PRBB) in Barcelona. It is organised by the Scientific Committee on Epidemiology in Occupational Health (EPICOH), an international organisation that is part of the International Commission on Occupational Health (ICOH).

The conference serves as a platform for early career researchers and professionals in the field of occupational epidemiology, industrial hygiene and occupational health to exchange ideas, share insights, and foster collaboration. The event will highlight research from early career researchers and will include keynote lectures and networking activities. Barbara Harding, researcher at ISGlobal, is the Chair of the Organising Committee.

More information about the event will follow.


Research, Chagas

Fexinidazole Is Not Effective in Treating Chagas Disease

A new study shows that the drug is well tolerated by patients, but is not effective in eliminating the parasite that causes the disease


A new clinical trial for the treatment of Chagas disease has shown that the low-dose drug fexinidazole is well tolerated by patients, but is not effective in sustainably eliminating the Trypanosoma cruzi parasite, responsible for causing the disease. The results have just been published in the scientific journal The Lancet Infectious Diseases.

The FEXI-12 study, funded by DNDi and coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, was conducted in five hospitals in Spain with extensive experience in the care of patients with Chagas disease. Fexinidazole was shown to be effective in an earlier clinical trial that was stopped because the doses tested were not well tolerated. The new phase 2 trial evaluated fexinidazole at lower doses and with a shorter duration of treatment. In total, three fexinidazole regimens with different durations and doses were evaluated. Although the volunteers tolerated all the regimens tested and the parasite load decreased significantly after treatment, a rebound effect was observed ten weeks later. The research team therefore decided to discontinue the development of fexinidazole as a monotherapy for the treatment of Chagas disease.

"Despite its good tolerability, fexinidazole does not show sufficient efficacy against the T. cruzi parasite and is therefore not a viable alternative for the treatment of Chagas disease," says Julio A. Padilla, director of ISGlobal's Chagas Initiative. "The search for alternatives, whether new products or the recovery of compounds used in other diseases, is a priority. To this end, ISGlobal is participating in the TESEO study with the aim of optimising the current regimens of the drugs currently used (benznidazole and nifurtimox), while investigating potential biomarkers of therapeutic response".

Chagas, a neglected disease

Chagas disease is a neglected disease. It is estimated that less than 1% of patients have access to treatment with benznidazole or nifurtimox. Both drugs were developed more than 50 years ago and frequent side effects associated with their use are a major barrier to treatment, causing one in five patients to discontinue treatment. In several clinical trials, standard treatment with benznidazole has been shown to be effective against infection with a sustained effect for at least 12 months after treatment in about 80% of treated patients. Optimisation of existing treatments through the use of alternative regimens remains a promising line of research.

Shorter treatments for Chagas disease

"At DNDi, we are working with partners on the NuestroBen study, which aims to assess whether a shorter benznidazole regimen has the potential to become the standard for treating Chagas disease. We hope that a shorter treatment duration will improve the risk-benefit ratio of the drug and increase adherence. Making available therapies simpler and safer is a potentially faster way to improve the quality of life of those affected, while we advance the longer process of molecule research to find a completely new drug for Chagas disease," says María-Jesús Pinazo, head of DNDi's Chagas disease programme.

Following the completion of the BENDITA trial, which suggested that a shorter duration of benznidazole treatment could maintain high antiparasitic efficacy, new trials are underway. These trials aim to provide clearer evidence on the feasibility of alternative regimens to current drugs, and whether these can improve tolerability and adherence while reducing the incidence of adverse effects. Meanwhile, drug discovery efforts continue, with promising new chemical entities entering phase 1 and 2 trials.



Pinazo MJ, Forsyth C, Losada I, Trigo Esteban E, García-Rodríguez M, et al, on behalf of the FEXI-12 Study Team. Efficacy and safety of fexinidazole for treatment of chronic indeterminate Chagas disease (FEXI-12): a multicentre, randomised, double-blind, phase 2 trial. Lancet Infectious Diseases. 2024.