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  • Joy Crookes: Juniper review – sadness made sublime by streetwise soul and snappy wit | Music

    Joy Crookes: Juniper review – sadness made sublime by streetwise soul and snappy wit | Music

    In an overcrowded pop market, where artists are encouraged to maintain a constant presence and stream of what’s depressingly termed “product”, south London singer-songwriter Joy Crookes’s career has progressed in a curious series of fits and starts. After releasing a series of EPs, she ended 2019 as a hotly tipped act: appearances on Later … With Jools Holland, nominated for the Brits Rising Star award, placed high in the BBC’s Sound of 2020 poll, invited to support Harry Styles on tour. But the latter was nixed by Covid, and her real commercial breakthrough didn’t arrive for nearly two years: released at the tail-end of 2021, her debut album Skin made the Top 5 and, in Feet Don’t Fail Me Now, spawned one of those long-tail viral hits that achieves a weird omnipresence despite barely grazing the Top 30. She started working on a follow-up, then vanished again. The four years that separate her debut from Juniper were at least partly consumed by a period when she was “really sick” and “mentally unstable”.

    Joy Crookes: Juniper

    It’s a period that understandably hangs over the contents of Juniper: “I’m so sick, I’m so tired, I can’t keep losing my mind,” she sings on opener Brave; “I’m pretty fucking miserable,” runs the blunt chorus of Mathematics, ostensibly a breakup song that seems underpinned by something noticeably darker than romantic woe alone. You could argue that Juniper’s introspective tone comes at a cost – there’s no room for the kind of sharp, political songs about Brexit, gentrification and immigration that peppered Skin – but Crookes is an impressively snappy lyricist who comes across as smart, streetwise and gobby regardless of the personal trauma she’s describing.

    Moreover, she rigorously swerves the usual self-help platitudes about the kind of topics Juniper addresses, from co-dependency to intergenerational trauma. House With a Pool, about abusive relationships, and Carmen, about unattainable beauty standards, are all the more powerful for their light approach and avoidance of sentimentality in favour of wit. The latter dispenses with pat conclusions about the need to love yourself for who you are or how everyone is beautiful in their own way, and instead concludes unreconciled, with Crookes still glowering resentfully at its “peng” titular character: “Why am I working double for just half of what you got?”

    The music is similarly an impressively fresh and individual take on the familiar. The songs have big choruses and strong melodies – strong enough, in the case of Carmen, that it isn’t overshadowed by its backing track borrowing something as immediately recognisable as the staccato piano line from Elton John’s Bennie and the Jets. You could broadly categorise their style as post-Amy Winehouse retro-soul: electric pianos and Philadelphia International strings; warm, live-sounding bass and drums; the odd dusting of distortion on Crookes’s vocals, which slip from smokily powerful and lightly jazz-inflected to more conversational, rap-informed cadences.

    Joy Crookes: Perfect Crime – video

    It could easily seem run of the mill, but it doesn’t, because it’s filtered through an appealingly gauzy lens. Synths, harps and organ shimmer and flutter abstractly around the sound, the aural equivalent of catching something in the corner of your eye. There are liberal applications of dub reggae-esque echo; everything has a slightly woozy, late-night quality. Listening to the thick bassline of Perfect Crime, or Pass the Salt, driven by a fantastic drum loop sampled from Serge Gainsbourg’s 1968 single Requiem pour un Con and featuring a brief but explosive guest verse from Vince Staples, you get the feeling that Crookes has an abiding love for trip-hop in its original, experimental mid-90s form, before it sank into the realm of blandly inoffensive dinner party soundtrack. It joins Crookes’s admirably eclectic roll call of influences: you really don’t get a lot of singer-songwriters in 2025 name-checking Black Uhuru, the Pogues and Nusrat Fateh Ali Khan in interviews.

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    It missteps once. First Last Dance feels jarringly perky given the atmospheric company it’s keeping, a state of affairs not much helped by its tune, which has a peculiar 80s Euro-pop quality. But one distracting stumble doesn’t matter much given how strong the rest of Juniper is, how clearly it asserts Crookes’s talent as a vocalist and songwriter. There are some big names here – as well as Staples, Kano turns up on Mathematics, while Sam Fender adds vocals to Somebody to You – but the main attraction never feels overshadowed or crowded out. Crookes has publicly worried about the gap between her second album and her debut: “Is anyone going to remember me?” she wondered aloud to one interviewer recently. You can understand why, but Juniper proves worth the wait.

    This week Alexis listened to

    Mark William Lewis – Petals
    Poppily melodic, driven by bright, clean guitar, but off-kilter and somehow ineffably creepy, Petals is the perfect advert for the complex pleasures of the London singer-songwriter’s eponymous, addictive album.

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  • Walcott wins javelin title in Tokyo – worldathletics.org

    1. Walcott wins javelin title in Tokyo  worldathletics.org
    2. Keshorn targets first World Champs medal to cap 2025 season  Trinidad and Tobago Newsday
    3. Walcott into third World Champs javelin final  Trinidad Guardian
    4. MEDAL BID  Trinidad Express Newspapers
    5. Keshorn Walcott Wins Javelin Gold At World Athletics Championships, Anderson Peters 2nd | Sports News  News18

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  • The Fat Duck alumni’s partnership behind Trivet and Labombe, the pair’s new venture in Mayfair

    The Fat Duck alumni’s partnership behind Trivet and Labombe, the pair’s new venture in Mayfair

    The second project from longtime collaborators and Trivet co-founders Jonny Lake and Isa Bal has finally opened its doors in Mayfair. Lake, a Canadian-born chef whose career has taken in acclaimed kitchens from Canada to Italy, and Bal, one of the world’s most respected master sommeliers, first joined forces at Heston Blumenthal’s three-Michelin-starred restaurant The Fat Duck in Bray. In 2019 they struck out on their own with Trivet, which earned its first Michelin star in 2022 and a second in 2024.

    The pair’s new venture, Labombe by Trivet, is at the Como Metropolitan on Old Park Lane, taking over the space that once housed the legendary Met Bar. The name comes from Lake’s school days in Canada, when he dreamed up an imaginary French restaurant called Labombe for a class project. Thirty years later, that idea has come to life.

    Labombe displays the easy confidence of people doing what they love: relaxed, welcoming cooking with brilliant wines and the same attention to detail that made Trivet so special – an exciting addition to Mayfair and a lighthearted continuation of their story.

    This interview has been edited for length and clarity. Listen to the full conversation on ‘The Entrepreneurs’, from Monocle Radio.

    Cooking up a storm: Jonny Lake (centre, front) and Isa Bal (left)

    When you first started working together at The Fat Duck, did you immediately sense this was a partnership that could go further?
    Jonny Lake: It was an intense, exciting period when it felt like the world’s attention was on this tiny restaurant. We clicked straight away and what struck me was that if I showed an interest in Isa’s world of wine, he always made time for me, which was rare. In most restaurants, if you were lucky enough to work with a wine team they didn’t want to talk about wine to people outside of that team. Isa was different.

    We were a similar age, came into the industry in similar ways and shared a real passion for what we were doing. We never said it out loud at the time but it was clear that we both knew where we wanted to go. You can even see it in old photographs – the body language shows a partnership forming, even before we ever spoke about it.

    Like a great wine and food pairing, it comes down to chemistry. What was your approach to building the business when you were starting?
    JL: From the moment that we said out loud we were going to do something together – even though it had been in our minds for a while – we had to work to figure out what we wanted to do. It was great that we wanted to have our own restaurant but what did that look like? That took us a few years because it wasn’t super obvious and we didn’t know what we were doing operationally.

    There’s creating the concept and then there’s actually doing it. We worked with some great people and had some good conversations to draw what we wanted out of ourselves. Once we had that, we had to think of the practical considerations, such as location. But among everything, we tried to stay true to what we wanted to achieve, knowing that we didn’t know what we were doing and asking a lot of questions to try to figure it out. It was a valuable experience of learning – maybe we would do it differently another time, but we gained a lot through that experience. 

    It’s amazing how many entrepreneurs claim that early-stage naivety was a superpower when it came to launching their businesses. Do you have any regrets about the moves that you made?
    Isa Bal: It brought out the fighting spirit in me. We were going to find a way to make what we wanted to happen, happen, one way or another. 

    What conversations happen around you when you start to see success? Once things go well, is everyone knocking on your door with new opportunities?
    JL: It’s good to explore opportunities when they present themselves but only within what makes sense for you. We didn’t have any prospects for a long time, so when interest arrived, we couldn’t take it for granted. From the start, we had ideas beyond just a single restaurant but Trivet is such a personal project that we could never replicate it. Over the years we have explored a few opportunities of varying scales but they didn’t come to fruition for different reasons. We turned down some because they weren’t right for us, while others fell through on the other side. This new restaurant is the first one that has worked and feels right for us – and we’re excited about it.

    Plate expectations: Vibrant fish crudo
    Top table: A plate of Milanese

    Where did the seed of Labombe first appear?
    JL: The name comes from a school project I did when I was about 12 or 13, growing up in Canada. In French class, we were given an assignment to create a menu for a restaurant and I called mine Restaurant Labombe. I rediscovered the project in my parents’ basement a few years ago while I was helping them move.

    Inside was a handwritten menu: some simple bistro dishes and others completely over the top – things you would only see in royal banquets. Prices were all in French francs and the teacher’s only comment was that I’d forgotten to list any drinks. It felt oddly fitting that, decades later, I would end up opening a restaurant with a sommelier, finally completing the missing piece of that school project.

    IB: He brought the folder back to London and showed it to me at the restaurant. As soon as I saw it, I said, “That’s it – that’s what we’re going to call the next one.”

    At the time, we were trying to open Trivet an extra day each week, because we were closed for two days. But honestly it wasn’t possible because it would have put too much pressure on the team. So we began thinking about what we could do with fewer people, less intensity.

    We’ve always enjoyed wine bars and wine-focused restaurants, so we thought, “Let’s do Labombe on Monday evenings at Trivet.” The idea was to have a simpler menu – though of course it turned out to be more complicated than expected – and highlight a few wines while keeping the full list available. That’s how it started.

    Isa, your approach to wine is unusual. Instead of focusing on geography, you have looked at chronology, tracing wines back through history to their origins. Why is that important?
    IB: When I was at The Fat Duck, I had the chance to taste wines that people worship but, after a while, it became repetitive. I realised that I was focusing my career on three or four regions and maybe 20 producers. I needed a way to keep myself excited.

    Being from Turkey, which has one of the world’s oldest winemaking histories, I began to think about wine differently. I recalled a lecture from Patrick McGovern, a biomolecular archaeologist, about the origins of fermented drinks. That inspired me to create a wine list in chronological order. I even emailed him to check the sequence and he suggested a couple of tweaks.

    What resulted was an engaging and informative wine list, without the preachiness. It sparked better conversations between guests and staff and it reignited my passion. The chronological approach is something I’ll carry into the new restaurant too, though in a slightly different form.

    Jonny, do you feel the same with food – that you sometimes need to step back and re-energise your own creativity?
    JL    : Ideas can come from anywhere and we have always worked on new dishes together, often with input from the whole team. We don’t keep track of what other restaurants are doing, strangely enough, but it’s worked for us.

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  • Could a Novel miRNA-Targeting Therapy Reprogram Obesity? – Medscape

    1. Could a Novel miRNA-Targeting Therapy Reprogram Obesity?  Medscape
    2. New weight loss jab ‘will reprogramme how the body uses fat’  The Sun
    3. Scientists unveil new obesity drug that reprograms fat and energy use  News-Medical
    4. Fat burning jabs could help people lose weight – while eating the same amount  The Mirror
    5. New weekly jab targets long-lasting weight loss  The Independent

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  • Visceral leishmaniasis service delivery in Somalia: a comprehensive li

    Visceral leishmaniasis service delivery in Somalia: a comprehensive li

    Introduction

    Visceral leishmaniasis also known as kala-azar, is a parasitic disease caused by protozoa of the genus Leishmania donavani complex, which includes Leishmania donavani and Leishmania infantum.1,2 It is transmitted to humans through the bite infected female phlebotomine sand flies.3 The leishmania disease manifests in three clinical forms including cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (ML) and visceral leishmaniasis (VL).4 Visceral leishmaniasis is the most severe and potentially fatal form, which primarily affects internal organs, including the liver, spleen and bone marrow, leading to severe systemic illness. It is a major public health problem, particularly in tropical and subtropical regions, and it’s classified as one of the world’s neglected tropical diseases (NTDs).5 VL disproportionately affects the poorest and most marginalized populations in endemic regions. The disease’s epidemiology is linked to poverty, malnutrition, displacement, and environmental changes, making it a significant public health challenge in many low and middle income countries (LMICs).6

    The pathogenesis of VL is complex and involves a combination of parasite factors, host immune response, and environmental influences.7 The immune response plays a crucial role in determining the outcome of infection. In individuals with a strong cell-mediated immune response, the infection may be controlled and remain asymptomatic.8 However, in individuals with a weakened immune system, the parasite can proliferate unchecked, leading to the development of clinical disease.9 Factors such as malnutrition, co-infections (eg, HIV), and genetic susceptibility can predispose individuals to severe forms of VL.10,11

    The clinical presentation of VL varies depending on the stage of the disease and the immune status of the host.3 The incubation period typically ranges from several weeks to months, although it can be longer in some cases. The onset of symptoms is often insidious, with the disease progressing gradually over time. The hallmark symptoms of VL include prolonged fever, significant weight loss, hepatosplenomegaly (enlargement of the liver and spleen), and pancytopenia (a reduction in the number of red and white blood cells, as well as platelets). Patients may also present with generalized weakness, anemia, and hypergammaglobulinemia (elevated levels of antibodies in the blood).12–15 As the disease progresses, massive splenomegaly becomes more pronounced and can lead to complications such as hypersplenism, where the spleen becomes overactive in removing blood cells, exacerbating the anemia and pancytopenia.

    In the absence of treatment, VL is almost always fatal, with death typically resulting from complications such as hemorrhage, secondary bacterial infections, or severe malnutrition. Even with treatment, the disease can cause long-term health consequences, including chronic anemia and immune suppression. In some cases, treated individuals may develop post-kala-azar dermal leishmaniasis (PKDL), a condition characterized by the appearance of nodular or hypopigmented skin lesions that can persist for years.16,17

    Global Burden of Visceral Leishmaniasis

    Epidemiology of Visceral Leishmaniasis

    Visceral leishmaniasis is endemic in over 70 countries across Asia, East Africa and Latin America with an estimated 50,000 to 90,000 cases annually.1 However, the true incidence is much higher due to underreporting and misdiagnosis particularly in remote and conflict-affected areas.18

    South Asia

    In the Indian subcontinent, primarily in India, Bangladesh, and Nepal, VL accounts for approximately 50–70% of the global reported cases.19 In India, the state of Bihar alone account for over 50% of the cases in India.20 The disease primarily effects the rural populations living in poverty with poor housing conditions, malnutrition and limited access to healthcare.21 Efforts to control the disease in South Asia particularly in India, Bangladesh and Nepal have made significant progress which has led to a substantial decline of reported cases achieving elimination of VL as a public health problem.22–27

    East Africa

    East Africa is another region with a high burden of visceral leishmaniasis primarily in Sudan, South Sudan, Ethiopia, Kenya and Somalia.28,29 The epidemiology of the disease in this region is complex, with the disease associated with conflict, displacement and environmental changes. It often encounters frequent outbreaks, linked to population movements and the breakdown of health systems.6,30,31 Visceral leishmaniasis in East Africa is characterized by high morbidity and mortality rates, particularly among malnourished children and immunocompromised individuals. The challenges of accessing and delivering healthcare in conflict-affected and remote areas, combined with weak health system, make VL a major public health concern in the region.6,28,32,33

    Latin America

    Brazil accounts for 90% of the cases in the region. The disease is endemic in several states, particularly in the northeast, where poverty, deforestation, and urbanization have contributed to its spread. The migration of people from rural to urban areas has resulted in the emergence of the disease in urban settings, complicating control efforts.34–37 Other countries in the region, such as Paraguay, Venezuela, and Colombia, also report cases, though on a much smaller scale contd to Brazil.38

    Other Regions

    While the majority of cases in south Asia, East Africa and Latin America, the disease is also prevalent in other parts of the world, including the Mediterranean, Central Asia and North Africa. These regions report sporadic cases often associated with zoonotic transmission from domestic dogs, which serve as reservoirs for leishmania infantum. Like many other endemic regions, the disease in these regions is often associated with rural poverty, limited access to healthcare, and the presence of sandfly vectors.39–42

    Visceral Leishmaniasis Burden in Somalia

    A Brief History of Visceral Leishmaniasis in Somalia

    Visceral leishmania in Somalia dates back several decades, with sporadic cases reported in the mid-20th century. However in the late 20th and early 21st centuries, the disease was recognized as a public health problem in the country.43–45 Somalia’s complex history of political instability, armed conflict, and displacement has created conditions conducive to the spread of VL, particularly in the southern and central regions where the disease is most prevalent.46,47

    In the colonial era, and during the military government regime, there were few reported cases of visceral leishmaniasis,48–51 as the focus of public health efforts was on largely other infectious diseases including Malaria, Tuberculosis and Cholera. However, with the collapse of the central government in 1991 and the subsequent outbreak of civil wars, the country’s health infrastructure broke down, leading to an increase in the emergence of neglected tropical diseases primarily visceral leishmaniasis.52 The conflict resulted in large scale displacement of populations to rural areas, coupled with poor living conditions, malnutrition, and limited access to healthcare, which created an environment where neglected tropical diseases mainly visceral leishmaniasis could spread more easily.47

    In the early 2000s, as many international humanitarian partners including Médecins Sans Frontières (MSF) documented, visceral leishmaniasis emerged as a more visible public health problem particularly in the south and central regions, including the Bay, Bakool, Gedo and Lower Shabelle regions.53,54 The disease was primarily reported among internally displaced persons (IDPs) and nomadic communities, who were living in overcrowded and poor sanitary conditions, which made them susceptible to sandfly proliferation. In addition to that, the lack of reliable surveillance systems, and the continuing conflict made it uneasy to assess the true burden of visceral leishmaniasis during this period.55 However, it was believed that the disease was becoming an increasingly public health problem.

    Epidemiology of Visceral Leishmaniasis in Somalia

    The epidemiology of the disease is influenced by a range of factors, including environmental conditions, population movement and the lack of access to health services due to ongoing conflict in the endemic areas.6 The disease is currently prevalent in the south and central regions of the country, where the presence of sandfly parasite vectors and animal reservoirs such as domestic animals, contribute to its transmission.43,44 These regions have historically been hotspots for VL due to their favorable environmental conditions for sandfly breeding and the presence of animal reservoirs. The disease was also recently reported in the northeastern regions including Puntland, although the burden is relatively smaller compared to the southern regions.56 The geographical distribution of VL in Somalia and East Africa in general is closely linked to the presence of specific sandfly species, such as Phlebotomus orientalis and Phlebotomus martini, which are known vectors of Leishmania donovani.57–60

    While the exact number of cases is difficult to determine due to underreporting and limited surveillance, it is estimated that hundreds of cases occur each year, with the majority of cases reported in the southern regions.61 The disease is often fatal if left untreated, and the case fatality rate in some areas is believed to range from 2% to as a high as 39%, particularly in settings where access to treatment is limited and among specific groups such as VL/HIV coinfection.62,63 The transmission of VL in Somalia is influenced by seasonal patterns, with the peak transmission period typically occurring during the rainy season, when sandfly populations are most active. The disease is transmitted by the bite of infected sandflies, which may acquire the parasite from animal reservoirs, such as domestic dogs and livestock, or directly from infected humans, before transmitting it to humans. The presence of these animal reservoirs in close proximity to human dwellings contributes to the ongoing transmission of VL in endemic areas.64

    Current Status of Visceral Leishmaniasis Service Delivery in Somalia

    The delivery of visceral leishmaniasis services in Somalia faces significant challenges due to the countries ongoing political instability, financial hardships and the limited health infrastructure.55

    Service Availability

    The availability of services is heavily influenced by the country’s healthcare infrastructure, which has been severely damaged by decades of conflict and instability. Healthcare facilities providing VL services are limited or unavailable, particularly in the rural and conflict-affected areas where the endemicity of the disease is highest.65 The majority of facilities are not equipped to diagnose and treat VL and most of the services are concentrated in urban centers and large towns, where hospitals and health clinics are more likely to be staffed with trained personnel and equipped with the necessary diagnostic tools and medications.66 For example, the capital city of Mogadishu, despite its own challenges, has some facilities capable of managing VL cases, though these are often overwhelmed by demand. In contrast, rural areas, where many of the at-risk populations reside, often lack even basic healthcare services, let alone specialized VL care. This geographical disparity significantly impacts on the availability of VL services, leaving many patients in rural areas without access to timely diagnosis and treatment.

    Diagnostic Services

    Diagnostic services are limited, with a scarcity of laboratories capable of conducting the necessary tests to confirm VL cases.67 The diagnosis of VL typically relies on a combination of clinical evaluation, serological tests (such as the rK39 rapid diagnostic test), and parasitological confirmation (eg, spleen or bone marrow aspiration).68 However, the availability of these diagnostic tools varies widely across the country. In urban centers, some hospitals and clinics have the capacity to perform serological tests, but parasitological confirmation, which requires more specialized equipment and expertise, is often unavailable.69 In many rural areas, diagnostic services are nonexistent, leading to underdiagnosis and misdiagnosis of the disease.

    Treatment Services

    The treatment of VL is also severely limited, with many healthcare facilities lacking the necessary medications and resources to manage the disease effectively.31 The standard treatment available for VL includes antimonial drugs, such as sodium stibogluconate, or paromycine and in some areas a limited supply of liposomal amphotericin B, which is considered the treatment of choice in many settings, due to its higher efficacy and lower toxicity compared to antimonials, though its high cost and limited availability restrict access.70 However, the availability of these drugs remains inconsistent, with stockouts and supply chain disruptions common, particularly in conflict-affected regions. In some areas, traditional healers may be the only option for patients, leading to delays in receiving effective treatment and increasing the risk of mortality.71

    Surveillance Programs

    The surveillance of the disease is hindered by the country’s weak health information systems and the lack of a coordinated national strategy for disease monitoring and relative priority given to other communicable diseases such as polio and others.72 The ongoing conflict and insecurity in many parts of the country have made it difficult to establish and maintain robust surveillance systems.73,74 As a result, data on the incidence and prevalence of VL are often incomplete or outdated, complicating efforts to target resources and interventions effectively. In areas where surveillance systems do exist, they are often rudimentary, relying on passive case detection through healthcare facilities, which may miss a significant number of cases, particularly in remote or underserved areas.

    The Accessibility of Visceral Leishmaniasis Services in Somalia

    The accessibility of health services in general is severely compromised by the country’s poor infrastructure and the vast distances that many patients must travel to reach healthcare facilities. The road network is underdeveloped, with many areas, particularly in rural regions, lacking paved roads or reliable transportation. During the rainy season, many roads become impassable, further isolating communities and limiting access to healthcare services. For patients in remote areas, the nearest healthcare facility may be several hours or even days away, making it difficult to seek timely diagnosis and treatment.75,76

    Insecurity in many parts of the country, particularly in southern and central regions, also restricts movement and access to healthcare services. Conflict-related barriers, such as roadblocks, checkpoints, and violence, can prevent patients from reaching healthcare facilities, leading to delays in diagnosis and treatment. In some cases, entire regions may be cut off from healthcare services due to ongoing fighting or the presence of armed groups, leaving populations without any access to VL care.77,78

    The cost of standard treatment, including medications, hospitalization, and supportive care, is often prohibitively expensive for many patients.79 While some international organizations and NGOs provide free or subsidized treatment in certain areas, these services are not universally available, and many patients are forced to pay out of pocket for their care. This financial burden can lead to delays in seeking treatment, as patients may need to borrow money or sell assets to afford the necessary care. In some cases, patients may forgo treatment altogether, leading to fatal outcomes. Free of-charge VL services are available in some parts of the country, primarily through the efforts of international organizations, NGOs, and humanitarian agencies including UNICEF and WHO.80 These organizations often operate in partnership with local health authorities to provide free diagnosis, treatment, and follow-up care for patients. However, the availability of these services is limited and often concentrated in specific regions or urban centers.31 In many rural and conflict-affected areas, free services including those for VL are not available, leaving patients without access to essential care. Even where free services are available, patients may still face indirect costs, such as transportation, accommodation, and lost income, which can further limit access to care.81

    Barriers to Visceral Leishmaniasis Service Delivery in Somalia

    The delivery of health services particularly NTD services including VL in Somalia faces significant barriers that compromise the ability to diagnose, treat, and control the disease effectively. These barriers are multifaceted, including health system constraints, infrastructural challenges, sociocultural factors, economic difficulties, and political and security issues.

    Health System Barriers

    Resource Limitations

    The Somali health system has been severely weakened by decades of conflict, political instability, and underinvestment. This has resulted in a lack of essential resources, including trained healthcare staff, medical equipment, and medications necessary for the diagnosis and treatment of VL.75

    Staffing Shortages

    There is a critical shortage of trained healthcare professionals in Somalia, particularly in rural and conflict-affected areas where VL is most prevalent. The limited number of doctors, nurses, and laboratory technicians has been exacerbated by the ongoing emigration of skilled workers seeking better opportunities abroad and the concentration of these health personnel in the urban areas and large towns. The healthcare workers often lack specialized training in the management of VL, leading to misdiagnosis and suboptimal treatment. Additionally, the overburdened staff are unable to provide the necessary follow-up care for VL patients, increasing the risk of relapse and mortality.75,82

    Equipment Deficiencies

    The diagnostic process for VL requires specific equipment and laboratory facilities, such as serological test kits, microscopes, and centrifuges. However, many healthcare facilities in Somalia lack these essential tools, especially in remote and underserved areas. The absence of proper diagnostic equipment leads to delays in diagnosis, misdiagnosis, and underreporting of VL cases. Even in facilities where basic diagnostic tools are available, they are often outdated, poorly maintained, or in short supply, further hindering accurate and timely diagnosis.83

    Medication Shortages

    The treatment of VL requires specific medications, including antimonial drugs like sodium stibogluconate, paromycine and liposomal amphotericin B. However, the availability of these medications in Somalia is inconsistent due to supply chain disruptions, lack of funding, and logistical challenges. Frequent stockouts of essential drugs are common, forcing healthcare providers to resort to less effective or inappropriate treatments. Additionally, the lack of standardized treatment protocols and the irregular supply of medications contribute to the emergence of drug-resistant strains of the Leishmania parasite, complicating efforts to control the disease.75

    Infrastructural Barriers

    Healthcare Infrastructure

    The infrastructure of healthcare facilities in Somalia is inadequate, particularly in regions where VL is endemic. Many hospitals and clinics operate in dilapidated buildings with limited access to clean water, electricity, and sanitation facilities. This lack of basic infrastructure hampers the ability of healthcare providers to deliver quality care and maintain hygienic conditions, which are crucial for the treatment of immunocompromised VL patients.75

    Transportation and Communication

    The geographical landscape of Somalia, combined with its underdeveloped transportation network, poses significant challenges to accessing healthcare services. The majority of roads in rural areas are unpaved and often become impassable during the rainy season. The lack of reliable transportation means that patients, particularly those in remote areas, must travel long distances on foot or by makeshift means to reach the nearest healthcare facility. This not only delays the diagnosis and treatment of VL but also discourages patients from seeking care altogether. Additionally, the lack of communication infrastructure in many parts of the country limits the ability to coordinate healthcare services, share information, and respond to disease outbreaks. The absence of reliable communication channels makes it difficult for healthcare workers to receive training, report cases, and access the latest guidelines on VL management.84

    Sociocultural Barriers

    Stigma

    Stigma associated with NTDs in particular Leprosy and VL is a significant barrier to service delivery in Somalia. The visible symptoms of VL, such as severe weight loss, splenomegaly (enlarged spleen), and skin changes, can lead to social isolation and discrimination. In some communities, VL is mistakenly believed to be a curse or punishment from a higher power, leading to further marginalization of affected individuals. This stigma discourages patients from seeking timely medical care, as they may fear being ostracized by their community or judged by healthcare providers.85

    Community Perceptions

    Misconceptions about NTD in particular VL are widespread in many parts of Somalia, particularly in rural and low-literacy populations. Some communities may not recognize the disease as a medical condition that requires treatment and may instead attribute the symptoms to supernatural causes or other illnesses including Malaria and Typhoid. This lack of understanding about the disease can lead to delays in seeking treatment and a preference for traditional healers over formal healthcare services. In some cases, families may prioritize traditional remedies, believing them to be more effective or safer than biomedical treatments, despite the lack of evidence supporting their efficacy.86

    Traditional Beliefs and Practices

    Traditional beliefs and practices play a significant role in shaping health-seeking behavior in Somalia. Many communities have long-standing traditions of consulting traditional healers, who are often the first point of contact for individuals with health concerns. While traditional healers may provide supportive care and remedies, they are generally not equipped to diagnose or treat VL effectively. Reliance on traditional medicine can result in delays in seeking appropriate care, leading to worsening of the disease and increased mortality. Additionally, some traditional practices, such as the use of herbal concoctions or bloodletting, can have harmful effects and may exacerbate the condition of VL patients.71

    Economic Barriers

    The economic impact of VL on affected households is substantial. In addition to the direct costs of medical care, families must also contend with indirect costs, such as transportation to healthcare facilities, lost income due to illness, and the need to care for sick relatives. For many families, the financial strain of VL can push them further into poverty, creating a cycle of vulnerability that is difficult to break. In some cases, families may resort to selling assets, borrowing money, or withdrawing children from school to cover the costs of treatment, further exacerbating their economic hardship.87

    Political and Security Barriers

    Impact of Conflict and Instability

    Somalia has been plagued by ongoing conflict and political instability for several decades, which has had a profound impact on the delivery of healthcare services, including those for VL. In regions where VL is endemic, such as southern and central Somalia, conflict and insecurity have severely disrupted healthcare services, making it difficult for patients to access care.55 The presence of armed groups, frequent clashes, and widespread violence have led to the destruction of healthcare facilities, displacement of populations, and a general breakdown of law and order in many parts of Somalia. Insecurity in these regions restricts the movement of healthcare workers, patients, and supplies, making it difficult to establish and maintain VL services. Healthcare providers operating in conflict zones face significant risks, including the threat of attacks, abductions, and killings, which further exacerbates the shortage of healthcare personnel in these areas. Additionally, ongoing conflict has led to the displacement of millions of people, many of whom live in overcrowded and unsanitary conditions in internally displaced persons (IDP) camps, where the risk of VL transmission is high and access to healthcare is limited.65

    Governance and Policy Challenges

    The governance and policy environment in Somalia poses significant barriers to the effective delivery of VL services. The central government in Somalia has limited control over large parts of the country, particularly in the south and central regions, where armed groups and local clans exert considerable influence.55 This lack of centralized authority hampers efforts to coordinate and implement national health programs, including those for VL. The Somali health system suffers from weak governance, characterized by limited oversight, accountability, and regulatory capacity. This has led to the fragmentation of health services, with different regions and actors implementing their own programs and priorities, often with little coordination or standardization.65 The absence of a coherent national strategy for VL control has resulted in gaps in service delivery, with some regions receiving more attention and resources than others. Additionally, the lack of reliable health data and surveillance systems makes it difficult to assess the true burden of VL in Somalia and to allocate resources effectively.

    Policy Gaps

    Despite the significant burden of VL in Somalia, there has been limited attention to the disease in national health policies and strategies. The focus of health policy in Somalia has been on addressing more visible and immediate health crises, such as cholera outbreaks, malnutrition, and maternal and child health. As a result, VL has not received the necessary attention and resources to mount an effective response. The lack of a national VL control program, inadequate funding, and insufficient integration of VL services into the broader health system are significant barriers to improving service delivery for the disease.

    Recommendations and Way Forward

    Enhancing visceral leishmaniasis (VL) service delivery in Somalia requires addressing several key barriers, including the insufficient integration of VL services into primary healthcare, lack of sustained capacity-building for healthcare workers, over-reliance on international aid, limited local research capacity, inadequate community engagement in remote areas, underutilization of technological innovations, and weak public-private partnerships. To overcome these barriers, Somalia should focus on integrating VL services within the broader primary healthcare system, ensuring that diagnosis and treatment are available at the local level. Continuous training and capacity-building initiatives for healthcare workers, particularly in underserved regions, will be essential to ensure they are equipped to manage VL cases effectively.

    To promote sustainability and reduce reliance on international aid, the Somali government should increase domestic funding for VL control programs, ensuring long-term local ownership of these initiatives. Local training programs should be institutionalized, making them independent of external funding and allowing Somali healthcare professionals to receive the skills needed to provide effective care. Expanding operational research and building local research capacities are critical to ensure that Somalia can contribute to global VL knowledge and innovate in the field. Empowering local leaders, NGOs, and community groups to intensify awareness campaigns, especially in remote areas, will promote timely health-seeking behavior and reduce the stigma and misinformation surrounding VL.

    Technological innovations, such as the District Health Information Software 2 (DHIS2) and telemedicine, should be scaled up to improve disease surveillance, patient management, and access to care, particularly in underserved areas. Recent advances in VL diagnostics and treatments, such as rapid diagnostic tests (RDTs) and combination therapies, should be integrated into the standard of care, ensuring they are widely accessible and effectively monitored. Finally, strengthening public-private partnerships will enhance the availability and affordability of essential VL medications and supplies. Collaborating with pharmaceutical companies and private healthcare providers, as well as expanding drug donation programs, will reduce the financial burden on patients and improve treatment adherence. By addressing these barriers and implementing these recommendations, Somalia can significantly improve VL service delivery and the effectiveness of its control programs.

    Conclusion

    This review highlights significant disparities in the availability, accessibility, and quality of visceral leishmaniasis (VL) services in Somalia. Diagnostic services are concentrated in urban areas, leaving rural and remote populations underserved. Similarly, treatment facilities are scarce, heavily reliant on international aid and NGO-run clinics. Although surveillance systems exist, they are hampered by resource shortages and instability, leading to underreporting and delayed outbreak responses.

    Key barriers to effective VL service delivery include health system limitations, such as inadequate infrastructure, shortages of trained healthcare workers, and insufficient access to diagnostic tools and medications. These challenges are compounded by infrastructural issues like poor road networks and lack of transportation, which prevent patients from accessing healthcare facilities. Sociocultural barriers, including stigma, traditional beliefs, and reliance on traditional medicine, delay timely care. Economic barriers, especially the high cost of treatment, exacerbate the problem in a context of widespread poverty. Furthermore, political and security challenges, including conflict, weak governance, and policy gaps, undermine efforts to enhance VL services, particularly in conflict-affected areas.

    This review concludes that overcoming these barriers requires a multifaceted approach, involving health system strengthening, sociocultural interventions, financial support mechanisms, and political stability, with collaboration between government, international organizations, and local stakeholders.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Disclosure

    The authors report no conflicts of interest in this work.

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  • Kate welcomes Melania Trump to Meghan’s former home Frogmore Cottage

    Kate welcomes Melania Trump to Meghan’s former home Frogmore Cottage

    Britain’s Catherine, Princess of Wales and U.S. first lady Melania Trump walk as they tour Frogmore Cottage in Windsor, Britain, September 18, 2025. REUTERS/Nathan Howard/Pool

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    U.S. first lady Melania Trump and Britains Catherine, Princess of Wales interact with kids as they tour Frogmore Cottage in Windsor, Britain, September 18, 2025. REUTERS/Nathan Howard/Pool
    U.S. first lady Melania Trump and Britain’s Catherine, Princess of Wales interact with kids as they tour Frogmore Cottage in Windsor, Britain, September 18, 2025. REUTERS/Nathan Howard/Pool

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    Britains Catherine, Princess of Wales, meets UK Scouts at Frogmore House in Windsor, Britain, on Thursday, September 18, 2025. Andrew Testa/Pool via REUTERS
    Britain’s Catherine, Princess of Wales, meets UK Scouts at Frogmore House in Windsor, Britain, on Thursday, September 18, 2025. Andrew Testa/Pool via REUTERS

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    Check it out Below:

    U.S. first lady Melania Trump and Britains Catherine, Princess of Wales, meet with UK Scouts at Frogmore House in Windsor, Britain, on Thursday, September 18, 2025. Andrew Testa/Pool via REUTERS
    U.S. first lady Melania Trump and Britain’s Catherine, Princess of Wales, meet with UK Scouts at Frogmore House in Windsor, Britain, on Thursday, September 18, 2025. Andrew Testa/Pool via REUTERS


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  • Heavy rain forecast raises new flood fears across Punjab

    Heavy rain forecast raises new flood fears across Punjab

    The National Disaster Management Authority (NDMA) has warned of heavy rainfall over the next two days in Rawalpindi, Islamabad, Gujrat, Gujranwala, and Lahore divisions, with intermittent showers also expected in Peshawar, Kohat, Bannu, Sargodha, Faisalabad, and Zhob.

    Rising river inflows are feared in upper catchment areas, raising the risk of fresh flooding.

    At present, Guddu Barrage is experiencing a medium-level flow of 500,000 cusecs, Sukkur Barrage is at high flood levels with 571,000 cusecs, and Kotri Barrage is under medium-level flow with possible flood risk.

    According to the  Provincial Disaster Management Authority (PDMA ), water levels in the Indus, Jhelum, Ravi, and Chenab rivers have returned to normal, while Panjnad is stable.

    However, a medium flood persists at Ganda Singh Wala on the Sutlej, and a low flood remains at Sulaimanki and Islam Headworks. Hill torrents in Dera Ghazi Khan are also reported to be flowing normally.

    Meanwhile, Mangla Dam has reached 95 per cent capacity and Tarbela Dam is at full capacity. Across the border, Bhakra Dam has filled to 88 per cent, Pong Dam to 94 per cent, and Thein Dam to 88 per cent.

    The NDMA has directed all relevant institutions to remain on high alert and ensure preventive measures, while urging citizens to avoid crossing rivers, bridges, or submerged roads during high flows. 

    Residents of flood-prone areas have also been advised to stay informed through TV and mobile alerts and use the Pak NDMA Disaster Alert app for timely updates.

    Read: Flood loss estimates balloon

    Relief efforts

    The flooding in Punjab’s rivers has already caused widespread devastation. According to Relief Commissioner Punjab Nabeel Javed, more than 4.7 million people have been affected and over 4,700 villages damaged due to the severe flood situation in the Ravi, Sutlej, and Chenab rivers. Recent incidents during the floods have claimed 119 lives.

    Around 2.614 million stranded residents have been relocated to safer places, while 329 relief camps and 425 medical camps have been established. In addition, 367 veterinary camps have been set up, and 2.09 million animals have been shifted to safe areas.

    “On the directives of the Chief Minister of Punjab, compensation will be provided to citizens for their losses,” Javed said, confirming that a damage assessment survey is underway and payments will be made “transparently and easily.”

    The PDMA noted that while water levels are receding rapidly in many flood-hit areas, the provincial administration remains on alert as per CM directives. Relief operations continue, and citizens can contact the emergency helpline 1129 for assistance.

    Read more: Low flood at Kotri as Indus ebbs at Guddu

    Medical response

    The Punjab Health and Population Department reported that over 822,000 flood victims have been provided medical treatment, including 31,000 in the past 24 hours.

    Provincial Minister Khawaja Imran Nazir said 603 medical relief camps, 23 field hospitals, and 12 boat clinics are serving flood-hit areas. He added that 31,000 hygiene kits have been distributed so far.

    Health authorities also confirmed 164 snakebite cases during the floods, including eight in the past 24 hours, alongside treatment for diabetic patients and 343 pregnant women.

    “The department is committed to ensuring uninterrupted healthcare for flood-affected communities,” Nazir said.

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  • IHC to hear appeals of PTI founder, Bushra Bibi on Sep 25

    IHC to hear appeals of PTI founder, Bushra Bibi on Sep 25

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    ISLAMABAD, Sep 18 (APP):A division bench of the Islamabad High Court (IHC) would take up the appeals of PTI founder and his wife Bushra Bibi for hearing on September 25, against their sentences in 190 million pounds reference.

    A two-judge bench comprising Chief Justice Sardar Sarfraz Dogar and Justice Muhammad Azam Khan would hear the case on the said date. The last hearing into the appeals was held on June 29.

    An accountability court had announced 14 years imprisonment sentence to PTI founder on January 17, while Bushra Bibi was awarded seven year jail term in 190 millions pounds reference.

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  • Warming waters, declining Prochlorococcus | Nature Reviews Microbiology

    The small marine cyanobacteria Prochlorococcus are the most abundant photosynthetic organism on Earth. They make up a substantial proportion of the phytoplankton biomass and are an important contributor to marine ecosystem function by providing photosynthetically fixed carbon for other marine organisms. Global warming leads to a rise in sea surface temperatures, but the effects of future ocean temperature shifts on Prochlorococcus are not well understood. Ribalet et al. analysed data they collected over the past decade with SeaFlow (a flow cytometer developed for the continuous observation of small phytoplankton) across the tropical and subtropical Pacific Ocean to determine the in situ thermal sensitivity of Prochlorococcus. They generated in situ division rate estimates and report an initial increase in division rates of the cyanobacteria (at around 28 °C), which is followed by a sharp decline at high temperatures (by 31 °C). Moreover, a global ocean ecosystem model projects that increases in sea surface temperatures will lead to a decline in Prochlorococcus biomass production in tropical oceans or a near-complete collapse of the populations in the Western Pacific Warm Pool. Finally, hypothetical warm-adapted Prochlorococcus may delay but not prevent the negative impact of warming sea surface temperatures on Prochlorococcus populations.

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  • Cornish festival offers film and a meal for £1 to improve access

    Cornish festival offers film and a meal for £1 to improve access

    Darshan Harode/99p Films A man stands in front of a stage and before an audience in a cinema.Darshan Harode/99p Films

    Organisers said 99p from the pay-what-you-can tickets will go to the filmmakers

    A community interest cinema is hoping to improve access to film viewings and eating out, by offering tickets starting at £1.

    Social cinema company 99p Films has announced its first autumn film series.

    Each screening also includes mindful breathing, a discussion and a vegetarian or vegan meal, made from local ingredients.

    Founder Alex Fish said the pay-what-you-can screenings were “more than just film nights” and would give people a chance to explore “subjects that matter”.

    Darshan Harode/99p Films Dozens of people sit on either side of two long tables, eating. There are long windows at the end and left hand side of the room. On the right hand side, people are being served food from a large pot.Darshan Harode/99p Films

    The screenings are followed by a discussion about the topics raised and a vegan or vegetarian meal

    Organisers said 99p from the tickets would go to the filmmakers, with the top-priced option costing £25.

    Mr Fish said the events were “not only about what we watch”.

    He added: “The breathing at the start, the conversation afterwards, and the shared meal at the end turn the evening into something much richer.”

    Organisers hope the events will connect people and raise awareness about social and environmental issues.

    Screenings will take place at various spaces around the county, including Falmouth, Truro, Redruth, Helston and Newquay.

    Starts in Truro

    The series is part of Falmouth Creates, a programme from Falmouth Business Improvement District (BID) to support local events.

    The first screenings will be of My Garden of a Thousand Bees – a series of short films about the role bees and other pollinators play in the ecosystem.

    The screenings start in Truro on Thursday 18 September and Falmouth on Sunday 21 September 2025, followed by events in Helston and Redruth later in the year.

    Other events include films about sustainable fashion, Palestinian communities living in a conflict zone, and engineless sailing.

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