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Articles by Pascal Geldsetzer
Preprimary education laws and women’s gender attitudes, empowerment and reproductive autonomy in 117 low- and middle-income countries
Abstract Preprimary education is central to the global education agenda, including Sustainable Development Goal 4.2. Despite global momentum in low- and middle-income countries, cross-national evidence on long-term outcomes associated with preprimary education legislation remains limited. Here we applied a matrix-completion approach with subgroup and sensitivity analyses using 495 nationally representative surveys from 1990 to 2024, covering nearly 6.7 million women across 117 countries.
COVID-19 lockdown and coverage of maternal health and nutrition care in rural West Bengal, India: a single interrupted time-series analysis
Abstract While COVID-19 lockdowns globally disrupted healthcare, the extent of changes in India’s maternal health and nutrition services coverage in rural settings requires further empirical investigation.
Policy, trust, and symptoms: a multi-stakeholder qualitative study of COPD awareness in rural China
Abstract Despite the disproportionately high burden of Chronic obstructive pulmonary disease (COPD) in rural China, disease awareness remains profoundly low. Existing quantitative assessments outline the prevalence of this awareness deficit but offer limited insight into the complex sociocultural and structural factors driving the awareness gap of COPD. This study aimed to identify the key facilitators and barriers shaping COPD awareness among multiple stakeholders in rural southwest China.
Policy, trust, and symptoms: a multi-stakeholder qualitative study of COPD awareness in rural China
Abstract Despite the disproportionately high burden of Chronic obstructive pulmonary disease (COPD) in rural China, disease awareness remains profoundly low. Existing quantitative assessments outline the prevalence of this awareness deficit but offer limited insight into the complex sociocultural and structural factors driving the awareness gap of COPD. This study aimed to identify the key facilitators and barriers shaping COPD awareness among multiple stakeholders in rural southwest China.
Associations between male child marriage and intimate partner violence across low- and middle-income countries
Abstract Male child marriage (before age 18 years) remains prevalent in many low- and middle-income countries (LMICs), yet its consequences for men’s roles in intimate partner violence (IPV) are poorly understood. Using Demographic and Health Survey data from 41 low- and middle-income countries (LMICs), we show that male child marriage is substantially associated with higher risks of perpetrating nearly all types of IPV and experiencing physical IPV in the past 12 months.
Why large-scale randomized trials of live-attenuated shingles vaccination for dementia prevention are urgently needed
In my view, we have never had as robust a body of evidence from observational data on an intervention for dementia as we do for live-attenuated shingles vaccination. Both a recent US National Institutes of Health expert workshop and an international expert consensus on Alzheimer’s disease drug repurposing identified large-scale randomized trials of shingles vaccination for dementia prevention as the crucial next step for the field.
The effect of shingles vaccination at different stages of the dementia disease course
Keywords herpes zoster vaccination immunization dementia Alzheimer’s disease mild cognitive impairment natural experiment quasi-experiment varicella zoster virus Introduction Given the key role of neuroinflammation in the development and progression of dementia,1 it is conceivable that neurotropic viruses could be a factor that causes or accelerates the dementia disease process.
Herpes zoster vaccination and incident dementia in Canada: an analysis of natural experiments
Introduction Microbes have long been suggested to have a role in the pathogenesis of dementia.1–3 Neurotropic herpesviruses have received particular attention because they preferentially target the nervous system,4 their reactivation becomes more common with age and can cause encephalitis,4,5 and they are highly prevalent.4 Herpesviruses can promote the accumulation of β-amyloid in mice and increase tau phosphorylation in human brain organoids and human neuronal cell culture.1,6–8 Targeting...
Varicella-zoster virus reactivation and the risk of dementia - Nature Medicine
Abstract Varicella-zoster virus (VZV) is a neurotropic virus that establishes lifelong latency in humans. VZV reactivation is associated with a wide range of symptoms, including herpes zoster (HZ; also known as shingles), and has been implicated in the development of dementia, although to an unknown extent.
Evaluating the impact of National Essential Public Health Services Pro
Back to Journals » Risk Management and Healthcare Policy » Volume 19 Authors Luo Y , Cao Z, Geldsetzer P, Chen Q, Hao Z , He L , Bärnighausen T, Wang C, Chen S Received 10 September 2025 Accepted for publication 7 February 2026 Published 4 March 2026 Volume 2026:19 564931 DOI https://doi.org/10.2147/RMHP.S564931 Checked for plagiarism Yes Review by Single anonymous peer review Peer reviewer comments 4 Editor who approved publication: Dr Keon-Hyung Lee Yuheng Luo,1,* Zhong Cao,2,*...
National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries - Nature Communications
Abstract Given rising diabetes prevalence globally, access to diabetes treatments is gaining urgency. Yet, it remains unknown which glucose-lowering medication types people with diabetes across low- and middle-income countries (LMICs) use. In this cross-sectional analysis, we pooled nationally representative data of 223,283 adults aged ≥25 years in 62 LMICs from 2009 to 2019. We found that 51.9% [95%-CI: 49.6%, 54.2%] of 21,715 individuals with diabetes were undiagnosed.
Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India
Indian state governments are implementing and scaling up large home-based screening programmes to address the growing burden of cardiometabolic diseases. Studies evaluating home-based screening activities in China and Malawi find that they lead to modest improvements in blood pressure levels. However, studies from South Africa and Germany find null effects of home-based screening on blood pressure and long-term cardiometabolic outcomes.
A natural experiment on the effect of herpes zoster vaccination on dementia
Abstract Neurotropic herpesviruses may be implicated in the development of dementia1,2,3,4,5. Moreover, vaccines may have important off-target immunological effects6,7,8,9. Here we aim to determine the effect of live-attenuated herpes zoster vaccination on the occurrence of dementia diagnoses. To provide causal as opposed to correlational evidence, we take advantage of the fact that, in Wales, eligibility for the zoster vaccine was determined on the basis of an individual’s exact date of birth.
Clinical Evaluations of Early Warning Scores-Reply
Clinical Evaluations of Early Warning Scores—Reply Effectiveness of an AI–Enabled Intervention for Detecting Clinical Deterioration Robert J. Gallo, MD; Lisa Shieh, MD, PhD; Margaret Smith, MBA; Ben J. Marafino, PhD; Pascal Geldsetzer, MD, PhD; Steven M.
Disparities in air pollution attributable mortality in the US population by race/ethnicity and sociodemographic factors - Nature Medicine
Abstract There are large differences in premature mortality in the USA by race/ethnicity, education, rurality and social vulnerability index groups.
Sociodemographic and geographic variation in mortality attributable to air pollution in the United States
The authors have declared no competing interest. PG is a Chan Zuckerberg Biohub investigator. DF is supported by the Gerhard C. Starck Foundation. MVK is supported by National Institutes of Health (NIH) grant R00DA051534. EB is supported by NIH grants R01AI127250 and R01HD104835. SHN is supported by the Robert Woods Johnson Foundation. TB is supported by NIH grant R01CA228147 and by the California Environmental Protection Agency's Office of Environmental Health Hazard Assessment (#21-E0018).
The prevalence of cardiovascular disease risk factors among adults living in extreme poverty - Nature Human Behaviour
Abstract Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank’s international line for extreme poverty (those with income <$1.90 per day) globally is sparse.
Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India
The authors have declared no competing interest. The study received no funding. I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review
Loading metrics Open Access Peer-reviewed Research Article Citation: Geldsetzer P, Flores S, Flores B, Rogers AB, Chang AY (2023) Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review. PLOS Digit Health 2(10): e0000156.
National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021
National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021 Key Points Question How does the diabetes care continuum (diagnosis, treatment, and control) vary by state, district, and sociodemographic characteristics in India? Findings In this 2019 to 2021 national survey study of 1.65 million adults in India, 74.2% of adults with diabetes were diagnosed, 59.4% reported taking medication, and 65.5% achieved control.
Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases
Abstract The root causes of dementia are still largely unclear, and the medical community lacks highly effective preventive and therapeutic pharmaceutical agents for dementia despite large investments into their development. There is growing interest in the question if infectious agents play a role in the development of dementia, with herpesviruses attracting particular attention.
Changing socioeconomic and geographic gradients in cardiovascular disease risk factors among Indians aged 15-49 years-evidence from nationally representative household surveys - The Lancet Regional Health - Southeast Asia
Summary Background Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomic and geographic gradients will persist or change.
A deep-learning algorithm to classify skin lesions from mpox virus infection - Nature Medicine
Abstract Undetected infection and delayed isolation of infected individuals are key factors driving the monkeypox virus (now termed mpox virus or MPXV) outbreak. To enable earlier detection of MPXV infection, we developed an image-based deep convolutional neural network (named MPXV-CNN) for the identification of the characteristic skin lesions caused by MPXV.
Prevalence of Short Peer Reviews in 3 Leading General Medical Journals
Key Points Question How often do very short peer reviews inform initial editorial decisions at 3 leading general medical journals? Findings This cross-sectional study of 11 466 peer reviews corresponding to 4038 published articles found that 20.9% of initial editorial decisions were based on review sets in which at least one-half of the peer reviews had fewer than 200 words.
The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries
Background: Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries.
The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries
17 WHO STEPwise approach to surveillance (STEPS). World Health Organization, Geneva, Switzerland and systematically requested the remaining eligible STEPS surveys that are listed on the website but not available publicly from countries that met our inclusion criteria.
Prevalence of depression in China during the early stage of the COVID-19 pandemic: a cross-sectional study in an online survey sample
Prevalence of depression in China during the early stage of the COVID-19 pandemic: a cross-sectional study in an online survey sample http://orcid.org/0000-0001-5377-9714Weina Liu1,2, http://orcid.org/0000-0002-5607-1102Fengyun Yu1,3, http://orcid.org/0000-0002-8878-5505Pascal Geldsetzer1,4, http://orcid.org/0000-0003-1180-391XJuntao Yang5, http://orcid.org/0000-0001-5175-8645Zhuoran Wang5, Todd Golden6, http://orcid.org/0000-0002-2505-7447Lirui Jiao7,...
Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
Loading metrics Open Access Peer-reviewed Research Article Maja E. Marcus , Cara Ebert, Pascal Geldsetzer, Michaela Theilmann, Brice Wilfried Bicaba, Glennis Andall-Brereton, Pascal Bovet, Farshad Farzadfar, Mongal Singh Gurung, Corine Houehanou, Mohammad-Reza Malekpour, Joao S. Martins, Sahar Saeedi Moghaddam, Esmaeil Mohammadi, Bolormaa Norov, Sarah Quesnel-Crooks, Roy Wong-McClure, Justine I. Davies, Mark A. Hlatky, Rifat Atun , Till W. Bärnighausen , Lindsay M.
Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: a microsimulation model
Abstract Background Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and healthcare costs of diagnosis, treatment, and control of blood pressure,...
Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults - The Lancet
Summary Background The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.
Cervical Cancer Screening in Low- and Middle-Income Countries-Reply
Original Investigation Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries Julia M. Lemp, MSc; Jan-Walter De Neve, ScD; Hermann Bussmann, MD; Simiao Chen, ScD; Jennifer Manne-Goehler, MD; Michaela Theilmann, MA; Maja-Emilia Marcus, MA; Cara Ebert, PhD; Charlotte Probst, PhD; Lindiwe Tsabedze-Sibanyoni, MPH; Lela Sturua, PhD; Joseph M. Kibachio, MD; Sahar Saeedi Moghaddam, MSc; Joao S. Martins, PhD; Dismand Houinato, PhD; Corine Houehanou, PhD; Mongal S.
A cross-sectional study of cardiovascular disease risk clustering at different socio-geographic levels in India
Abstract Despite its importance for the targeting of interventions, little is known about the degree to which cardiovascular disease (CVD) risk factors cluster within different socio-geographic levels in South Asia.
Revisiting the association between temperature and COVID-19 transmissibility across 117 countries
Simiao Chen, Klaus Prettner, Bin Cao, Pascal Geldsetzer, Michael Kuhn, David E. Bloom, Till Bärnighausen, Chen Wang ERJ Open Research 2020 6: 00550-2020; DOI: 10.1183/23120541.00550-2020 Abstract There is a robust and significant negative association between #COVID19 transmissibility and ambient temperature at the country level. An increase of 1°C in temperature is associated with a decrease in the prevalence of COVID-19 by ∼5.4%.
Mapping physical access to health care for older adults in sub-Saharan Africa and implications for the COVID-19 response: a cross-sectional analysis
Summary Background Severe acute respiratory syndrome coronavirus 2, the virus causing COVID-19, is rapidly spreading across sub-Saharan Africa. Hospital-based care for COVID-19 is often needed, particularly among older adults. However, a key barrier to accessing hospital care in sub-Saharan Africa is travel time to the nearest health-care facility.
A stepped-wedge randomized trial and qualitative survey of HIV pre-exposure prophylaxis uptake in the Eswatini population
PrEPping to prevent HIV Clinical trials have demonstrated that pre-exposure prophylaxis (PrEP) can prevent HIV infection in high-risk populations. Geldsetzer et al. conducted a randomized study of health care facilities in Eswatini to see whether promoting PrEP could increase uptake among the general population at high risk of acquiring HIV.
Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries
Epidemiology/Health Services Research Abstract OBJECTIVE The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk.
Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey
Background: The behavior of the general public will probably have an important bearing on the course of the coronavirus disease 2019 (COVID-19) epidemic. Human behavior is influenced by people's knowledge and perceptions (1). Objective: To assess knowledge and perceptions about COVID-19 among a convenience sample of the general public in the United States and United Kingdom.
Immediate ART Initiation Impacts on HIV Patient Satisfaction
Abstract and Introduction Abstract Objectives: Immediate ART (or early access to ART for all, EAAA) is becoming a national policy in many countries in sub-Saharan Africa. It is plausible that the switch from delayed to immediate ART could either increase or decrease patient satisfaction with treatment. A decrease in patient satisfaction would likely have detrimental consequences for long-term retention and adherence, in addition to the value lost because of the worsening patient experience itself.
Evaluation of sex differences in dietary behaviours and their relationship with cardiovascular risk factors: a cross-sectional study of nationally representative surveys in seven low- and middle-income countries
Research Open Access Open Peer Review Published: 13 January 2020 Briar L. McKenzie ORCID: orcid.org/0000-0001-6972-66171, Joseph Alvin Santos1, Pascal Geldsetzer2, Justine Davies3,4, Jennifer Manne-Goehler5, Mongal Singh Gurung6, Lela Sturua7, Gladwell Gathecha8, Krishna K. Aryal9, Lindiwe Tsabedze10, Glennis Andall-Brereton11, Till Bärnighausen12,13,14, Rifat Atun12, Sebastian Vollmer15, Mark Woodward1,16,17, Lindsay M.
The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults
Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care.
Alternatives to Intention-to-Treat Analyses
To the Editor Drs DeMets and Cook discussed the intention-to-treat (ITT) principle, which is generally the most assumption-free method for analysis of randomized trials.1 However, the effect of intending to treat a group of individuals vs not intending to treat another group may not be the question of highest interest to patients, clinicians, or policy makers.
The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania
Elysia Larson1Email authorView ORCID ID profile, Pascal Geldsetzer1, Eric Mboggo2, Irene Andrew Lema2, David Sando1, Anna Mia Ekström3, Wafaie Fawzi1, Dawn W. Foster4, Charles Kilewo5, Nan Li6, Lameck Machumi2, Lucy Magesa2, Phares Mujinja5, Ester Mungure2, Mary Mwanyika-Sando7, Helga Naburi5, Hellen Siril2, Donna Spiegelman8, 10, Nzovu Ulenga2 and Till Bärnighausen9 Human Resources for Health201917:23 https://doi.org/10.1186/s12960-019-0355-7 © The Author(s).
Community health workers to improve uptake of maternal healthcare services: A cluster-randomized pragmatic trial in Dar es Salaam, Tanzania
Loading metrics Open Access Peer-reviewed Research Article Pascal Geldsetzer, Eric Mboggo , Elysia Larson, Irene Andrew Lema, Lucy Magesa, Lameck Machumi, Nzovu Ulenga, David Sando, Mary Mwanyika-Sando, Donna Spiegelman, Ester Mungure, Nan Li, Hellen Siril, Phares Mujinja, Helga Naburi, Guerino Chalamilla †, Charles Kilewo, Anna Mia Ekström, Dawn Foster, Wafaie Fawzi, [ ...
Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys
Loading metrics Open Access Peer-reviewed Research Article Jennifer Manne-Goehler , Pascal Geldsetzer, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K. Aryal, Brice Wilfried Bicaba, Pascal Bovet, Garry Brian, Maria Dorobantu, Gladwell Gathecha, Mongal Singh Gurung, David Guwatudde, Mohamed Msaidie, Corine Houehanou, Dismand Houinato, Jutta Mari Adelin Jorgensen, Gibson B. Kagaruki, Khem B. Karki, Demetre Labadarios, Joao S. Martins, Mary T.
Community delivery of antiretroviral drugs: A non-inferiority cluster-randomized pragmatic trial in Dar es Salaam, Tanzania
In this study, an ARV community delivery model performed at least as well as the standard of care regarding the critical health indicator of virological failure. The intervention did not significantly reduce patient healthcare expenditures, but satisfaction with the program was high and it is likely to save patients time. Policy-makers should consider piloting, evaluating, and scaling more ambitious ARV community delivery programs that can reach higher proportions of ART patients.
Collaboration for impact in global health
Many medical research institutes and funders consider only corresponding, first, second, or last authorship as relevant contributions to academic endeavours.1x1Casadevall, A and Fang, FC. Causes for the persistence of impact factor mania. mBio. 2014; 5: e00064–e00114Crossref | PubMed | Scopus (0) | Google ScholarSee all References This necessity potentially increases competition, discourages collaboration, and can lead to secrecy around ideas.2x2McCain, KW.
Geographic and sociodemographic variation of cardiovascular disease risk in India: A cross-sectional study of 797,540 adults
We used 2 large household surveys carried out between 2012 and 2014, which included a sample of 797,540 adults aged 30 to 74 years across India. The main outcome variable was the predicted 10-year risk of a CVD event as calculated with the Framingham risk score. The Harvard–NHANES, Globorisk, and WHO–ISH scores were used in secondary analyses. CVD risk and the prevalence of CVD risk factors were examined by state, rural–urban residence, age, sex, household wealth, and education.
Diabetes and Hypertension in India
Question How does the prevalence of diabetes and hypertension in India vary by geographical area and sociodemographic characteristics?
Improving the performance of community health workers in Swaziland: findings from a qualitative study
Analyzing the data from the semi-structured qualitative interviews with the 54 CHWs and 15 CHW program managers, we found that CHWs and program managers viewed the following four factors as needing improvement to increase CHW performance: (i) higher monetary compensation, (ii) a more reliable supply of equipment and consumables, (iii) additional training, and (iv) extending CHW responsibilities to allow them to attend to a wider variety of healthcare needs.
What research is needed to address the co-epidemics of HIV and cardiometabolic disease in sub-Saharan Africa?
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect. HIV-positive populations in sub-Saharan Africa are both growing and ageing.1 These population changes are due in large part to the massive scale-up of antiretroviral therapy and its success in averting HIV-related mortality.
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