Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

Background: Although the prognosis of advanced schistosomiasis patients has significantly improved, the impact of historical disease conditions on life expectancy remains unclear.

Methods: Utilizing data from an advanced schistosomiasis cohort (n=10 362) from 2008 to 2019 in Hunan, China, we examined five historical disease conditions: times of praziquantel treatment, the history of ascites, splenectomy, upper gastrointestinal bleeding (UGIB) and hepatic coma. Using latent class analysis, participants were categorized into three groups: Group 1 (characterized by no risk conditions), Group 2 (had ≤3 times of praziquantel treatment without UGIB history) and Group 3 (had UGIB history). Life expectancies were calculated using the life table method.

Results: At the age of 45 y, patients with ≤3 times of praziquantel treatment, a history of ascites, UGIB, hepatic coma and those without splenectomy exhibited lower life expectancies. Groups 1, 2 and 3 had estimated life expectancies of 32.32, 26.76 and 25.38 y, respectively. Compared with Group 1, women in Group 3 experienced greater life expectancy loss than those in Group 2, with the difference narrowing with age.

Conclusions: Based on the consideration of overall physical conditions, tailored treatment and healthcare, along with public health interventions targeting diverse populations, could mitigate the prevalence of poor disease conditions and premature deaths.

Background: Podoconiosis is a neglected debilitating yet preventable disease. Despite its public health significance, podoconiosis is often misdiagnosed and confused with lymphatic filariasis. No appropriate diagnostic tests exist, contributing to underestimation and the absence of control interventions.

Methods: A population-based cross-sectional survey was conducted in seven districts with suspected or reported cases of podoconiosis or an altitude of 1200 m above sea level. Conducted from 30 January to 19 March 2023, the survey employed multilevel stratified sampling to reach eligible household members.

Results: Of the 10 023 participants sampled, 187 (confidence interval 1.25 to 2.78) had clinical features of podoconiosis. The highest prevalence was recorded in Nakapiripirit (7.2% [58/809]) and Sironko (2.8 [44/1564]) and the lowest in Kasese (0.3% [5/1537]), but ranged from 1.1 to 1.8% in Zombo, Rukungiri, Gomba and Hoima districts. The duration of podoconiosis was reported to range from 1 to 57 y. Factors associated with podoconiosis occurrence included advanced age, tungiasis, household cleanliness and personal hygiene. Sleeping on a bed, bathing daily, use of soap and use of footwear in at least moderate condition were protective against podoconiosis.

Conclusions: Podoconiosis occurred in all the sampled districts and was linked to personal hygiene. Long-standing cases suggest an absence of treatment. There is potential for early intervention using a holistic care model in managing this condition. Urgent action and stakeholder engagement are essential for effective podoconiosis management.

Background: Little is known about community knowledge and stigma towards leprosy in endemic settings. The aim of this study was to evaluate community knowledge, attitudes and stigma towards leprosy in Nigeria.

Methods: This was a mixed-methods study consisting of a quantitative cross-sectional survey of community members and qualitative focus group discussions with community members and people affected by leprosy as well as key informant interviews with healthcare workers and community leaders.

Results: Of the 811 survey participants, 401 (49.4%) had a poor knowledge of leprosy that was driven by cultural beliefs, fear of its contagiousness and poor knowledge of its means of transmission. The participants reported high stigma levels with a mean score of 18.96±7.73 on the Explanatory Model Interview Catalogue Community Stigma Scale and 9.39±7.03 on the Social Distance Scale. Stigma levels were influenced by age, residence, education and knowledge of leprosy. Qualitative data suggested that community members were scared of leprosy infectiousness, and local illness concepts and misconceptions informed attitudes and behaviour towards leprosy in the community.

Conclusion: Community members have a poor knowledge of, and high stigma levels towards leprosy. Culture-specific health education and behavioural change interventions are needed to address the identified gaps.

Malaria Consortium supports delivery of seasonal malaria chemoprevention (SMC) to children ages 3-59 months using sulfadoxine-pyrimethamine plus amodiaquine. Lot quality assurance sampling (LQAS) was adapted as a cost-efficient method for end-of-cycle SMC monitoring surveys across supported countries and an implementation challenges reporting system was established in Nigeria. We present a case study of its application in Nasarawa State. LQAS facilitated timely local performance assessment across 16 indicators. Development of new reporting tools has played a key role in stimulating national-level discussions on improvements to SMC supervisory processes and implementer training and provided a framework for engagement with local stakeholders.

Background: Neglected tropical diseases (NTDs), including soil-transmitted helminths (STHs) and schistosomiasis, continue to impose a heavy burden, especially in sub-Saharan Africa and Uganda, despite being preventable. Integration of NTD management into primary healthcare has been inadequate. While researchers have explored community perspectives, there is a notable gap in understanding the viewpoints of healthcare workers (HCW), which is crucial for effective NTD control strategies. This study explores HCW' perspectives in Eastern Uganda, highlighting challenges in schistosomiasis and STH prevention and management.

Methods: In this qualitative descriptive study, we conducted semistructured interviews with 10 key informants who were HCW in Eastern Uganda with experience in managing STHs and schistosomiasis. Participants were selected purposively and interviewed through Zoom guided by a comprehensive interview guide. The data were transcribed, coded and analyzed thematically.

Results: We identified five key themes regarding the impact and management of NTDs: (i) the burden of NTDs, where schistosomiasis and STHs were notably prevalent among children and communities adjacent to water bodies; (ii) transmission of NTDs, emphasizing water bodies and poor sanitation as primary routes of disease spread; (iii) clinical manifestations of NTDs, detailing the symptomatic presentations that complicate diagnosis and management; (iv) challenges in managing and diagnosing NTDs, highlighting the shortages of essential medications and diagnostic tools, along with the under-prioritization of NTDs within healthcare systems; and (v) fatalities and complications arising from NTDs, reporting on the severe outcomes and under-reporting of deaths associated with NTDs due to misdiagnosis, delayed treatment and traditional healing preferences.

Conclusion: The interviewed Ugandan HCW demonstrated sufficient knowledge of schistosomiasis and STHs, but faced challenges due to inadequate diagnostic tools and medication shortages. The study underscores the need for NTD prioritization with direct funding and government involvement, alongside strategies that integrate continuous medical training, effective community outreach and an enhanced healthcare system response to reduce the burden of NTDs.

Background: India experiences the highest snakebite burden globally, with 58 000 predicted deaths annually. The central Indian state of Madhya Pradesh is thought to have a substantial snakebite burden and provides compensation to families who can demonstrate by postmortem and hospital treatment reports that their relatives have died due to snakebite. This study represents the first report on the frequency of distribution of compensation for snakebite deaths in Madhya Pradesh.

Methods: Statewide snakebite death compensation data from 2020-2021 and 2021-2022, provided by the Madhya Pradesh health authorities, were analysed alongside interviews with 15 families that described the events that ultimately led to their compensation claims.

Results: Compensation was paid to a total of 5728 families, with a total value equating to 22 912 Lakhs (approximately US${$}$27.94 million). Families described commonly recognised snakebite risk factors and behaviours in the events that resulted in their relatives' deaths.

Conclusions: The snakebite burden in Madhya Pradesh is significant, both in terms of mortality and economic expenditure of the state. Sustained investment in preventative interventions, as well as monitoring of the rate of compensation payouts due to snakebite death as a measure of intervention effectiveness, should be considered to substantially reduce snakebite incidence and mortality.

Background: Control interventions recommended by the World Health Organization have successfully resulted in low-intensity schistosomiasis transmission areas. To achieve elimination of transmission, new diagnostic screening tools are needed to overcome less than adequate sensitivity of the currently used Kato-Katz faecal thick smear method. Ideally, in-house serological tests should be avoided due to not having a continuous supply of kits as would be necessary for large population studies. Quality assurance provided by manufacturers and proper performance evaluations are also needed. We evaluated the accuracy of two commercially available serology tests as screening methods for detecting light schistosomiasis infections.

Methods: Serum samples were collected in 2015 from individuals living in a low-endemicity locality in northeastern Brazil and deposited in a biorepository. We evaluated immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) and an immunochromatographic test (ICT). The Helmintex method was used to define true-positive samples.

Results: Overall sensitivity was close to 90% for both the IgG ELISA and ICT, yet specificity was 28% and 18%, respectively. For the IgM ELISA, the values were estimated to be 55% and 43%, respectively.

Conclusions: Poor specificity and positive predictive values prevent these tests from being recommended for screening populations in low-intensity schistosomiasis-endemic areas.

One Health surveillance involves the analysis of human, animal and environmental samples, recognising their interconnectedness in health systems. Such considerations are crucial to investigate the transmission of many pathogens, including drug-resistant bacteria and parasites. The highest rates of antimicrobial resistance (AMR)-associated deaths are observed in sub-Saharan Africa, where concurrently the waterborne parasitic disease schistosomiasis can be highly endemic in both humans and animals. Although there is growing acknowledgment of significant interactions between bacteria and parasites, knowledge of relationships between schistosomes, microbes and AMR remains inadequate. In addition, newly emergent research has revealed the previously underappreciated roles of animals and the environment in both AMR and schistosomiasis transmission. We consider shared environmental drivers and colonisation linkage in this narrative review, with a focus on extended-spectrum beta-lactamase-mediated resistance among bacteria from the Enterobacteriaceae family, which is exceedingly prevalent and responsible for a high burden of AMR-associated deaths. Then we examine novel findings from Malawi, where the landscapes of AMR and schistosomiasis are rapidly evolving, and make comparisons to other geographic areas with similar co-infection epidemiology. We identify several knowledge gaps that could be addressed in future research, including the need to characterise the impact of intestinal schistosomiasis and freshwater contact on intestinal AMR colonisation, before proposing a rationale for connecting AMR surveillance and schistosomiasis research within a One Health framework.

Chagas cardiomyopathy (ChC) presents many biopsychosocial complexities, highlighting the need to have patient self-report questions. This study demonstrates the scope of the use of patient-reported outcome measures (PROMs) in patients with ChC and highlights the main research gaps. This is a scoping review and the search strategy was performed in the Online Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica database (EMBASE), Accumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central, Latin American Literature and Caribbean in Health Sciences (LILACS) and Diagnostic Test Accuracy (DITA). The search identified 4484 studies and 20 studies met the inclusion criteria. The Short-Form of 36 items (SF-36) had potential prognostic value and the ability to identify systolic dysfunction. The Human Activity Profile was able to screen for functional impairment, and the New York Heart Association showed potential prognostic value. The SF-36 and Minnesota Living with Heart Failure Questionnaire were responsive to interventions. The pharmaceutical care affected adherence to treatment as assessed by the Morisky score and also for SF-36. Despite the increased use of PROMs, there are still a large number of gaps in the literature, and further studies using PROMs are needed.

Background: Tuberculosis (TB) remains an important infectious disease and different genotypes have been reported. This study aimed to investigate the genetic diversity and molecular epidemiology of TB in the lower northern region of Thailand, where genotyping data are limited.

Methods: A total of 159 Mycobacterium tuberculosis complex (MTBC) isolates from this region were genotyped by spoligotyping and the major spoligotypes were further subdivided by the mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) method.

Results: Spoligotyping identified 34 types and classified them into 14 clusters. East African-Indian (EAI) groups were the most frequent (44.7%), followed by Beijing (36.5%), with a higher prevalence of drug resistance. By 15-loci MIRU-VNTR typing, the major groups of the Beijing and EAI2_NTB were further differentiated into 44 and 21 subtypes forming 9 and 5 subclusters with cluster rates of 0.26 and 0.44, respectively. The Hunter-Gaston Discriminatory Index among the Beijing and EAI2_NTB groups were 0.987 and 0.931, respectively, indicating high diversity.

Conclusions: This is the first look at the MTBC genotypes in the lower northern region of Thailand, which could aid in understanding the distribution and potential spread of MTBC and Mycobacterium bovis in the target region to support TB control in Thailand.