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

Background: Malaria during pregnancy remains a major public health challenge in endemic regions, contributing to maternal anaemia, low birth weight, and neonatal mortality. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), derived from routine blood counts, have gained attention in infectious disease research. However, their role in pregnancy-associated malaria is poorly understood.

Methods: We investigated the behaviour and relevance of NLR and MLR in 270 third-trimester pregnant women attending antenatal care in two health centres in Nanoro District, Burkina Faso. Malaria was diagnosed using light microscopy and rapid diagnostic tests. Haematological parameters were analysed using a Sysmex XN350 analyser. Associations between NLR/MLR and malaria status or parasitaemia were assessed via receiver operating characteristic (ROC) analysis and logistic regression.

Results: MLR was significantly higher in malaria-infected women (0.48 vs 0.40; p=0.021), while NLR was elevated in those with high parasitaemia (3.06 vs 2.55; p=0.029). MLR yielded ROC values of 0.60 for infection and 0.61 for parasitaemia. MLR independently predicted malaria (OR=4.19) and high parasitaemia (OR=7.16), although diagnostic performance was modest.

Conclusions: MLR and NLR may serve as supportive markers for malaria in pregnancy. Their integration into antenatal care could aid early risk stratification in resource-limited, malaria-endemic settings. Further validation is needed.

Background: Snakebite envenoming is one of the world's devastating yet underrecognized public health emergencies. Despite the long-standing awareness of its deadly toll, detailed analytical data on factors associated with snakebite mortality remain scarce, particularly in sub-Saharan Africa.

Methods: We conducted a retrospective 1:1 matched case-control study without replacement at the Snakebite Treatment and Research Hospital (SBTRH). We included all mortalities between January 2019 and December 2024 and paired patients who survived, matched on age, month of presentation and state of origin. Patient characteristics were compared between cases (deaths) and controls (survivors) to determine which factors contributed to patient survival.

Results: Between January 2019 and December 2024, there were 226 snakebite fatalities at the SBTRH with matched controls. The median age was 24 y (interquartile range 14-40) and most patients were male (n=308 [68%]). Multivariable conditional regression analyses revealed predisposed hypertension (odds ratio [OR] 3.61 [95% confidence interval {CI} 1.33 to 9.77]), taking ≥48 h to arrive at the hospital (OR 2.31 [95% CI 1.41 to 3.77]) and haematological symptoms (OR 2.39 [95% CI 1.44 to 3.97]) as factors increasing the likelihood of mortality.

Conclusions: These findings support clinical emphasis on screening for comorbidities and timely intervention. Accordingly, healthcare workers should prioritize intensive symptom monitoring during the initial admission period and policymakers should focus on strengthening referral systems in endemic areas.

Background: Long-lasting insecticidal nets (LLINs) are essential for malaria control, but their effectiveness is threatened by increasing resistance of Anopheles to pyrethroids. In 2021, Côte d'Ivoire distributed both standard and new-generation LLINs during its mass distribution campaign. This study assessed the physical integrity and residual efficacy of these nets 3 y after their distribution.

Methods: A cross-sectional survey was conducted in 10 health districts chosen for ecological diversity. A total of 570 LLINs were withdrawn from randomly selected households and evaluated through WHO cone bioassays using both the susceptible Anopheles gambiae strain, Kisumu, and a local pyrethroid-resistant strain from Tiassalé. Multivariate analysis was performed to explore factors influencing mosquito mortality.

Results: LLIN coverage remained high (2.49 nets per household; 86.6% usage). However, 58.25% of LLINs had at least one hole, especially among standard LLINs in the North. While full efficacy was retained against the Kisumu strain, mortality dropped to 50% against the resistant strain. New-generation LLINs were more effective in the North, whereas standard LLINs were more effective in the South.

Conclusion: These findings underscore the importance of adapting LLIN distribution strategies to local resistance profiles and maintaining regular monitoring to ensure sustained protection and guide vector control policies.

Background: The immune response of people living with HIV (PLHIV) coinfected with intestinal and/or blood helminths is still understudied in Gabon. The aim of this study was to compare IgE levels between HIV-positive and HIV-negative people depending on parasite carriage.

Methods: Samples from PLHIV and HIV-negative individuals, carriers or not of intestinal parasites and/or microfilariae and/or Plasmodium falciparum, were used as the study materials. The total IgE assay was performed using the VIDAS PC.

Results: Samples from 152 participants were included in the study, 91 HIV-positive and 61 HIV-negative. Overall, 13.1% (n=20/152) of the samples were infected with soil-transmitted helminths (STH), 29.0% (n=44/152) with intestinal protozoa, 18.4% (n=28/152) with P. falciparum and 36.8% (n=56/152) by blood microfilariae. Median total IgE tended to be higher in HIV-negative participants compared with PLHIV (1287.0 kUI/L; IQR 379.2-3975.2 kUI/L vs 660.3 kUI/L; IQR 236.9-3445.7 kUI/L) (p=0.07). Carriers of STH had higher IgE levels than the other groups (p=0.02). There was a positive correlation between malaria parasitaemia, age and IgE levels in the HIV-negative group (rho=0.283; p=0.0008 and rho=0.5; p=0.0003, respectively).

Conclusions: This study showed that PLHIV had lower IgE levels than HIV-negative people. Mansonella perstans and STH were associated with elevated IgE values, requiring further studies to better understand their immunomodulatory potential.

Leprosy, podoconiosis and lymphatic filariasis (LF) cause impairment and disability affecting family quality of life (FQoL). The purpose of this study was to assess and compare FQoL and associated factors in people in Ethiopia with disabilities caused by leprosy, FL or podoconiosis and their family members. A cross-sectional study was conducted in the East and West Gojjam Zones of Ethiopia. Study participants with visible disabilities were selected by simple random sampling; however, family members were selected purposively. Data were collected using the FQoL, SARI, PHQ-9 and Participation Scale. Descriptive statistics and linear regression were used to analyse the data. These findings are based on baseline data collected before the intervention phase of a randomized controlled trial. A total of 416 people with disabilities and 416 family members participated in the study. The overall mean FQoL score for both groups was 75.4. Among people with disabilities, FQoL was significantly associated with increasing age (β=0.045, p<0.001), disease type (leprosy, β=0.561, p<0.029), stigma (β=-0.274, p<0.001) and participation restriction (β=-0.740, p<0.001). For family members, disease type (leprosy, β=3.910, p<0.001), student or unpaid work (β=3.640, p<0.001), marital status (single, β=1.803, p<0.033) and residence (rural, β=3.160, p<0.002) showed a significant association with FQoL. To improve FQoL, a targeted family-based care package should address challenges related to age, disease type, stigma and participation restrictions of people with disabilities as well as the sociodemographic factors affecting their family members.

Background: Pre-implementation activities have been shown to modify planned implementation strategies by uncovering new insights, refining understanding and addressing stakeholders' concerns. This study aimed to determine the pre-implementation context for the integration of mental health screening and guided referral in the care of persons with noma and their caregivers.

Methods: This was a qualitative study utilizing a focus group discussion (FGD) of implementation deliverers (i.e. nurses, social workers, a dentist and a clinical psychologist) and semi-structured interviews of top management officials in the study setting. Both inductive and deductive approaches were utilized to extract transcribed discussions. These were subsequently mapped into the Consolidated Framework for Implementation Research.

Results: The pre-implementation discussions with the stakeholders informed the modification of two earlier planned implementation strategies, namely the time for screening and the place to refer those who screened positive. Screening for common mental disorders among patients with Noma and their caregivers was acceptable to the implementers. Key barriers recognized were the culture of stigma, particularly with regard to mental illness, and perceived increased workload, while enablers include well-developed infrastructure, top management buy-in and implementation team readiness.

Conclusions: Our findings show that implementing screening and referral for mental disorders in noma care is acceptable. The modification of the planned implementation strategies buttressed the usefulness of co-designing with relevant stakeholders for successful implementation.

Background: Tuberculosis (TB) remains a major public health challenge in Brazil, characterised by marked regional heterogeneity. This study aimed to analyse the temporal dynamics of TB in a state of northeast Brazil.

Methods: This was an ecological time-series study using official TB surveillance data on newly reported TB cases from 2010 to 2024. Age-standardised incidence rates (ASIRs) were analysed through seasonal-trend decomposition by Loess (STL) and Joinpoint regression models. Furthermore, the rates were decomposed to quantify the contributions of population ageing, population growth and epidemiological changes.

Results: A total of 10 690 TB cases were reported. Time-series analysis revealed consistent seasonality, with peaks occurring in March-May and October-November. The ASIR declined from 25.8 per 100 000 in 2010 to 22.6 in 2024 (average annual percentage change -1.51 [95% confidence interval -2.50 to -0.38). The decline was most pronounced among women and individuals ages 50-79 y, whereas incidence increased among younger age groups. Decomposition analysis indicated that epidemiological improvements offset demographic effects until 2015. However, from 2023 onwards, population ageing and growth became the predominant drivers, leading to a net increase in incidence.

Conclusions: Although TB incidence declined overall, recent resurgence highlights the growing impact of demographic dynamics and persistent regional disparities.

Background: Secondary dengue infection (SDI), often associated with increased disease severity, remains a diagnostic and public health challenge in endemic regions. This study evaluates the use of combined IgG and PCR testing in identifying SDI cases and explores the demographic, geographic and clinical characteristics of SDI in Saudi Arabia.

Methods: A total of 2850 patient samples were collected from six regions in Saudi Arabia, from January 2022 to March 2024. Laboratory testing included NS1 antigen detection, IgM and IgG ELISA and RT-PCR for viral RNA. SDI was defined as IgG+/PCR+ based on the WHO criteria.

Results: Of 1448 PCR-confirmed dengue cases, 493 (34%) were classified as SDIs. The highest proportions of SDIs were observed in Asir (71.4%), Jazan (60.0%) and Makkah (50.4%), with Makkah contributing the largest number of SDI cases overall (243/482). The highest burden was observed in males and individuals aged 21-40 y. Four deaths occurred among IgG+ patients with comorbidities.

Conclusions: Combined IgG and PCR profiling enhances the early identification of SDIs. Regional clustering and age-related patterns also underscore the need for targeted clinical monitoring and public health interventions.

Background: Eosinophilia is an important marker of helminthic infection. This study evaluated the seroprevalence of Toxocara spp., Strongyloides stercoralis, and Fasciola spp. among eosinophilic patients in Khuzestan, southwestern Iran.

Methods: From 2022 to 2024, 482 individuals (aged ≥5 y) with eosinophilia (>500 cells/µl) were recruited. Serum samples tested by ELISA for IgG antibodies against Toxocara spp., S. stercoralis, and Fasciola spp.

Results: Seroprevalence of S. stercoralis was 34.5% (166/482; 95% CI 30.338.9), whereas seropositivity for Toxocara spp. was low (0.8%; 4/482), and no Fasciola spp. infections were detected (0.0%; 0/482). Strongyloidiasis was most frequent among patients aged >60 y (59.4%, 129/217; p<0.001) and was strongly associated with illiteracy (60.5%, 78/129; vs. 17.5%, 22/126 in educated individuals; p<0.001), agricultural or maritime occupations (59.4%, 41/69; in farmers; 59.5%, 25/42; in sailors; p<0.001), history of soil exposure (58.9%, 103/175; vs. 22.6%, 37/164 in unexposed individuals), and metabolic disorders (64.9%, 37/57). Seropositive patients showed significantly higher absolute (1,473 vs. 1,182 cells/µl) and relative eosinophil counts (18.97% vs. 15.04%).

Conclusions: The results highlight S. stercoralis as the predominant helminth cause of eosinophilia, attributable to the adult cohort and regional ecological and sociocultural factors. The strong associations with age, occupation, and soil contact delineate high-risk groups. Routine serological screening for S. stercoralis is recommended in endemic areas, particularly before immunosuppressive therapy, to prevent sever complications.