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

Background: The World Health Organization re-established snakebite as a neglected tropical disease in 2017. An overview is provided on snakebite financial assistance in relation to the policy landscape change.

Methods: The Organisation for Economic Co-operation and Development Creditor Reporting System database was searched and 184 results obtained from 1999 to 2022 underwent simple Excel analysis.

Results: Contributions increased from $0.05 million in 1999 to a peak of $100.8 million in 2020. Most assistance was directed towards treatment research.

Conclusions: Contributions increased since snakebite was reprioritised by global health stakeholders, aligning with policy landscape changes. Financial reprioritisation of strategic priorities beyond treatment research may be required for established goals to be met.

Background: Snakebite affects 5.4 million people annually, causing up to 2.7 million envenoming cases and 137 880 deaths. Its rise has been linked to flooding. This study examines the distribution, trends and incidence of snakebite cases in the Volta Region and identifies snakebite outbreaks in flood-affected districts.

Methods: We undertook a descriptive secondary data analysis of 2018-2023 snakebite cases from the District Health Information and Management Systems II database for the Volta Region. Cumulative Sum was used to identify missed outbreaks. The results are presented in tables, graphs and maps.

Results: A total of 1637 snakebite cases were reported across the 6-y study period, with an overall incidence rate of 15.8 cases per 100 000 population and a case fatality rate of 0.4% (7/1637). Case patients aged 20-34 y were the most affected (26.7%; 437/1637). Most of the cases peaked in March during the rainy season. The incidence of snakebites decreased from 18 cases per 100 000 population in 2018 to 15.8 cases per 100 000 population in 2023. Each of the flood-affected districts reported snakebite outbreaks before the flooding event. No new outbreaks were detected during or after the floods as of December 2023.

Conclusions: While snakebite incidence has decreased overall in the Volta Region, the burden remains alarmingly high in Ketu North. Young adults are particularly vulnerable. Urgent efforts are needed to enhance education, emphasising the importance of protective attire during the wet season for community safety.

Background: In this study we examine the feeding efficiency of copepods locally found in Guatemala on first instar Aedes aegypti larvae. Copepods are a potential tool for Aedes vector control that has shown promising results in the laboratory and in community-based field trials.

Methods: Four different copepod species from different habitat types were included in the laboratory assays of this study.

Results: All four tested copepod species decreased the number of the first instar Aedes larvae that were inserted into the glass vessels compared with controls. However, average predation rates between the tested species were highly different, with Thermocyclops crassus and Mesocyclops longisetus achieving the highest, with 31.0% (standard deviation [SD] 18.9) and 28. 9% (SD 11.2), respectively.

Conclusions: The copepod species with identified high predation rates are potential candidates for planned and other future field trials for community-based Aedes vector control with copepods in the region.

Background: Snakebite envenomation is a global public health concern, especially in tropical and subtropical regions. We describe the demography, presentations, treatments and outcomes of snakebites from a community snakebite treatment centre in Nepal.

Methods: This was a retrospective study of snakebite cases from 2008 to 2021 presenting in a community-based treatment centre in eastern Nepal. The data were collected from predesigned forms in the centre.

Results: The median age of the victims (N=13 825) was 29 y (interquartile range 18-43) predominantly comprising farmers (39.5%). Cobras (Naja spp.) were the predominant species. Self-treatment practices like the application of tourniquets are common (74.5%) and antivenom was infused to 3.3% of victims. Motorcycles (57.9%) were the primary mode of transport, significantly reducing the time to reach healthcare centres compared with other means (p<0.001). The majority of patients visiting the community snakebite centre exhibited improvement (98.4%), with a low referral rate (0.6%) and case fatality rate (1.26%).

Conclusions: Snakebites are a common problem in rural Nepal. Neurotoxic envenomation, inflicted by the common cobra, predominates in this area. This community-based snakebite treatment centre, managed by paramedics, exemplifies the successful outcome of snakebite management in Nepal.

Background: There is a dearth of information regarding mpox risk perception and vaccine acceptance among people living with human immunodeficiency virus (HIV), especially in countries with a dual burden of HIV and mpox, such as Nigeria.

Methods: We used an explanatory mixed methods design and structured questionnaires administered to a clinic-based sample of people living with HIV (n=430), followed by in-depth interviews with a purposive subsample (n=20). Data were analysed using binary logistic regression and the framework approach.

Results: More than one-third (38.1% [n=164]) of the respondents self-perceived a high risk of mpox and 64.4% (n=277) indicated a willingness to receive the vaccine. Willingness to accept the mpox vaccine was positively associated with male sex, older age, non-Muslim faith, unmarried status, post-secondary education and current civil service employment. The odds of accepting the mpox vaccine was also higher among respondents who perceived mpox as a serious disease (adjusted odds ratio [aOR] 1.41 [95% confidence interval {CI} 1.12 to 2.35]), self-assessed a higher risk (aOR 1.66 [95% CI 1.19 to 3.06]) and were concerned about contracting the disease (aOR 1.78 [95% CI 1.12 to 3.94]). Reasons for hesitancy included anxiety about vaccine-antiretroviral drug interactions, low risk perception, perceived protection from antiretroviral treatment, the newness of the vaccine, mistrust of authorities and pharmaceutical companies and concerns regarding vaccine safety.

Conclusions: Mpox risk perception and vaccine acceptance were suboptimal. Vaccine acceptance was influenced by sociodemographic, perceived susceptibility and health behaviour-related factors. Targeted risk communication will enhance acceptance of mpox vaccination among people living with HIV in Nigeria.

Background: This study aimed to evaluate mass drug administration (MDA) coverage for lymphatic filariasis (LF) in selected endemic districts of Jharkhand, India, and to identify household-level determinants of drug consumption.

Methods: A cross-sectional coverage evaluation survey was conducted in the Deoghar, Giridih and Godda districts of Jharkhand in 2023 within 6 wk of the completion of the MDA campaign. The survey included 9039 individuals from 1680 households across 56 randomly selected clusters (three urban, eight tribal and 45 rural).

Results: Approximately 78.5% of households reported that at least one member consumed MDA drugs, with 54.5% reaching 'complete epidemiological drug coverage'. Factors positively associated with achieving 'complete epidemiological drug coverage' included higher education levels (adjusted OR [AOR] 1.02), awareness of LF (AOR 2.32), prior communication about MDA (AOR 1.38) and previous MDA participation (AOR 4.42). By contrast, larger family sizes were associated with a lower likelihood of achieving complete coverage (AOR 0.78). Adverse events were experienced by 14.9% of participants, primarily when MDA drugs were consumed on an empty stomach. Key reasons for non-compliance included perceived absence of disease (25.5%), fear of side effects (22.4%) and absence during the campaign (20.9%).

Conclusions: MDA coverage was suboptimal, with only one-half of households achieving 'complete epidemiological drug coverage'. Enhancing MDA coverage and compliance requires intensified Information, Education, and Communication efforts, especially among marginalized communities, both during campaigns and all year round.

Background: Cognition, behaviours and social environment are associated with Clonorchis sinensis infection, a prevalent liver fluke disease in China. This study aimed to use social cognitive theory (SCT) to investigate these three aspects and their interaction in an endemic area.

Methods: We conducted three semi-structured focus group discussions in Da'ao town, Jiangmen city, Guangdong Province, China. Thematic analysis was used to extract themes.

Results: Twenty-four people were interviewed. The participants exhibited inadequate knowledge about C. sinensis infection and were unaware of the health risks. Although some have reduced their consumption of raw fish, some continue to consume it frequently. Compared with stopping eating raw fish, receiving tests and taking medicines were easier behaviours to adopt. Guided by the SCT, we considered the reciprocal determinism between people and the social environment as the basis of the persistent raw fish consumption behaviour. While the social environment could influence the cognition and behaviours of people, people also can reshape the social environment. Based on the reciprocal determinism, we proposed an integrated intervention framework.

Conclusions: Our study unveiled a reciprocal determinism between the cognition, behaviours and social environment related to C. sinensis infection in high-endemic areas of China, providing insights for establishing control strategies.

Background: Marburg virus disease (MVD) is categorized among viral hemorrhagic fevers. MVD is associated with high rates of morbidity and mortality. This study aimed to identify factors affecting MVD knowledge, attitudes and practices in sub-Saharan African countries.

Methods: Using a validated questionnaire, a cross-sectional survey was conducted from 21 April to 23 May 2023 in eight English-speaking sub-Saharan African countries (Ethiopia, Ghana, Kenya, Lesotho, Nigeria, Senegal, South Africa and Tanzania).

Results: Of 3142 participants, 51% were males, 66.0% were aged 18-29 y, 74.4% were living in urban areas, 47.9% completed their university education and 21.7% were healthcare workers (HCWs). Tanzanians had the highest good knowledge (89%), while Kenyans had the lowest (26%). Tanzanians had the highest positive attitude (82%), while Nigerians had the highest negative attitude (95%). The best practices exhibited were by Ethiopians (70%), and the poorest practices exhibited were by Ghanaians (94%). The predictors of good knowledge were marital status (adjusted OR [aOR]=0.75; 95% CI 0.59 to 0.94; p=0.013), knowing the correct mode of transmission (aOR=18.31; 95% CI 13.31 to 25.66; p<0.001), whether the participant has heard before about MVD (aOR=2.24; 95% CI 1.82 to 2.75; p<0.001), whether they modified their working habits (aOR=2.79; 95% CI 2.12 to 3.67; p<0.001), nationality (p<0.001) and being a HCW (aOR=2.71; 95% CI 2.01 to 3.67; p<0.001). The predictors of good attitude were being female (aOR=0.71; 95% CI 0.60 to 0.85; p<0.001), age (aOR=0.99; 95% CI 0.98 to 0.99; p=0.01), place of residence (aOR=3.13; 95% CI 2.46 to 3.99; p<0.001), level of education (aOR=1.67; 95% CI 1.37 to 2.04; p<0.001), knowing the correct mode of transmission (aOR=1.59; 95% CI 1.28 to 1.98; p<0.001), modification of working habits (aOR=1.30; 95% CI 1.01 to 1.68; p=0.039) and nationality (p<0.001). The predictors of practice were being female (aOR=1.17; 95% CI 1.01 to 1.37; p=0.042), place of residence (aOR=1.23; 95% CI 1.02 to 1.48; p=0.033), marital status (aOR=0.65; 95% CI 0.55 to 0.78; p<0.001), knowing the correct mode of transmission (aOR=0.46; 95% CI 0.38 to 0.56; p<0.001), modification of working habits (aOR=0.40; 95% CI 0.32 to 0.49; p<0.001) and occupation (aOR=0.37; 95% CI 0.30 to 0.46; p<0.001).

Conclusions: Different modifiable and non-modifiable risk factors can be targeted to improve population perspectives towards MVD.

Tanzania has the highest age-adjusted prevalence of diabetes in sub-Saharan Africa. Diabetic retinopathy, a common complication, is a significant cause of vision loss; but with effective screening and treatment this often can be prevented. However, with very few specialist eye care staff in Tanzania this is a major challenge. Artificial intelligence (AI) systems, which automate clinical decision making and therefore task-shift away from specialist staff, could contribute to improved diabetic retinopathy screening services in low-resource settings. This article describes our experiences of selecting, procuring and implementing an AI system into a regional diabetic eye screening programme in northern Tanzania.

Dengue is a vector-borne infection, which contributes to significant morbidity and mortality in endemic areas. It manifests rapidly within 2 wk from febrile, critical to recovery phase. The point-of-care test (POCT) comprises the non-structural protein 1 (NS1) antigen, IgM and IgG, which aids rapid diagnosis, leading to timely treatment. Despite the high specificity of various POCTs, a few false-positive NS1 cases have been reported. We report the first case of false-positive NS1 antigen in pregnancy. A 24-y-old female in her second trimester of pregnancy presented with fever and chills for 9 d and a non-productive cough for 3 d. The dengue POCT showed NS1 antigen positive, IgM and IgG negative. Her symptoms were resolved with treatment of urinary tract infection with cefuroxime. Urine culture subsequently yielded Escherichia coli. Her recovery and delivery were uneventful. Her NS1 antigen was persistently positive for 18 d. The confirmatory real time-PCR for dengue and pan-Flaviviruses was negative.