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

Background: About 32 million pregnant women are at the risk of malaria infection yearly in malaria-endemic sub-Saharan Africa. To mitigate the risks associated with malaria in pregnancy, the WHO recommends ≥3 doses of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP), covering from the second trimester of pregnancy until delivery.

Methods: This cross-sectional study assessed the uptake and extent of adherence with IPTp-SP among pregnant women in Osun State, Nigeria, from October 2020 to March 2021. Assessment of the uptake was done by extracting information from the validated case report forms. Venous blood samples were obtained to assess the levels of sulphadoxine in plasma through HPLC-UV.

Results: In total, 49.24%, 38.17% and 12.58% of the study participants obtained 1, 2 and ≥3 doses of IPTp-SP, respectively. In assessing the extent of adherence, 46.67% obtained their last dose within 28 d before sample collection. Uptake of IPTp-SP is not associated with gravidity (p=0.603), but is weakly associated with the age of the study participants (p=0.04). The median (IQR) plasma sulphadoxine concentration was 10.6248 (2.8124-27.1242) ug/mL.

Conclusions: Utilisation of the intervention is still very low and adherence appears to be inadequate among the study population, suggesting that more advocacy on the IPTp-SP strategy and the implementation of directly observed therapy is necessary.

Background: Snakebite is one of the neglected tropical diseases in Uganda affecting rural areas, especially during the rainy season. Households mainly rely on traditional remedies for management, which are not always effective, leading to disability and sometimes death. We explored the knowledge, perceptions and healthcare practices related to snakebites in Kamuli District.

Methods: We used the participatory research appraisal (PRA) method to conduct the study. Six PRA sessions were carried out in five purposively selected villages of Wankole subcounty, Kamuli District, as they reported a high number of snakebites. In addition, we conducted 15 in-depth interviews with current and past snakebite victims and 10 key informant interviews with professional healthcare providers and traditional healers. Audio files were transcribed and translated verbatim and data were analysed to identify themes. Analysis was conducted using ATLAS.ti version 8.0.

Results: Overall, the community considered snakebites a big problem that worsens during rainy seasons. Knowledge of snakebite management was inadequate. Perceptions about snakes and snakebites included snakes are related to traditions, ancestral spirits and witchcraft. Practices following snakebites included applying a tourniquet and the use of herbs, paraffin and a 500-shilling coin. Snakebites were associated with out-of-pocket expenditures and limited capacity to manage.

Conclusions: The study calls for policy changes to improve snakebite management in Eastern Uganda, highlighting gaps in knowledge and harmful practices. It emphasizes the need for health education and financial support for affected households. Collaboration between healthcare providers, traditional healers and the community is crucial for effective prevention and management.

Snakebite is a neglected public health problem in tropical countries. Snakebite envenomation-associated acute kidney injury (SBE-AKI) is a major complication accounting for significant morbidity and mortality. The pathogenesis of SBE-AKI may be multifactorial, including prerenal AKI secondary to hemodynamic alterations, intrinsic renal injury, immune-related mechanisms, venom-induced consumptive coagulopathy and capillary leak syndrome. Epidemiological factors include snake species, duration and severity of snakebite, traditional healers and native medication and accessibility to modern healthcare and antisnake venom. Renal histopathology observed consist of acute tubular necrosis, interstitial nephritis, cortical necrosis, disseminated intravascular coagulation, rhabdomyolysis and thrombotic microangiopathy. Glomerular involvement is rare. Proteinuria can be present rarely, hematuria is more common, most often due to venom-induced coagulopathy or hemolysis; it is only rarely due to renal injury. Management includes supportive care and renal replacement therapy when indicated. Progression to chronic kidney disease remains one of the biggest concerns of SBE-AKI. Hence the role and timing of renal biopsy remain controversial, given the risk involved and the benefit obtained in cases of interstitial nephritis. Various biomarkers, including cystatin C, neutrophil gelatinase-associated lipocalin, clusterin and beta-2-glycoprotein, have shown a tendency to predict AKI and also predict progression to chronic kidney disease.

Background: The WHO states that antivenom is the only safe and effective treatment to neutralize snake venom. Snakebite antivenom typically involves horse hyperimmunization with crude venom and Freund's adjuvant.

Methods: In the current work, we analyzed the ascorbyl palmitate liquid crystal structure with snake protein or PLA2, the carrier charge capacity, and we evaluated the immune response induced by the enzyme P9a(Cdt-PLA2) formulated in a nanostructure using CpG-ODN, determining the titer of IgG antibodies. BALB/c mice were subcutaneously immunized on days 0, 15 and 30 with P9a(Cdt-PLA2)/CpG-ODN/Coa-ASC16 or P9a(Cdt-PLA2)/Freund's adjuvant (complete first and incomplete-booster). On day 48 the mice were sacrificed. The neutralization ability of antibodies from animals immunized with P9a(Cdt-PLA2)/CpG-ODN/Coa-ASC16 or P9a(Cdt-PLA2)/Freund's adjuvant was tested against PLA2 activity and venom lethality.

Results: In both groups of immunized mice, the antibody titers in blood samples at the assayed time were high (approximately 1×105). The antibodies were able to neutralize P9a(Cdt-PLA2) activity in vitro and lethality in vivo. Microscopic analysis showed that P9a(Cdt-PLA2)/CpG-ODN/Coa-ASC16 produces minimal damage at injection sites compared with Freund's adjuvant.

Conclusion: The Coa-ASC16/CpG-ODN formulation shows promise as a safe and effective adjuvant against crotalic PLA2, inducing a strong humoral response and reducing local tissue damage compared with Freund's adjuvant.

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.