Tropical Medicine and Health最新文献

Hepatitis B virus (HBV) poses a major occupational risk for healthcare workers (HCWs) in sub-Saharan Africa (SSA), where endemicity and resource limitations hinder effective prevention. Mandatory Hepatitis B vaccination (HepB) policies for HCWs are critical to addressing vaccination gaps, yet their implementation is challenged by dosing inconsistencies, lack of post-vaccination immunity testing, and ethical considerations. In many countries in SSA, adults are given a four-dose pediatric formulation of the vaccine due to limited access to adult formulations that require fewer doses, creating logistical challenges and increasing the risk of incomplete immunization. In addition, the absence of routine post-vaccination immunity testing undermines efforts to ensure adequate protection, leaving vaccinated HCWs potentially vulnerable to HBV infection. Ethical issues, including inadequate informed consent, out-of-pocket vaccination costs, and inequities in access, further complicate mandatory vaccination programs. Addressing these barriers requires a multi-sectoral approach, including increased access to adult formulations of vaccines, integration of immunity testing into vaccination protocols, subsidized vaccine costs, and culturally tailored education campaigns. These strategies are essential for ensuring that vaccination policies are effective, equitable, and ethical. Protecting HCWs against HBV not only safeguards their health but also strengthens healthcare systems and public health outcomes in SSA.

Background: Women living with genital fistula often endure prolonged suffering and face multiple barriers to accessing treatment. Bangladesh's government has enhanced referral mechanisms, enabling case detection in communities and facilitating surgical interventions at medical college hospitals through nationwide initiatives. However, research on barriers and facilitators for fistula treatment in Bangladesh remains limited. Detailed insights into treatment-seeking paths with time sequences are scarce. This study aimed to explore facilitators and barriers to completing fistula treatment with the description of treatment-seeking paths. This study is important to assist with future policy and program strategies for fistula treatment.

Methods: A facility-based qualitative study was conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh. Data were collected from February to May 2024 through 18 in-depth interviews (IDIs) with in-patients, five IDIs with families, and 11 key informant interviews with health service providers. Participants' treatment-seeking paths were described chronologically and identified patterns of treatment-seeking paths. Thematic analysis, guided by the Partners for Applied Social Sciences model for health-seeking behavior and access to care, was used to analyze case histories.

Results: The average duration of treatment-seeking by the women was 39 months, with a maximum of 22 years. Women with fistula often sought care at multiple facilities (up to eight), suspended treatment, and encountered systemic obstacles that delayed treatment. Key barriers included scarce information on illness and treatment in the community, less decision-making power, failure of medical communication, and systemic failures in cost, treatment, and referral systems. Facilitators that motivated women to complete treatment included informal peer support through shared treatment experiences and emotional, physical, and financial support.

Conclusions: Analysis of treatment-seeking paths revealed the absence of standardized treatment routes for women with fistula. To ensure effective care, raising societal awareness about fistula, improving treatment and referral systems, enhancing medical communication, and providing peer and emotional support are strongly recommended.

Background: About 90% of blind children come from low- and middle-income countries. The main cause of childhood blindness is cataract. Cataract surgery can improve vision, but regular follow-up is necessary. Low attendance at follow-up is a medical and statistical challenge, as missing information can lead to biased results. Two research questions arise: what social factors influence attendance at first follow-up? What social factors influence a poor outcome of visual acuity at first follow-up?

Methods: An observational cohort study was conducted, and the total base population was analysed. The study includes children who received cataract surgery at Saint Joseph Hospital (Kinshasa, Democratic Republic of the Congo) from 2001 to 2021. Cox regression was used to examine attendance at the first follow-up (n = 1100 operated eyes), ordinal logistic regression to analyse visual acuity at the first follow-up (n = 699 operated eyes), both clustered by patient identification number. Due to the high number of missing values, multiple imputation was performed as a sensitivity analysis.

Results: Female sex, young age, very good visual acuity after surgery, and disease in both eyes led to lower attendance at follow-up. Poor visual acuity outcome at follow-up was associated with female sex, young age, poor financial situation, blindness after surgery and nystagmus.

Conclusions: As regular follow-up is crucial for an improved visual acuity outcome, it is recommended that special attention needs to be paid to the groups identified in our analysis to better integrate them into follow-up. In particular, the higher risk of poor outcome in younger children is surprising and requires further analysis.

The Monkeypox virus (MPXV), which causes Monkeypox (Mpox) is an invasive ailment with global implications. MPXV, categorized within the Orthopoxvirus genus, exhibits diverse clades with varying fatality rates. Initially discovered in monkeys and later in humans, the disease predominantly affects regions across West and Central Africa. Clinical manifestations encompass a spectrum from mild flu-like symptoms to severe eruptions. This article aims to give the scientific community a comprehensive overview of Mpox Pathophysiology and delve into the intricate landscape of host immune responses against MPXV infection. It offers crucial insights into the virus's Pathophysiology, spanning its entry, replication, dissemination, and elicited host responses. The immune reaction to Mpox involves innate immunity, B-cell immunity, and T-cell immunity. Moreover, this review underscores the immunological response and resistance mechanisms against MPXV. It also highlights imperative research areas warranting prioritization to devise more efficacious treatments for controlling viral propagation within healthcare systems. In addition, it gives us a look into possible futures that could help the progress of immunotherapies and cutting-edge biotechnological solutions for protecting against MPXV.

Background: The Direct Fluorescent Antibody Test (DFAT), the standard rabies confirmatory test, is less sensitive when used with decomposed brain samples, a frequent issue in rabies-endemic regions. This study evaluates the diagnostic accuracy of the ADTEC lateral flow device (LFD) for rabies post-mortem diagnosis using decomposed brain samples.

Methods: We used 34 animal heads submitted with a cold chain to an animal diagnostic laboratory located in central Philippines including 26 DFAT-positive and eight DFAT-negative samples. After defrosting the heads, the entire brain was extracted and left at room temperature to induce decomposition. The decomposition status was scored after 1 day, 3 days, and 4 days at room temperature. DFAT and LFD were performed using the brain samples at each timepoint to evaluate the diagnostic accuracy. The day of animal head submission to the laboratory was defined as day 0, and the DFAT results were used as the reference. Image analysis was performed to measure the intensity of the LFD-positive bands.

Results: The decomposition scores dropped by day 3 and day 4, with all samples exhibiting signs of advanced decomposition. The sensitivity of DFAT was 96.2% (95% confidence interval 80.4-99.9) on day 1, but dropped to 61.5% (P < 0.01) by day 3 and further decreased to 38.5% (20.2-59.4) by day 4. In contrast, the sensitivities and specificities of LFD on day 1, day 3, and day 4 were consistently 100% (86.3-100) and 100% (63.1-100), respectively. Visual examination of the test band intensity on the LFD suggested that the intensity of the positive bands increased as decomposition progressed.

Conclusions: ADTEC LFDs demonstrated consistently high sensitivity and specificity with decomposed brain samples observed up to day 4, making them a reliable screening tool for rabies post-mortem diagnosis in decomposed brain samples, particularly in resource-limited settings. Furthermore, LFD positive bands became more distinct as decomposition advanced.

Background: Female genital schistosomiasis (FGS) is the outcome of the deposition of Schistosoma haematobium egg in the ovaries, fallopian tubes, uterus or cervix of women in schistosomiasis endemic areas. Chronic and untreated FGS can result in an increased risk of human immunodeficiency virus (HIV) acquisition and infertility. This study aimed to evaluate the burden of visual FGS among women with infertility in the Volta region of Ghana.

Methods: This study was a comparative cross-sectional study involving women with infertility defined as women with inability to achieve pregnancy after 12 months or more of frequent (3-4 times a week) unprotected sexual intercourse and nursing mothers (fertile women) from selected districts in the Volta Region. Questionnaire administration was used to obtain sociodemographic information including recent and childhood contact with water bodies as well as the practice of open defecation and clinical information such as the presence of genital symptoms. Urine samples were collected for detection of eggs of S. haematobium, and the women's lower genital tracts were examined using a handheld colposcope by two gynecologists and a third to resolve discrepancies. Data were analyzed using SPSS version 23 with frequency distribution done for the sociodemographic variables and the prevalence of FGS in the women. Pearson Chi-square analysis was performed to find any significant difference between the prevalence of FGS among infertile and fertile women and any significant association between any socioeconomic and clinical variables with FGS. Logistics regression analysis was performed to investigate sociodemographic and other risk factors for FGS among women.

Results: Of the 265 sampled women 132 (49.8%) were infertile and 133 (50.2%) were nursing mothers (fertile women). More women had visual FGS (155, 58.5%) and most with FGS were fertile [96, 76.1%; infertile, 59(45.3%); p < 0.001], with infertile women having lower odds of FGS in this study (AOR, 0.29 [95% CI 0.17-0.50]; p < 0.001); adjusted for childhood and current contact with rivers and streams, availability of toilets facility, practice of open defecation and age. More women with FGS had childhood contact with rivers and streams (68.4%, p = 0.007) with lower odds of FGS seen in women without childhood contact with rivers and streams (AOR, 0.52 [95% CI 0.31-0.88]; p = 0.015).

Conclusion: In this study, infertile women unexpectedly had lower odds of FGS suggesting the need for more rigorous research on this topic to elucidate the true contribution of FGS on infertility.

Background: This study aimed to discuss the method for designing a community project, especially in a resource-limited setting, using a health needs assessment tool, the Community Health Issues Interview Sheet, for the design of a project in the initial phase.

Methods: The Community Health Issues Interview Sheet was developed; this tool applied more than four field and modified based on feedback from researchers and stakeholders.

Results: When researchers from outside a target community design a community project, there are three factors to consider: resource size, target population, and focused health issues. The interview sheet was aimed at identifying priority health issues among the target population.

Conclusions: All community projects should be well-designed, and priority health issues should be assessed using a health needs assessment tool, such as the interview sheet in the initial project stage. Further education for researchers about project design in communities with resource-limited settings should be provided, and research on the experience of using the health needs assessment tool should be accumulated.

Background: The fast-food industry, a rapidly expanding business due to the influence of urbanization and busy lifestyles, has significantly shaped consumer food habits and quality food-seeking behavior. However, this fast-growing sector is frequently challenged by bacteria of clinical, microbiological, and economic importance, including Escherichia coli (E. coli). While many strains of E. coli are harmless and support digestion, pathogenic variants such as E. coli O157:H7 are responsible for severe foodborne illnesses, public health crises, and economic losses.

Main body: Our study explores consumer behavior within the fast-food industry, highlighting its role in shaping responses to E. coli outbreaks. Also, it examines how increased awareness of food safety risks has influenced consumer decisions, such as adopting hygienic practices and preferring establishments that prioritize food safety. Furthermore, the study investigates the contribution of poor fast-food preparation practices-such as undercooking and cross-contamination-to the spread of E. coli and emphasizes the critical need for improved hygiene awareness among fast-food workers. We analysed notable case studies involving E. coli outbreaks linked to fast-food chains, and subsequently identified gaps in industry practices and consumer behavior that exacerbate the risk of foodborne illnesses. This emphasizes the importance of preventive measures, including industry-driven reforms such as enhanced food handling protocols and consumer education programs, to mitigate future outbreaks.

Conclusions: This study aims to provide evidence-based insights into the shared responsibility of fast-food establishments and consumers in reducing the prevalence of E. coli infections. By addressing gaps in hygiene awareness and preparation practices, the findings emphasize the potential for collaborative efforts to strengthen public health outcomes and prevent further outbreaks.

Background: Early detection of dengue fever is pivotal to help differentiate against other febrile illnesses, especially in the dengue-endemic regions. Currently, febrile patients would have to go to the healthcare facility to get tested for dengue. A diagnostic approach that empowers febrile persons to perform their own tests is needed. Here, we evaluated the utility and the usability of the dengue NS1 rapid diagnostic test and whether it could be accepted as a home self-test. A lateral flow immunochromatography test (ICT) using DENV NS1 was converted to a possible self-test kit by providing the kit with a test device, an alcohol swab, a lancet, a disposable dropper, an assay buffer, and a test manual.

Methods: Twenty volunteers were recruited for this study. The participants performed the self-test under the observation of trained observers who recorded if any procedural error was committed. The results of each test were interpreted by the participants using a given interpretation table.

Results: Ninety-five percent (95%) of the study participants found the instruction manual was easy to follow and 70% felt the test kit was easy to use. Additionally, 80% of the participants successfully obtained the expected results. A majority (80%) would consider using the test kit if needed and would recommend it to family members and friends. Seventy percent (70%) of the participants, most of whom with monthly income of less than USD417, were willing to pay less than USD2 for the test kit.

Conclusion: Findings from the study suggested that a self-test diagnostic for dengue fever is highly acceptable and, hence, could be a viable approach for the early detection of the infection. Trial registration MRECID.NO: 2022628-11345.

Background: Chronic kidney disease (CKD) is a global health challenge with diverse etiologies. However, research on the incidence trends of CKD attributable to specific causes remains limited, and the incidence and mortality rates vary across regions. This study aims to identify the patterns and temporal trends of CKD incidence, providing valuable information for the development of targeted prevention strategies and interventions.

Methods: CKD data from the 2021 Global Burden of Disease Study (1990-2021) were analyzed by sex, region, country, cause, and Socio-demographic Index (SDI). Disease burden was assessed using age-standardized incidence (ASIR), mortality rates (ASMR), and estimated annual percentage changes (EAPC). Decomposition analysis evaluated population aging, growth, and epidemiological impacts. The autoregressive integrated moving average (ARIMA) model was used to predict the burden of CKD from 2021 to 2031, and the age-period-cohort (APC) model was employed to assess the effects of age, time, and cohort. Health inequality was analyzed using Slope Index of Inequality (SII) and Concentration Index (CI).

Results: In 2021, Saudi Arabia had the highest ASIR, while Mauritius had the highest mortality. China and India contributed the most cases and deaths. ARIMA forecasts CKD cases will rise to 22.21 million and deaths to 1.81 million by 2031. Epidemiological changes drove incidence growth in medium SDI regions and mortality in high SDI regions. EAPC correlated with ASIR and ASMR. APC analysis showed incidence peaked between 70-80 years, with earlier cohorts facing higher risks. Unknown causes, type 2 diabetes, and hypertension were the leading CKD etiologies. From 1990-2021, health inequality in CKD incidence and mortality worsened, especially in high SDI regions, where the mortality CI shifted from 0.05 to - 0.09.

Conclusions: This study estimated the temporal trends of CKD incidence and mortality globally, as well as at the national and regional levels, from 1990 to 2021. It was observed that countries with higher socio-demographic index (SDI) exhibited unfavorable trends, suggesting that these countries should develop more targeted and specific strategies to address the growing burden of CKD.