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Plasmodium falciparum genetic diversity and multiplicity of infection among asymptomatic and symptomatic malaria-infected individuals in Uganda. 乌干达无症状和有症状疟疾感染者的恶性疟原虫遗传多样性和感染多重性。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-14 DOI: 10.1186/s41182-024-00656-7
Alex Mwesigwa, Moses Ocan, Bryan Cummings, Benson Musinguzi, Shahid Kiyaga, Steven M Kiwuwa, Stephen Okoboi, Barbara Castelnuovo, Everd Maniple Bikaitwoha, Joan N Kalyango, Charles Karamagi, Joaniter I Nankabirwa, Samuel L Nsobya, Pauline Byakika-Kibwika

Background: Plasmodium falciparum (P. falciparum) remains a significant public health challenge globally, especially in sub-Saharan Africa (SSA), where it accounts for 99% of all malaria infections. The outcomes of P. falciparum infection vary, ranging from asymptomatic to severe, and are associated with factors such as host immunity, parasite genetic diversity, and multiplicity of infection (MOI). Using seven neutral microsatellite markers, the current study investigated P. falciparum genetic diversity and MOI in both asymptomatic and symptomatic malaria individuals in Uganda.

Methods: This cross-sectional study analyzed 225 P. falciparum isolates from both asymptomatic and symptomatic malaria patients, ranging in age from 6 months to ≥ 18 years. P. falciparum genetic diversity, MOI, and multi-locus linkage disequilibrium (LD) were assessed through genotyping of seven neutral microsatellite markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34-313, and C3M69-383. Genetic data analysis was performed using appropriate genetic analysis software.

Results: P. falciparum infections exhibited high genetic diversity in both asymptomatic and symptomatic individuals. The mean expected heterozygosity (He) ranged from 0.79 in symptomatic uncomplicated malaria cases to 0.81 in asymptomatic individuals. There was no significant difference (p = 0.33) in MOI between individuals with asymptomatic and symptomatic infections, with the mean MOI ranging from 1.92 in symptomatic complicated cases to 2.10 in asymptomatic individuals. Polyclonal infections were prevalent, varying from 58.5% in symptomatic complicated malaria to 63% in symptomatic uncomplicated malaria cases. A significant linkage disequilibrium (LD) was observed between asymptomatic and symptomatic uncomplicated/complicated infections (p < 0.01). Genetic differentiation was low, with FST values ranging from 0.0034 to 0.0105 among P. falciparum parasite populations in asymptomatic and symptomatic uncomplicated/complicated infections.

Conclusion: There is a high level of P. falciparum genetic diversity and MOI among both symptomatic and asymptomatic individuals in Uganda. Asymptomatic carriers harbor a diverse range of parasites, which poses challenges for malaria control and necessitates targeted interventions to develop effective strategies.

背景:恶性疟原虫(P. falciparum)仍然是全球公共卫生面临的重大挑战,尤其是在撒哈拉以南非洲地区(SSA),该地区的疟疾感染率高达 99%。恶性疟原虫感染的结果各不相同,从无症状到病情严重不等,并与宿主免疫力、寄生虫遗传多样性和感染倍数(MOI)等因素有关。本研究使用七个中性微卫星标记,调查了乌干达无症状和有症状疟疾患者的恶性疟原虫遗传多样性和感染率:这项横断面研究分析了来自无症状和有症状疟疾患者的 225 株恶性疟原虫分离株,这些患者的年龄从 6 个月到 18 岁不等。通过对 7 个中性微卫星标记进行基因分型,评估了恶性疟原虫的遗传多样性、MOI 和多焦点连锁不平衡(LD):Poly-α、TA1、TA109、PfPK2、2490、C2M34-313 和 C3M69-383。使用适当的遗传分析软件进行遗传数据分析:结果:恶性疟原虫感染在无症状和有症状的个体中均表现出较高的遗传多样性。平均预期杂合度(He)从无症状疟疾病例的 0.79 到无症状个体的 0.81 不等。无症状感染者和有症状感染者的 MOI 没有明显差异(p = 0.33),平均 MOI 从有症状复杂病例的 1.92 到无症状感染者的 2.10 不等。多克隆感染很普遍,在有症状的复杂疟疾病例中占58.5%,在无症状的疟疾病例中占63%。在无症状感染和有症状的无并发症/并发症感染中,恶性疟原虫寄生虫种群之间存在明显的连锁不平衡(LD)(p ST 值从 0.0034 到 0.0105 不等):乌干达有症状和无症状的个体中恶性疟原虫的遗传多样性和感染率都很高。无症状带菌者携带多种寄生虫,这给疟疾控制工作带来了挑战,需要采取有针对性的干预措施来制定有效的策略。
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引用次数: 0
Mapping lymphatic filariasis morbidities in 24 endemic districts of Ethiopia through the health extension program. 通过卫生推广计划绘制埃塞俄比亚 24 个流行区的淋巴丝虫病发病图。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-13 DOI: 10.1186/s41182-024-00657-6
Haileleuel Bisrat, Fikre Hailekiros, Mebratu Mitiku, Asrat Mengiste, Merga Mekonnon, Fikre Seife, Birhanu Oljira, Haileyesus Terefe, Tamrat Bekele, Tsegahun Manyazewal

Background: The primary strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is morbidity management and disability prevention (MMDP), aimed at alleviating the suffering of affected populations. A significant challenge in many LF-endemic areas is the effective registration and identification of individuals with LF, which is crucial for planning and ensuring access to MMDP services. This study seeks to map the geographical distribution of LF-related morbidities across 24 endemic districts in Ethiopia.

Methods: A community-based cross-sectional study was conducted to identify individuals affected by LF in 24 endemic districts using primary health care units (PHCUs). The study involved 946 trained health extension workers (HEWs) conducting house-to-house visits to identify and register cases of lymphedema and hydrocele, with support from 77 trained supervisors and 87 team leaders coordinating the morbidity mapping. Certified surgeons performed confirmatory evaluations through clinical assessments on a randomly selected sample of cases to validate HEW diagnoses, ensuring accurate identification of lymphedema and hydrocele. Statistical analysis of the data, including the severity of lymphedema and acute attacks, was conducted using STATA 17.

Results: This study involved 300,000 households with nearly 1.2 million individuals, leading to the identification of 15,527 LF cases-14,946 (96.3%) with limb lymphedema and 581 (3.7%) with hydrocele. Among those with lymphedema, 8396 (54.1%) were women. Additionally, 13,731 (88.4%) patients resided in rural areas. Of the 14,591 cases whose acute attack information was recorded, 10,710 (73.4%) reported experiencing at least one acute attack related to their lymphedema in the past 6 months, with a notable percentage of males (74.5%; n = 4981/6686). Among the 12,680 recorded cases of leg lymphedema, the percentage of acute attacks increased with severity: 64% (n = 5618) mild cases, 68% (n = 5169) moderate cases and 70% (n = 1893) severe cases.

Conclusion: This study successfully mapped the geographical distribution of LF morbidities across 24 LF-endemic districts in Ethiopia, identifying a substantial number of lymphedema and hydrocele cases, particularly in rural areas where healthcare access is limited. The findings underscore the potential of Ethiopia's health extension program to identify affected individuals and ensure they receive necessary care. The findings inform targeted interventions and access to MMDP services, contributing to Ethiopia's goal of eliminating LF by 2027.

背景:实现消除淋巴丝虫病全球计划(GPELF)第二个目标的主要战略是发病率管理和残疾预防(MMDP),旨在减轻受影响人群的痛苦。在许多淋巴丝虫病流行地区,有效登记和识别淋巴丝虫病患者是一项重大挑战,这对于规划和确保人们获得 MMDP 服务至关重要。本研究旨在绘制埃塞俄比亚 24 个地方病流行区与地方淋巴瘤相关疾病的地理分布图:方法:我们开展了一项基于社区的横断面研究,通过初级卫生保健单位(PHCUs)在 24 个地方病流行区确定受 LF 影响的个体。这项研究涉及 946 名经过培训的卫生推广人员(HEWs),他们在 77 名经过培训的监督员和 87 名负责协调发病率调查的小组负责人的支持下,挨家挨户进行访问,以确定和登记淋巴水肿和鞘膜积液病例。认证外科医生通过对随机抽取的病例进行临床评估,对 HEW 的诊断进行确认评估,确保准确识别淋巴水肿和鞘膜积液。使用 STATA 17 对数据进行统计分析,包括淋巴水肿和急性发作的严重程度:这项研究涉及 300,000 个家庭,近 120 万人,共发现 15,527 例淋巴结核病例,其中 14,946 例(96.3%)患有肢体淋巴水肿,581 例(3.7%)患有鞘膜积液。在淋巴水肿患者中,8396(54.1%)人为女性。此外,13731 名(88.4%)患者居住在农村地区。在记录了急性发作信息的 14591 个病例中,有 10710 人(73.4%)报告在过去 6 个月中至少经历过一次与淋巴水肿相关的急性发作,其中男性患者所占比例较高(74.5%;n = 4981/6686)。在记录的 12,680 例腿部淋巴水肿病例中,急性发作的比例随着严重程度的增加而增加:轻度病例占 64%(n = 5618),中度病例占 68%(n = 5169),重度病例占 70%(n = 1893):这项研究成功绘制了埃塞俄比亚 24 个淋巴结核流行区的淋巴结核发病地理分布图,发现了大量淋巴水肿和鞘膜积液病例,尤其是在医疗条件有限的农村地区。这些发现强调了埃塞俄比亚卫生推广计划在识别受影响人群并确保他们获得必要治疗方面的潜力。这些发现为有针对性的干预措施和获得 MMDP 服务提供了依据,有助于实现埃塞俄比亚在 2027 年前消除淋巴水肿的目标。
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引用次数: 0
Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study. 埃塞俄比亚将传统护理与现代医疗保健系统相结合对减少结核病诊断延误的影响:一项分组随机对照研究。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-13 DOI: 10.1186/s41182-024-00641-0
Desalegne Amare, Kefyalew Addis Alene, Fentie Ambaw

Background: Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay.

Methods: A cluster randomized controlled trial was conducted among TB patients, with 510 participants, 255 individuals were assigned to the intervention group and 255 to the control group. Training in the intervention group was provided for both traditional and modern healthcare providers in three rounds to enhance their knowledge, attitudes, and skills in TB screening and referral. A non-parametric independent sample test was used to compare the baseline and end-line data. The effect size was determined using Cohen's d. To account for individual and cluster-level variations, a mixed-effect parametric survival model was employed. Furthermore, conditional (fixed only) and marginal (random effects) graphs were used to compare between the intervention and control groups.

Results: A total of 510 participants were included in the baseline study, with a similar number of participants included in the endline study. In the intervention group, the delay in diagnosis was 4.185 per 1000 person-days post-intervention, compared to 4.608 per 1000 person-days pre-intervention. In the control group, the delay for diagnosis was 4.759 per 1000 person-days pre-intervention and 5.031 per 1000 person-days post-intervention. The median time to diagnosis was 135 days. The non-parametric comparison showed that the intervention significantly reduced patient delays in the intervention group compared to the control group (p = 0.006), with a Cohen's d effect size of 0.246. The intervention also significantly reduced diagnosis delay in the intervention group compared to the control group (p = 0.036), with a Cohen's d effect size of 0.187. The diagnosis of TB was accelerated by 1.076 times due to the integration of traditional care with the modern healthcare system in the intervention group compared to the control group (δ: 1.076; 95% CI 1.021, 1.134).

Conclusions: The involvement of traditional care providers in TB control programs significantly reduced diagnosis delays in Ethiopia. These findings suggest the need for integrating traditional care with modern healthcare systems for the effective prevention of TB in high-burden countries. Clinical trial registration ClinicalTrials.gov ID: NCT05236452.

背景:在资源有限的环境中,结核病(TB)的诊断和治疗启动延误是一项重大挑战。这些延误会导致治疗效果不佳、疾病传播和成本增加。本研究旨在评估将传统护理与现代医疗保健系统相结合对减少结核病诊断延误的影响:方法: 在结核病患者中开展了一项分组随机对照试验,共有 510 人参加,其中 255 人被分配到干预组,255 人被分配到对照组。干预组对传统和现代医疗服务提供者进行了三轮培训,以提高他们在结核病筛查和转诊方面的知识、态度和技能。采用非参数独立样本检验来比较基线数据和终点数据。为考虑个体和群组水平的差异,采用了混合效应参数生存模型。此外,还使用条件图(仅固定效应)和边际图(随机效应)对干预组和对照组进行比较:基线研究共纳入了 510 名参与者,终点研究也纳入了同样数量的参与者。在干预组中,干预后的诊断延迟率为每 1000 人天 4.185 例,而干预前为每 1000 人天 4.608 例。在对照组中,干预前每 1000 人天的诊断延误率为 4.759,干预后每 1000 人天的诊断延误率为 5.031。诊断时间的中位数为 135 天。非参数比较显示,与对照组相比,干预组的患者延误时间明显减少(p = 0.006),Cohen's d效应大小为0.246。与对照组相比,干预组的诊断延误也明显减少(p = 0.036),Cohen's d效应大小为0.187。与对照组相比,由于干预组将传统医疗与现代医疗系统相结合,结核病的诊断速度加快了 1.076 倍(δ:1.076;95% CI 1.021,1.134):在埃塞俄比亚,传统医疗服务提供者参与结核病控制项目大大减少了诊断延误。这些研究结果表明,在结核病高发国家,有必要将传统医疗与现代医疗系统相结合,以有效预防结核病。临床试验注册 ClinicalTrials.gov ID:NCT05236452。
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引用次数: 0
In vitro antifungal activities of medicinal plants used for treatment of candidiasis in Pader district, Northern Uganda. 乌干达北部帕德尔地区用于治疗念珠菌病的药用植物的体外抗真菌活性。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-13 DOI: 10.1186/s41182-024-00628-x
Betty Akwongo, Esezah K Kakudidi, Anthony M Nsubuga, Morgan Andama, Mary Namaganda, Patience Tugume, Savina Asiimwe, Godwin Anywar, Esther Katuura

Background: The emergence of multidrug resistant Candida species to available drugs has led to renewed interest in the use of herbal medicines globally. This study scientifically verified antifungal effectiveness of five commonly used plant species in Pader district, against selected pathogenic candida strains.

Methods: Powdered roots of Momordica foetida, Sansevieria dawei and Distimake dissectus; and stem barks of Khaya anthotheca and Mitragyna rubrostipulata were extracted sequentially using petroleum ether and methanol, respectively; and total water extraction at 24.4 °C (maceration), 60 °C (decoction) and boiling water at 87 °C (hot water infusion). Extracts and their combinations, positive controls (amphotericin B, and fluconazole) and negative control (80% dimethyl sulfoxide, verified to be tolerable concentration to the tested Candida species) were screened and verified for their antifungal activity against Candida albicans (ATCC: American Type Culture Collection reference strain 10231, ATCC 90028, 0770a and 0796), C. glabrata (VVc 004, ATCC 2950) and C. tropicalis (ATCC 750 and 0210) using agar well diffusion and broth micro-dilution, respectively.

Results: Aqueous extract (24.4 °C) of M. rubrostipulata (ZOI: 18.00 ± 1.00 to 38.33 ± 0.17; MIC: 3.13 ± 0.00 to 20.83 ± 4.17; MFC: 12.50 ± 0.00 to 200.00 ± 0.00), methanol extract of K. anthotheca (10.11 ± 0.31 to 15.11 ± 0.65; 1.04 ± 0.26 to 12.50 ± 0.00; 12.50 ± 0.00 to 100.00 ± 0.00), and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca (7.89 ± 0.26 to 19.67 ± 0.37; 0.78 ± 0.00 to 50.00 ± 0.00; 12.50 ± 0.00 to 200.00 ± 0.00) exhibited broad spectrum antifungal activities and were fungistatic against all tested Candida species, which comprised 8 clinical/control and susceptible/resistant strains. None of the conventional drugs used demonstrated broad spectrum antifungal activity across all tested Candida species/strains.

Conclusion: Methanol extract of K. anthotheca, aqueous extract (24.4 °C) of M. rubrostipulata, and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca could be effective in the treatment of candidiasis. They demonstrated potential broad spectrum antifungal activity against different species and strains of tested Candida than the fluconazole and amphotericin B drugs. Their fungistatic nature showed their ability to inhibit fungal growth. Hence, these extracts/extract combination can offer better treatment option for candidiasis if they are standardized and also their active curative compounds isolated and made into antifungal drugs.

背景:由于出现了对现有药物具有多重耐药性的念珠菌,全球范围内对草药的使用重新产生了兴趣。本研究科学地验证了帕德尔地区五种常用植物对部分致病念珠菌菌株的抗真菌效果:方法:分别使用石油醚和甲醇,以及 24.4 °C(浸泡)、60 °C(煎煮)和 87 °C(热水浸泡)的全水萃取法,对 Momordica foetida、Sansevieria dawei 和 Distimake dissectus 的粉末根茎,以及 Khaya anthotheca 和 Mitragyna rubrostipulata 的茎皮进行提取。筛选并验证了提取物及其组合、阳性对照(两性霉素 B 和氟康唑)和阴性对照(80% 的二甲亚砜,经证实为受试念珠菌的耐受浓度)对白色念珠菌(ATCC:美国模式培养物保藏中心参考菌株 10231、ATCC 90028、0770a 和 0796)、C.分别使用琼脂井扩散法和肉汤微量稀释法对白色念珠菌(ATCC:美国类型培养物保藏中心参考菌株 10231、ATCC 90028、0770a 和 0796)、白色念珠菌(VVc 004、ATCC 2950)和热带念珠菌(ATCC 750 和 0210)进行抗菌:结果:M. rubrostipulata 的水提取物(24.4 °C)(ZOI:18.00 ± 1.00 至 38.33 ± 0.17;MIC:3.13 ± 0.00 至 20.83 ± 4.17;MFC:12.50 ± 0.00 至 200.00 ± 0.00)、K.anthotheca的甲醇提取物(10.11 ± 0.31 至 15.11 ± 0.65;1.04 ± 0.26 至 12.50 ± 0.00;12.50 ± 0.00 至 100.00 ± 0.00),以及 D. dissectus的水提取物(60 °C)+甲醇提取物的组合。D. dissectus + K. anthotheca 的甲醇提取物(7.89 ± 0.26 至 19.67 ± 0.37;0.78 ± 0.00 至 50.00 ± 0.00;12.50 ± 0.00 至 200.00 ± 0.00)的组合具有广谱抗真菌活性,对所有测试的念珠菌菌种(包括 8 个临床/对照菌株和易感/耐药菌株)均有杀真菌作用。在所有测试的念珠菌种类/菌株中,没有一种常规药物具有广谱抗真菌活性:结论:K. anthotheca 的甲醇提取物、M. rubrostipulata 的水提取物(24.4 °C)以及 D. dissectus 的水提取物(60 °C)+ K. anthotheca 的甲醇提取物的组合可有效治疗念珠菌病。与氟康唑和两性霉素 B 相比,它们对不同种类和菌株的念珠菌具有潜在的广谱抗真菌活性。它们的杀真菌性表明了它们抑制真菌生长的能力。因此,如果对这些提取物/提取物组合进行标准化,并将其活性治疗化合物分离出来制成抗真菌药物,就能为念珠菌病提供更好的治疗选择。
{"title":"In vitro antifungal activities of medicinal plants used for treatment of candidiasis in Pader district, Northern Uganda.","authors":"Betty Akwongo, Esezah K Kakudidi, Anthony M Nsubuga, Morgan Andama, Mary Namaganda, Patience Tugume, Savina Asiimwe, Godwin Anywar, Esther Katuura","doi":"10.1186/s41182-024-00628-x","DOIUrl":"10.1186/s41182-024-00628-x","url":null,"abstract":"<p><strong>Background: </strong>The emergence of multidrug resistant Candida species to available drugs has led to renewed interest in the use of herbal medicines globally. This study scientifically verified antifungal effectiveness of five commonly used plant species in Pader district, against selected pathogenic candida strains.</p><p><strong>Methods: </strong>Powdered roots of Momordica foetida, Sansevieria dawei and Distimake dissectus; and stem barks of Khaya anthotheca and Mitragyna rubrostipulata were extracted sequentially using petroleum ether and methanol, respectively; and total water extraction at 24.4 °C (maceration), 60 °C (decoction) and boiling water at 87 °C (hot water infusion). Extracts and their combinations, positive controls (amphotericin B, and fluconazole) and negative control (80% dimethyl sulfoxide, verified to be tolerable concentration to the tested Candida species) were screened and verified for their antifungal activity against Candida albicans (ATCC: American Type Culture Collection reference strain 10231, ATCC 90028, 0770a and 0796), C. glabrata (VVc 004, ATCC 2950) and C. tropicalis (ATCC 750 and 0210) using agar well diffusion and broth micro-dilution, respectively.</p><p><strong>Results: </strong>Aqueous extract (24.4 °C) of M. rubrostipulata (ZOI: 18.00 ± 1.00 to 38.33 ± 0.17; MIC: 3.13 ± 0.00 to 20.83 ± 4.17; MFC: 12.50 ± 0.00 to 200.00 ± 0.00), methanol extract of K. anthotheca (10.11 ± 0.31 to 15.11 ± 0.65; 1.04 ± 0.26 to 12.50 ± 0.00; 12.50 ± 0.00 to 100.00 ± 0.00), and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca (7.89 ± 0.26 to 19.67 ± 0.37; 0.78 ± 0.00 to 50.00 ± 0.00; 12.50 ± 0.00 to 200.00 ± 0.00) exhibited broad spectrum antifungal activities and were fungistatic against all tested Candida species, which comprised 8 clinical/control and susceptible/resistant strains. None of the conventional drugs used demonstrated broad spectrum antifungal activity across all tested Candida species/strains.</p><p><strong>Conclusion: </strong>Methanol extract of K. anthotheca, aqueous extract (24.4 °C) of M. rubrostipulata, and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca could be effective in the treatment of candidiasis. They demonstrated potential broad spectrum antifungal activity against different species and strains of tested Candida than the fluconazole and amphotericin B drugs. Their fungistatic nature showed their ability to inhibit fungal growth. Hence, these extracts/extract combination can offer better treatment option for candidiasis if they are standardized and also their active curative compounds isolated and made into antifungal drugs.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"84"},"PeriodicalIF":3.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Examination of factors impacting spitting or vomiting among children under 5 years of age during seasonal malaria chemoprevention: a quantitative study in Burkina Faso, Chad, Nigeria and Togo. 季节性疟疾化学预防期间影响 5 岁以下儿童吐奶或呕吐的因素研究:布基纳法索、乍得、尼日利亚和多哥的定量研究。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-12 DOI: 10.1186/s41182-024-00642-z
Chen Gao, Sikai Huang, Taiwo Ibinaiye, Benoît Sawadogo, Adama Traore, Cheick Saïd Compaoré, Fantche Awokou, Chukwudi A Nnaji, Kevin Baker, Duoquan Wang, Sol Richardson

Background: Since 2012, the World Health Organization has recommended seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) for children aged 3-⁠59 months in regions where malaria transmission is seasonal. Full ingestion of SMC medicines without spitting or vomiting during a complete 3-day course is critical to ensure effectiveness of SMC medicines and to avoid development of antimalarial resistance. Although evidence suggests that spitting or vomiting is not rare, there is limited analytical evidence on potential factors associated with spitting or vomiting in SMC campaigns.

Methods: We utilized data from SMC coverage surveys conducted in Burkina Faso, Chad, Togo and Nigeria between 2020 and 2022. Episodes of spitting or vomiting were defined as SMC-eligible children spitting out most of the dose or vomiting the entire dose within 30 min of SPAQ administration as reported by primary caregivers. We conducted a cross-sectional study using mixed-effects logistic regression with variables including household socioeconomic variables and caregiver knowledge of SMC, to identify factors associated with spitting or vomiting.

Results: The proportion of SMC-eligible children spitting or vomiting SPAQ doses ranged from 1.81% in Nigeria to 4.36% in Chad. The odds of spitting or vomiting were lower among children administered medicines under community distributor (CD) supervision, and whose primary caregivers had a high degree of knowledge of SMC. Spitting or vomiting were negatively associated with caregiver adherence to AQ administration and caregiver reporting of children's adverse reactions to SMC medicines. Over half of the children experiencing a spitting or vomiting episode did not receive a replacement dose from CDs. Redosing was positively associated with caregiver educational attainment, caregiver knowledge of SMC, and directly supervised medicine administration.

Conclusions: CD-supervised administration of SPAQ can strengthen community engagement strategies to enhance appropriate administration and full ingestion of SMC medicines according to the SMC delivery protocol.

背景:自 2012 年起,世界卫生组织建议在疟疾季节性传播地区为 3-59 个月大的儿童使用磺胺乙胺嘧啶加阿莫地喹(SPAQ)进行季节性疟疾化学预防(SMC)。在为期 3 天的完整疗程中,完全摄入 SMC 药物而不吐痰或呕吐对于确保 SMC 药物的有效性和避免产生抗疟药物抗药性至关重要。虽然有证据表明吐药或呕吐的情况并不罕见,但有关 SMC 活动中吐药或呕吐的潜在相关因素的分析证据却很有限:我们利用了 2020 年至 2022 年期间在布基纳法索、乍得、多哥和尼日利亚进行的 SMC 覆盖率调查数据。根据主要照顾者的报告,吐奶或呕吐事件是指符合 SMC 条件的儿童在服用 SPAQ 后 30 分钟内吐出大部分剂量或呕吐全部剂量。我们采用混合效应逻辑回归法进行了一项横断面研究,变量包括家庭社会经济变量和护理人员对SMC的了解程度,以确定与吐奶或呕吐相关的因素:符合SMC条件的儿童吐奶或呕吐SPAQ剂量的比例从尼日利亚的1.81%到乍得的4.36%不等。在社区配药员(CD)的监督下用药的儿童中,吐药或呕吐的几率较低,而且这些儿童的主要照顾者对SMC有较高的了解。吐奶或呕吐与看护人是否坚持 AQ 给药以及看护人是否报告儿童对 SMC 药物的不良反应呈负相关。半数以上出现吐奶或呕吐症状的儿童没有从 CD 处获得替代剂量。重新给药与护理人员的教育程度、护理人员对 SMC 的了解程度以及直接监督给药呈正相关:在 CD 监督下服用 SPAQ 可以加强社区参与策略,从而促进按照 SMC 给药方案适当服用和完全摄入 SMC 药物。
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引用次数: 0
Assessing agricultural practices and insecticides resistance for effective malaria vector control in northwestern Iran. 评估伊朗西北部有效控制疟疾病媒的农业实践和杀虫剂抗药性。
IF 4.3 Q1 TROPICAL MEDICINE Pub Date : 2024-11-07 DOI: 10.1186/s41182-024-00653-w
Madineh Abbasi, Saideh Yousefi, Fatemeh Nikpour

Background: After three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region.

Methods: Larval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area.

Results: Alongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides.

Conclusions: These results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.

背景:在当地没有疟疾传播三年之后,伊朗于 2022 年爆发了疟疾疫情。伊朗的主要疟疾控制方法包括室内滞留喷洒(IRS)、长效驱虫蚊帐(LLINs)以及疟疾病例的及时诊断和治疗。沙氏按蚊是伊朗的主要疟疾病媒之一。本研究旨在确定伊朗西北部沙沙疟蚊对杀虫剂的抗药性状况,为该地区有效的病媒控制计划提供依据:方法:从阿拉斯河沿岸村庄的各种幼虫栖息地收集沙氏疟蚊幼虫。根据世界卫生组织(WHO)的指导方针,使用诊断剂量的杀虫剂对 An. sacharovi 进行了成虫药敏试验。研究还评估了农业杀虫剂和化肥的使用情况,以及蚊子在研究地区繁殖地的天敌存在情况:结果:除了不同剂量水平的二氧化硅、腐植酸、过磷酸钙、硫磺、尿素和溶血磷等化学品外,有机磷和拟除虫菊酯杀虫剂也常用于稻田和果园。沙氏疟蚊对杀虫剂的反应多种多样,对滴滴涕表现出抗性,但对马拉硫磷敏感,对氨基甲酸酯类和拟除虫菊酯类杀虫剂表现出相似的反应:这些结果为研究地区的农业实践和蚊子幼虫的存在提供了重要启示。一种特定除草剂的广泛使用表明,它在控制杂草方面很受农民欢迎,而其他农用产品则侧重于提高土壤肥力和生产力。在有捕食者的生境中没有蚊子幼虫,说明这些捕食者在控制蚊子数量方面很有用。蚊子对某些杀虫剂的抗药性突出表明,在病媒控制计划中需要谨慎选择和间歇使用杀虫剂。这些发现可以为制定有针对性的战略提供信息,以降低疟疾传播风险。进一步的研究对于评估这些干预措施的有效性至关重要。
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引用次数: 0
Addressing vaccination gaps among healthcare workers in sub-Saharan Africa: the role of mandatory Hepatitis B vaccination. 解决撒哈拉以南非洲地区医护人员的疫苗接种缺口:强制性乙型肝炎疫苗接种的作用。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-06 DOI: 10.1186/s41182-024-00652-x
Faithful Miebaka Daniel, Bonaventure Michael Ukoaka, Victoria Ezinne Emeruwa, Rosette Chidera Oti-Ashong, Gabriel Oluwafemi Falaiye

Hepatitis B virus (HBV) poses a significant public health threat, particularly in developing countries with high endemicity but poor vaccination among healthcare workers (HCWs). Needlestick injuries increase HCWs' risk, yet only about 42% of HCWs are fully vaccinated compared to 97% in high-income countries. Challenges to vaccine uptake include availability, demanding schedules with frequent unit rotations hindering access, high cost of acquiring shots, and stock shortages resulting in missed opportunities. Mandatory, cost-free HBV vaccinations for HCWs, supported by legislation, international aid, and digital reminders, could ensure self-protection and safety while contributing to the global objective of eradicating HBV by 2030.

乙型肝炎病毒(HBV)对公共卫生构成了严重威胁,尤其是在流行率高但医护人员(HCWs)接种率低的发展中国家。针刺伤增加了医护人员的风险,但只有约 42% 的医护人员完全接种了疫苗,而在高收入国家,这一比例高达 97%。疫苗接种面临的挑战包括:疫苗的可获得性、要求苛刻的日程安排(频繁的单位轮换阻碍了疫苗的获得)、获得疫苗的高成本以及库存短缺导致错失良机。在立法、国际援助和数字提醒的支持下,为高危工作者提供强制性、免费的 HBV 疫苗接种可确保自我保护和安全,同时为实现到 2030 年根除 HBV 的全球目标做出贡献。
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引用次数: 0
Trends and inequalities in the use of deworming medication during pregnancy in Sierra Leone, 2008-2019. 2008-2019 年塞拉利昂孕期使用驱虫药的趋势和不平等现象。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-11-04 DOI: 10.1186/s41182-024-00638-9
Augustus Osborne, Alpha Umaru Bai-Sesay, Alieu Tommy, Camilla Bangura, Bright Opoku Ahinkorah

Background: Intestinal worm infections are a significant public health concern for pregnant women in low- and middle-income countries. These infections can lead to anaemia, malnutrition, and adverse pregnancy outcomes, including premature birth and low birth weight. Deworming medication during pregnancy is a safe and effective strategy to prevent these complications and improve maternal and child health. This study aims to investigate the trends and inequalities in the use of deworming medication during pregnancy among women in Sierra Leone between 2008 and 2019.

Methods: The study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate various measures of inequality, including difference, ratio, population attributable risk, and population attributable fraction. An inequality assessment was conducted for five stratifiers: age, economic status, level of education, place of residence, and sub-national province.

Results: The prevalence of deworming medication during pregnancy was 43.8% in 2008, 72.4% in 2013, and 83.5% in 2019 in Sierra Leone. There was a decrease in age-related inequality from a difference of 3.7% in 2008 to -0.8% in 2019. Economic-related inequality increased from a difference of -8.5% in 2008 to -8.2% in 2019. Both population attributable fraction and population attributable risk were zero in all survey years for economic status, indicating no improvement in the setting average without economic-related inequality. Inequality in education increased from a difference of -8.9% in 2008 to -8.4% in 2019 and decreased from a difference of -2.6% in 2008 to -5.5% in 2019 for place of residence. Provincial inequality decreased from a difference of 29.5% in 2008 to 11.8% in 2019. The population attributable risk for province reveals that the setting average could have been 10.5 percentage points lower in 2008, 8.2 percentage points lower in 2013, and 5.9 percentage points lower in 2019 without provincial inequality.

Conclusion: The prevalence of deworming medication use during pregnancy substantially increased from 2008 to 2019 (43.8% to 83.5%) in Sierra Leone. This suggests a positive public health trend in maternal healthcare access and education. Inequalities related to economic status and education increased slightly while age-related, place of residence and provincial inequalities decreased. This indicates an inequitable distribution of this essential healthcare intervention across these stratifiers. The government and policymakers should continue efforts to raise awareness and promote the use of deworming medication during pregnancy.

背景:肠道蠕虫感染是中低收入国家孕妇的一个重大公共卫生问题。这些感染可导致贫血、营养不良和不良妊娠结局,包括早产和出生体重不足。孕期驱虫药是预防这些并发症和改善母婴健康的安全有效的策略。本研究旨在调查 2008 年至 2019 年期间塞拉利昂妇女在孕期使用驱虫药的趋势和不平等现象:研究利用了 2008 年、2013 年和 2019 年进行的塞拉利昂人口健康调查的数据。我们使用世界卫生组织开发的健康公平评估工具包来计算各种不平等度量,包括差异、比率、人口可归因风险和人口可归因分数。对年龄、经济状况、教育水平、居住地和次国家级省份这五个分层因素进行了不平等评估:塞拉利昂孕期驱虫药的使用率在 2008 年为 43.8%,2013 年为 72.4%,2019 年为 83.5%。与年龄相关的不平等有所减少,从 2008 年的 3.7% 降至 2019 年的-0.8%。与经济相关的不平等从 2008 年的-8.5% 增加到 2019 年的-8.2%。在经济状况的所有调查年份中,人口可归因分数和人口可归因风险均为零,表明在没有经济相关不平等的情况下,环境平均值没有改善。教育方面的不平等从 2008 年的-8.9%增至 2019 年的-8.4%,居住地方面的不平等从 2008 年的-2.6%降至 2019 年的-5.5%。各省的不平等从 2008 年的 29.5%下降到 2019 年的 11.8%。各省的人口可归因风险显示,如果没有各省的不平等,2008 年的环境平均值可能会降低 10.5 个百分点,2013 年降低 8.2 个百分点,2019 年降低 5.9 个百分点:从 2008 年到 2019 年,塞拉利昂的孕期驱虫药使用率大幅提高(从 43.8% 提高到 83.5%)。这表明在孕产妇保健和教育方面出现了积极的公共卫生趋势。与经济地位和教育有关的不平等略有增加,而与年龄、居住地和省份有关的不平等则有所减少。这表明,在这些分层中,这一基本医疗保健干预措施的分配并不公平。政府和政策制定者应继续努力提高人们的认识,促进孕期驱虫药的使用。
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引用次数: 0
Comments on: prevalence and risk factors for tuberculosis and HIV coinfections in Kenyan prison inmates. 评论:肯尼亚监狱囚犯中结核病和艾滋病毒合并感染的流行率和风险因素。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-10-31 DOI: 10.1186/s41182-024-00650-z
Muhammad Hamza, Zil-E-Huma Jalil, Abid Jan Abdul Sattar, Hamnah Sohail, Malik Olatunde Oduoye

The study by Mwatenga et al. found a tuberculosis (TB) prevalence of 10.2% and an HIV prevalence of 19.1% among inmates, with all TB cases co-infected with HIV. Education level, smoking history, and substance use are key predictors of coinfections. Although informative, its single-centred design and reliance on sputum samples may be insufficient for some patient groups, potentially compromising diagnostic accuracy. Expanding the study to include several jails and employing more diagnostic procedures may increase reliability and the ability to generalize. The report also notes the lack of debate on broader socioeconomic variables and structural barriers to healthcare in jails, which are crucial to understanding inmates' health challenges. Overcrowding, malnutrition, and a poor healthcare system are examples of environmental factors that probably contribute to the spread of tuberculosis and make managing HIV more difficult. Additionally, not enough is known about the dietary habits of prisoners and other health conditions like diabetes or mental health, which may have an impact on the course of HIV and TB. Future studies should take these extra characteristics into account to create more comprehensive approaches to controlling HIV coinfections and TB in prison populations. This will help build more effective therapies.

Mwatenga 等人的研究发现,在囚犯中,结核病(TB)发病率为 10.2%,艾滋病毒(HIV)发病率为 19.1%,所有结核病病例都同时感染了艾滋病毒。教育水平、吸烟史和药物使用是预测合并感染的关键因素。尽管该研究信息丰富,但其单一中心的设计和对痰样本的依赖可能无法满足某些患者群体的需求,从而可能影响诊断的准确性。将研究范围扩大到多个监狱并采用更多的诊断程序可能会提高可靠性和推广能力。报告还指出,对于监狱中更广泛的社会经济变量和医疗保健的结构性障碍缺乏讨论,而这些对于了解囚犯的健康挑战至关重要。过度拥挤、营养不良和糟糕的医疗保健系统都是环境因素的例子,这些因素可能会导致结核病的传播,并使艾滋病毒的管理变得更加困难。此外,人们对囚犯的饮食习惯和其他健康状况(如糖尿病或精神健康)的了解还不够,而这些可能会对艾滋病和结核病的病程产生影响。未来的研究应考虑到这些额外的特征,以制定更全面的方法来控制监狱人群中的艾滋病病毒并发感染和结核病。这将有助于建立更有效的疗法。
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引用次数: 0
Reply to: Comment on: Fetal femur length and risk of diabetes in adolescence: a prospective cohort study. 答复评论胎儿股骨长度与青春期糖尿病风险:一项前瞻性队列研究。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2024-10-30 DOI: 10.1186/s41182-024-00646-9
Urme Binte Sayeed
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引用次数: 0
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