Tropical Medicine and Health最新文献

Background: The rich biodiversity of West Africa supports a vast repository of medicinal plants, with traditional medicine playing a central role in managing diseases such as diabetes. Despite their widespread use, the safety and efficacy of these herbal treatments have not been scientifically explored. This study aims to analyze the traditional uses of antidiabetic plants in Economic Community of West African States countries in relation to the available scientific evidence.

Methods: A three-step approach was used. Firstly, ethnopharmacological studies on diabetes management in West Africa were identified. Secondly, the twelve most cited plants were selected on the basis of their frequency of citation of traditional antidiabetic uses, and their citation in at least five of the countries considered. Thirdly, scientific databases were searched for available in vitro, in vivo, and clinical studies examining the antidiabetic effects, antioxidant properties, and potential toxicity of the twelve plants selected.

Results: This study identified 638 medicinal plants from 32 ethnopharmacological studies conducted in eight West African countries. The twelve most cited plants were Mangifera indica, Rauvolfia vomitoria, Azadirachta indica, Morinda lucida, Launea taraxacifolia, Momordica charantia, Phyllanthus amarus, Vernonia amygdalina, Carica papaya, Annona senegalensis, Allium sativum and Ocimum gratissimum. Most remedies were prepared from leaves, roots, and bark, commonly as decoctions or macerations, and demonstrated notable hypoglycemic activity. However, the mechanism of action behind the antidiabetic activity of these plants has rarely been addressed, and few of these plants have undergone clinical trials and in-depth toxicological evaluations.

Conclusion: This review highlights a significant gap between traditional knowledge and scientific assessment. Although these traditional medicinal plants show promise for diabetes management, further scientific validation is needed to ensure their safe and effective use in modern healthcare systems.

Background: Chikungunya is an arbovirus capable of affecting the musculoskeletal system of infected individuals. Furthermore, it has the potential to progress from the acute to the chronic phase, marked by the prevalence of symptoms of arthralgia. Joint pain compromises the performance of daily activities, including psychological, economic, and physical functioning.

Methods: Through the use of data science techniques, such as data analysis, evaluation, and visualization, the aim is to understand the influence of pain points on disease progression. Furthermore, we also evaluate artificial intelligence models to calculate the likelihood of patients progressing to a chronic phase.

Results: The data analysis showed that arthralgia was reported by 97.70% of the sample (339 cases), followed by 74.06% edema (257 cases), 36.31% low back pain (126 cases) and 34.58% myalgia (120 cases), being factors that are related to chronicity. The artificial intelligence models have achieved metrics above 60%, demonstrating potential for estimating the likelihood of a patient's progression to the chronic phase.

Conclusions: Based on these estimates, healthcare professionals can adopt preventive measures capable of mitigating the disease's impacts. Implementing these models in the decision-making process becomes an important ally in the fight against Chikungunya in Brazil, helping to mitigate the social and economic impacts caused by the chronic phase.

Background: There is a high variability in the pattern of deployment of combinations of malaria vectors and parasite control interventions across sub-Saharan Africa. Effects of such deployment on disease progression from uncomplicated to severe malaria (a proxy measure of naturally acquired immunity against clinical malaria) is unknown. This systematic review and meta-analysis determined the prevalence of progression from uncomplicated to severe malaria, prevalence of parasitaemia and prevalence of gametocytemia among children in settings receiving different combinations of malaria control interventions in sub-Saharan Africa.

Methods: The protocol for this review was registered by the International Prospective Register for Systematic Review (PROSPERO) with registration number CRD 42024619945. The review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We comprehensively searched relevant articles published in PubMed, Embase, Web of Science, Scopus and Google Scholar from 1st January 2000 to 31st December 2024. Title, abstract and full text screening were done by inserting relevant search terms and Boolean operators in the search engines of the databases. Bibliography searches of referenced literature were also done. Risk of Bias analysis was done using modified Newcastle-Ottawa tool. Random effects model, Odds ratio and pooled 95% confidence interval in STATA ver 17.0 were used to perform bivariate meta-analysis and sub-group analysis.

Results: Twelve studies involving 9,283,160 individuals were included in this review. There was no significant difference in the odds of progression from uncomplicated to severe malaria in settings receiving different combinations of malaria control interventions (OR:0.56; 95%CI 0.31 to 1.02P = 0.06). Simultaneous deployment of more combinations of malaria control interventions were associated with significantly lower odds of severe malaria(pooled OR = 0.41; 95%CI0.30,to 0.56; p < 0.00), lower odds of parasitaemia (pooled OR = 0.52; 95%CI0.38 to 0.70; p < 0.00), lower odds of uncomplicated malaria (pooled OR = 0.64; 95% CI0.43 to 0.95; p = 0.003) and a lower odds of gametocytes (pooled OR = 0.41; 95% CI 0.28 to 0.60; p < 0.00). There is no significant difference in the odds of severe malaria between settings with single versus those with no interventions (pooled OR = 0.35; 95%CI 0.11 to 1.13). Selected articles exhibited high heterogeneity.

Conclusion: In comparison to single or no intervention, combination of multiple malaria control interventions significantly protects against severe malaria, parasitaemia, gametocytes and uncomplicated malaria. In comparison to single or no interventions, deployment of multiple combinations of control interventions did not offer additional protection against progression from uncomplicated to severe malaria.

Background: Tungiasis is a cutaneous parasitic disease caused by the female flea Tunga penetrans. The World Health Organization recommends two-component dimeticone (NYDA^®) as the sole treatment for tungiasis; however, this topical medication is not available in Kenya. In western Kenya, sodium carbonate has been adopted as a traditional village-based treatment. A pilot study found that the proportion of dead fleas on day 7 was higher with NYDA^® treatment than that with 5% sodium carbonate treatment (87% vs. 64%, respectively). This study was aimed at assessing the 11-day cure rates of tungiasis by comparing the efficacy of sodium carbonate and NYDA^® treatments in Vihiga County, Kenya.

Methods: A randomised, observer-blinded, non-inferiority trial was conducted, with the non-inferiority margin set at 10%. A total of 160 eligible children with 941 flea infections were matched and randomised. The number of lesions per child per foot ranged from 1 to 10, with a median of 5 lesions. Each participant received both treatments, with one treatment applied to each foot. Health conditions, including inflammation scores and adverse events, were recorded. Observations were recorded on days 3, 5, 7, 9, and 11 using a digital microscope to determine flea viability.

Results: Data from 157 children aged 4-15 years were analysed, comprising a total of 843 lesions. On day 11, the proportion of dead fleas was 88% for NYDA^® and 77% for 5% sodium carbonate solution (p < 0.05). No significant differences were observed in inflammation scores or symptoms such as pain and itchiness between the two treatments.

Conclusions: This study demonstrated that 5% sodium carbonate did not meet the non-inferiority margin compared with NYDA^® in treating tungiasis. Nevertheless, in settings where NYDA^® is not accessible, it may still be considered an alternative. Trial registration This study was registered with UMIN-CTR (Trial ID: UMIN000044320; reception desk number: R000050621) on 28 May 2021.

Background: Achieving universal social protection (SP) coverage for people affected by tuberculosis (TB) is increasingly recognised as an essential component of its response, as well as other diseases of poverty. Realising this goal requires to clearly understand the SP needs of people affected by TB and to identify means to maximise their access to existing or new SP benefits in an efficient, effective, and sustainable manner.

Main body: To address these questions, between 2022 and 2023, the WHO Western Pacific Regional office conducted the first SP baseline assessment for people affected by TB in Mongolia, Lao People's Democratic Republic, the Philippines, Cambodia, and Viet Nam. This exercise encompassed a desk review of SP programmes operating in these countries, followed by an expert consultation to discuss barriers and entry points to expand SP coverage among people affected by TB. Overall evidence gathered from publicly available reports and publications suggests that existing SP programmes in these countries are insufficiently accessible and inadequate to meet the needs of people affected by TB. Most countries provide TB-specific benefits only to people with multidrug-resistant TB, leaving most people with TB unserved. The most reported barriers to access to SP included lack of awareness, stigma, poverty, as well as programmes' fragmentation, and administrative and financial constraints. Identified solutions included raising awareness about SP, extending TB-specific SP benefits to all people with TB in need, advocating for a better inclusion of people with TB into existing governmental programmes, and strengthening the referral system across the health and SP sectors.

Conclusions: By identifying concrete policy entry points and actionable solutions, this SP baseline assessment provided a foundation for these five countries to embed social protection more systematically into their national TB responses. Ideally, this effort should now be replicated in all high TB-burden countries willing to achieve universal SP coverage among people affected by TB. The lessons that emerged from this baseline assessment are consistent with the recommended actions and principles underlying the Western Pacific Regional Framework for Reaching the Unreached and are thus transferrable to other diseases of poverty.

Background: While pulmonary tuberculosis (PTB) remains a leading notifiable cause of death in China, city-level monthly forecasts with sufficient resolution to guide vaccine, drug and bed logistics are scarce, and no head-to-head comparison of classical time-series versus machine-learning strategies under identical epidemiological conditions has been published.

Methods: Using 168 monthly PTB case reports from Fuzhou (January 2009-December 2022) and an 24-month prospective validation set (2023-2024), we developed, tuned and independently tested three forecasting frameworks: seasonal ARIMA with automatic order selection, Facebook Prophet with multiplicative seasonality and change-point detection, and extreme-gradient-boosting (XGBoost) fed with 1-12 month lagged incidence, calendar and linear-trend covariates. Hyper-parameters were optimized by grid search and early stopping; accuracy was quantified with MSE, RMSE and MAE, while residual diagnostics, stationarity and white-noise tests assessed model adequacy.

Results: All algorithms fitted the training data closely (RMSE 25.11, 25.31 and 0.0258 cases; MAE ≤ 22 cases). However, on unseen data XGBoost achieved substantially lower prediction errors (RMSE 9.80; MAE 2.93; MSE 96.10) than ARIMA (60.43; 50.28; 3651.86) or Prophet (64.74; 54.49; 4191.86), correctly anticipating the observed 5.7% annual decline and progressively narrowing spring-summer double peaks. Prophet slightly over-estimated seasonal amplitude, whereas ARIMA accumulated trend extrapolation bias; XGBoost residuals remained approximately white noise.

Conclusions: For cities with nonlinear waning epidemics and seasonally contracting amplitude, machine-learning-based XGBoost offers superior extrapolation robustness over traditional ARIMA or Prophet approaches, providing an evidence-based tool for monthly PTB early-warning, precise resource pre-positioning and targeted control in comparable high-density, coastal urban settings.

Background: Wild edible plants (WEPs) are vital components of traditional food systems, supporting nutrition, health, and livelihood resilience in food-insecure and climate-vulnerable regions. In eastern Ethiopia, particularly the Somali Region, communities rely on WEPs to supplement diets and cope with seasonal food shortages. However, comprehensive documentation of species diversity, indigenous knowledge, and conservation challenges remains limited. This study assessed the diversity, use patterns, indigenous knowledge, and public health relevance of WEPs in Gursum District.

Methods: An ethnobotanical survey was conducted from February to December 2024 using semi-structured interviews, focus group discussions, guided field walks, and market surveys. A total of 100 informants, including 25 key informants, were selected through purposive and snowball sampling. Plant specimens were collected and identified using standard taxonomic references, with voucher numbers assigned. Quantitative ethnobotanical indices and statistical analyses (ANOVA, regression) were applied to examine knowledge distribution across socio-demographic groups. Focus group discussions were audio-recorded, transcribed, and thematically analyzed to complement quantitative findings.

Results: Forty-four WEP species, representing 30 genera and 17 families, were documented. Fruits (61%) and leafy vegetables (27%) were the most commonly consumed plant parts, while tubers and roots (12%) served as important famine foods. Women, elders, married individuals, and illiterate informants demonstrated significantly higher WEP knowledge (p < 0.05). WEPs contributed to dietary diversity, micronutrient intake, income generation, and resilience during food shortages. Major threats to their sustainability included overharvesting, land-use change, climate variability, and erosion of indigenous knowledge.

Conclusion: WEPs play a critical role in supporting nutrition, health, and food security in Gursum District. Integrating indigenous knowledge with conservation, nutrition, and public health strategies is essential to safeguard these resources and enhance community resilience in semi-arid regions.

Background: The percentage of the population sleeping under insecticide-treated nets (ITN) increased in sub-Saharan Africa from 3 to 59% between 2000 and 2023. However, achieving universal coverage remains far from realized. Because ITNs are the most effective tools for preventing malaria, it is important to identify barriers to their use and maximize their protective effects. We investigated sex and age disparities in ITN use in a region of western Kenya where Plasmodium transmission remains high.

Methods: We examined sex- and age-related disparities in ITN use under two scenarios: households with sufficient ITNs and those with insufficient ITNs, focusing specifically on households possessing only one ITN. Residents were asked whether they had slept under an ITN the previous night, as well as their age and sex. They were also tested for P. falciparum (PF) infection using a rapid diagnostic test (RDT).

Results: The proportion of residents using ITNs was 91% in households with sufficient ITNs and 66% in households with insufficient ITNs. ITN availability averaged 1.7 persons per net (SD = 0.35; n = 1445) in households with sufficient ITNs and 4.4 persons per net in households with insufficient ITNs. A generalized additive mixed model revealed non-linear relationships between ITN use and age in households with insufficient ITNs. Adult females aged 19-40 years and infants were consistently prioritized, whereas residents aged 3-18 years exhibited lower levels of ITN use. In contrast, this pattern was not evident in households with sufficient ITNs. Among households possessing only one ITN, RDT-positive prevalence was below 15% among infants and adult females, whereas it exceeded 30% among young males and females. Overall, ITN use was associated with a 20% reduction in PF infection.

Conclusions: In households with insufficient ITNs, adult females and infants were typically prioritized for ITN use. Given that PF infection was negatively associated with ITN use, such prioritization represents an appropriate allocation strategy under conditions of limited net availability. However, the low level of ITN use and the high prevalence of PF infection among young residents remain a substantial concern.

Background: As the population ages worldwide, ovarian cancer (OC) poses a serious public health issue for elder women. The objective of this study is to outline the global impact of OC in individuals aged 60 and above from 1990 to 2021, thus guiding specific policies and approaches for prevention, screening, and treatment.

Methods: A global secondary data analysis using the Global Burden of Disease (GBD) 2021 data was performed to estimate the burden and project future trends of OC in older women (aged 60 and above). We gathered data regarding incidence, mortality rates, and disability-adjusted life years (DALYs) from the GBD 2021. For trend analysis, we employed joinpoint regression to assess temporal variations, calculating the average annual percentage change (AAPC) to quantify these trends. Furthermore, we used the age-period-cohort (APC) model to examine the influences of age, time, and birth cohort on incidence, mortality, and DALY figures. Additionally, the Bayesian age-period-cohort (BAPC) model was applied to forecast changes extending to the year 2050.

Results: A worldwide assessment of the impact of OC on public health from 1990 to 2021 highlights notable patterns: the age-standardized incidence rate (ASIR) showed a net decrease; however, its estimated annual percentage change (EAPC) was positive, indicating an overall upward trend in annual rates over the period. In contrast, the age-standardized prevalence rate (ASPR), the age-standardized DALYs, age-standardized death rate (ASDR), and the age-standardized mortality rate (ASMR) have all shown a decline. The distribution of the disease burden shows considerable regional disparities, with uncertainty analyses indicating a sustained decline in regions with a high socio‑demographic index (SDI) and a corresponding increase in regions with low‑to‑medium SDI. Among older women (aged 60 and above), the disease burden demonstrates a disproportionate concentration in younger elderly subgroups: the 60-64 age group experiences the highest incidence and prevalence burden, while mortality peaks in the 65-69 age group. This pattern is particularly pronounced in regions such as South Asia and Central Europe. Risk factor analysis identifies high body mass index (BMI) at 21% and occupational asbestos exposure at 7% as the two major risk factors contributing to OC mortality. Projections based on the BAPC model indicate that by 2050, the global prevalence of OC will continue to rise, while incidence rates are expected to persistently decline.

Conclusions: The global fight against OC confronts dual challenges: increasing incidence rates and a shifting disease burden toward low- and middle-income regions. Future efforts must embrace targeted global strategies that integrate improved prevention, diagnosis, treatment, and chronic disease management.