Tropical Medicine and Health最新文献

Background: Coronavirus disease 2019 (COVID-19) pandemic in March 2020 led to new restrictive policies in several countries, including Indonesia. The comprehensive school health (CSH) framework provides overall guidance for interventions most effective in achieving specific outcomes related to health, nutrition, and education, and creating CSH programmes that account for the main contextual variations in Indonesian communities and schools is important. This study aimed to clarify how school health-related policies made before and after the COVID-19 pandemic responded to COVID-19 control measures on Lombok Island, Indonesia.

Method: This was a qualitative observational analytic study. Researchers reviewed and analysed school health policy, held separate confirmation discussions and interviews with stakeholders and key informants, and observed policy implementation at public and private schools in Mataram.

Results: The analysis found weaknesses and opportunities. Weakness included lack of guidelines, comprehensive planning, inconsistent hierarchy of roles and responsibilities, and social and cultural barriers. Opportunities included the importance of funding for consistent CSH implementation, monitoring and evaluation system, implementation between public and private schools, and decentralisation. Positive findings included CSH policy integration into teaching and learning activities, regular healthy school competition program, teachers as role models, existing coordination and distribution of responsibilities between relevant stakeholders, and authorising schools to make needed adjustments. Factors influencing school health efforts included curriculum, school organisation, personal ethos, and healthcare provider partnerships. To effectively promote school health efforts, schools must assess existing health problems within the school environment and surroundings, organisational structure and capabilities including knowledge and skills, commitment, and leadership aspects.

Conclusion: The COVID-19 pandemic has prompted the implementation of CSH policies in schools of Lombok Island, demonstrating flexibility and dedication to student welfare. Despite confusion due to changing regulations, collaboration with local health organisations and community support has resulted in effective policy implementation.

Background: Although the harmfulness of second-hand smoke (SHS) exposure to foetuses is well-established, literature reporting foetal outcomes in experimental studies is limited. This follow-up study on preventing SHS exposure among non-smoking Indonesian pregnant women at home was based on a randomised controlled trial involving the provision of comic booklets with stickers to couples. This trial examined differences in the birth outcomes of participating couples between the experimental and control groups, factors associated with paternal smoking behaviour, and association between birth outcomes and paternal-related outcomes.

Methods: In total, 197 neonates of 286 couples who participated in an original trial were included. This study compared birth outcomes between participating couples using a comic booklet with stickers to reduce SHS exposure at home during pregnancy as the intervention. Pearson Chi-square tests were conducted to investigate significant differences in neonate sexes between the experimental and control groups. Independent sample t-tests were used to check for significant differences in birth outcome data between the experimental and control groups. A multiple regression analysis was applied to test the correlation between paternal smoking behaviour and the birth outcomes.

Results: The gestational age in the experimental group was longer than the age in control group (mean difference = 0.373, Cohen's d = 0.291, 95% CI [0.010-0.57], p-value = 0.048). Pregnant women's avoidance of SHS strongly influenced paternal smoking behaviour in both the experimental group (b = 0.559, 95% CI [1.175-2.109], p-value < 0.001) and the control group (b = 0.429, 95% CI [0.675-1.567], p-value < 0.001). No associations were observed between birth and paternal behaviour outcomes.

Conclusions: The neonates' gestational ages were greater in the experimental group than in the control group because of our intervention effect; pregnant women's avoidance of SHS strongly influenced paternal smoking behaviour in both groups. Thus, the comic booklet intervention for smoking fathers with non-smoking pregnant partners helped reduce the risk of foetal developmental disorders. Couple-based interventions should be actively integrated into health worker strategies to effectively mitigate second-hand smoke exposure among pregnant women. Trial registration This study was registered in the UMIN Clinical Trials Registry under the registration number UMIN000035423 (01/02/2019).

This letter discusses the possibility of Takotsubo cardiomyopathy (TTC) as an alternative diagnosis in a recently reported case of acute myocardial infarction following a hump-nosed viper bite. The patient's presentation, including delayed chest tightness, elevated troponin, ECG changes, and normal coronary arteries, coupled with complete recovery within 3 months, strongly suggests TTC. Multiple case reports have documented the association between snakebites and TTC, with proposed pathophysiological mechanisms including sympathetic surge from pain and stress, direct cardiotoxic effects of venom, and inflammatory mediators during envenomation. The excessive catecholamine response may trigger transient cardiac dysfunction characteristic of TTC. Recognizing TTC as a potential complication of snakebites has important clinical implications, as its management and prognosis differ from acute coronary syndrome. Understanding this association may enhance diagnostic approaches and treatment strategies in similar cases, particularly when normal coronary arteries and complete cardiac recovery are observed.

Background: As the Lao People's Democratic Republic is nearing malaria elimination, asymptomatic malaria infections remain a challenge to address. Control measures focusing on symptomatic persons do not effectively work for asymptomatic infections which often go undetected by conventional diagnostic tools. It is therefore crucial to understand the burden of asymptomatic malaria for tailored interventions to eliminate the disease. This study assessed the prevalence of asymptomatic malaria infections with associated risk factors in an endemic district of Savannakhet province.

Methods: In March 2024, a cross-sectional study was conducted in three villages of Nong District. Blood samples were collected from the fingertips of the participants for Plasmodium parasite identification using microscopy and Loop-mediated Isothermal Amplification (LAMP); those aged 13 years and above were also interviewed. Mann-Whitney U test and Fisher's exact test were performed to compare the medians of different age and temperature groups and determine the association between predictor variables and outcome variables respectively.

Results: A total of 622 individuals participated in this survey; Plasmodium parasites were detected in 2.1% (13/622) of participants. The prevalence of asymptomatic malaria was 1.8% (11/622). Plasmodium vivax accounted for 15.4% (2/13) of all positive cases. The remaining species could not be identified. Farmers aged 15 years and above accounted for 81.8% of the asymptomatic infections. Ninety percent (90%) of the participants used bed nets in the village. Among interviewed participants, 23.6% reported not using mosquito bed nets in the forest; 21.3% of the participants who had been to the forest were nighttime forest workers.

Conclusions: This study revealed a prevalence of 1.8% of asymptomatic malaria infections in the study areas with the majority of the infections clustered among farmers, and an important proportion of these populations not using protective measures in the forest. These findings showed that malaria reservoirs are notable with a lack of use of protective measures, which could threaten malaria control and elimination efforts. Therefore, malaria elimination in Lao PDR by 2030 would need interventions targeting high-risk adult populations for screening with sensitive tools coupled with sensitization on protective measures and asymptomatic malaria.

Background: The widespread resistance of malaria vectors to traditional neurotoxic insecticides has stimulated the search for new insecticide classes with novel modes of action. For that, the present study was designed to collect data on the susceptibility of field-collected Anopheles gambiae sensu lato (s.l.) to clothianidin, a neonicotinoid insecticide used in agriculture and that recently received WHO approval for use in indoor residual spraying.

Methods: An. gambiae s.l. were collected as larvae and pupae from 18 sites located along the south-north transect of Benin, and reared to adulthood. Female mosquitoes aged 2-5 days were exposed to clothianidin-impregnated papers (2% weight by volume (w/v) of SumiShield™ 50WG dissolved in distilled water). Due to the delayed action of clothianidin, mortality was daily recorded over 7 days. Polymerase chain reaction was used to assess the molecular species composition in the An. gambiae s.l. complex and the frequency of knockdown resistance (kdr) and insensitive acetylcholinesterase (Ace-1^R) mutations.

Results: Mortality rates of field-collected An. gambiae s.l. were very high (≥98%) between 2- and 7-day post-exposure, indicating full susceptibility to clothianidin. Molecular species identification revealed the presence of An. coluzzii (53.7%), An. gambiae sensu stricto (s.s.) (42.5%), and An. arabiensis (3.8%) in the An. gambiae s.l. complex. kdr and Ace-1^R mean frequencies were 84% (95% CI 82-86) and 3% (95% CI 2-4) in An. coluzzii, and 88% (95% CI 87-90) and 4% (95% CI 3-6) in An. gambiae s.s., respectively.

Conclusions: Findings of the present study indicates that An. gambiae s.l. populations collected along the north-south transect of Benin remain susceptible to clothianidin. This broadens the portfolio of indoor residual spraying products that the national malaria control programme can deploy to better control pyrethroid-resistant populations of vectors.

Sclerosing cholangitis is a rare progressive cholestatic disease that is classified as secondary sclerosing cholangitis when it is caused by an identifiable cause. Sclerosing cholangitis has been linked to infections like COVID-19 and parasitic infections like Clonorchis sinensis and Ascaris lumbricoides. However, leptospirosis has not been linked to sclerosing cholangitis in the medical literature. In this article, we report a 37-year-old gentleman who was diagnosed with leptospirosis, worsened by painless cholestasis, while he was improving from leptospirosis. Magnetic resonance cholangiopancreatography revealed multiple short-segment biliary strictures, segmental dilatation, and mural irregularities in both intrahepatic ducts confirming the diagnosis of sclerosing cholangitis. After ruling out other potential causes and considering the initial presentation during a leptospirosis infection, we concluded that leptospirosis caused secondary sclerosing cholangitis. We report this as the first case of secondary sclerosing cholangitis in a leptospirosis patient without renal, respiratory, or cardiac complications, emphasizing the importance of ruling out this cause in a leptospirosis patient with persistent cholestasis.

Pharmacy-based vaccination (PBV) programs have proven to be a promising strategy for improving vaccination coverage, particularly in resource-limited countries. These programs increase accessibility and convenience, increase vaccination rates, and benefit vulnerable populations. However, successful implementation requires addressing gaps in regulatory oversight, pharmacists training, inter-professional collaboration, and public awareness. With proper regulatory frameworks, advocacy, enhanced training programs, public education, and establishment of well-designed database, PBV can achieve outcomes comparable to high-resource settings. This commentary aims to inform stakeholders and offer practical recommendations to minimize risks while leveraging its benefits.

Background: Yellow fever surveillance systems are designed to identify cases of acute febrile jaundice, a clinical syndrome used to monitor the emergence of yellow fever outbreaks. However, this syndrome has diverse etiologies, particularly viral hepatitis. This study investigates the seroepidemiology of viral hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) among cases initially suspected to be yellow fever, aiming to elucidate the epidemiology of viral hepatitis in the Democratic Republic of Congo (DRC) and provide insights for improving public health interventions.

Methods: A retrospective cross-sectional study was conducted using serum samples collected between 2017 and 2018 through national yellow fever surveillance in the DRC. Samples from individuals testing negative for yellow fever were tested for IgM antibodies against HAV, HBc, HCV, and HEV and HBs antigen using validated ELISA kits. Acute HBV infection was defined by both HBc IgM and HBs antigen positivity. Multivariable logistic regression was used to assess the association of demographic, geographic, and environmental factors with each hepatitis type.

Results: Among 1239 participants (58.8% male; median age: 16 years), seroprevalence was 16.1, 11.2, 5.0, and 3.1% for HAV, HBV, HCV and HEV, respectively. HAV prevalence was highest in the youngest age group and rural residents. In contrast, the youngest group was most protected from HBV. HCV prevalence was highest in the oldest age groups. HEV exhibited higher prevalence during the dry season and in a humid subtropical climate. Several provinces were identified as hotspots of HAV, HCV and HEV.

Conclusions: Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province.

Background: Brucellosis remains a persistent public health challenge in Iran, particularly in rural regions such as Lorestan province, due to systemic, economic, and cultural barriers. Effective disease control requires multisectoral collaboration among stakeholders. This study aimed to map the stakeholder network involved in brucellosis prevention in Lorestan province, identify gaps in coordination, and provide actionable recommendations for improving control strategies.

Methods: This cross-sectional study employed social network analysis (SNA) to explore the relationships among key stakeholders in brucellosis prevention. Data were collected through a structured questionnaire administered to 75 experts from various sectors, including health, veterinary, agriculture, and non-governmental organizations. The SNA evaluated network density, clustering coefficient, and centrality metrics to determine the levels of collaboration and influence among stakeholders.

Results: The analysis revealed a moderately dense network (density: 0.2745; clustering coefficient: 0.2839) with central roles played by the Veterinary Organization of Lorestan Province, Lorestan University of Medical Sciences, and the Ministry of Agriculture. These organizations exhibited high levels of influence, support, and interest in brucellosis prevention. However, limited involvement of community-based organizations and environmental agencies was identified, highlighting a critical gap in grassroots engagement. Fragmented coordination was particularly evident in rural areas, where traditional livestock practices, inadequate veterinary services, and the consumption of unpasteurized dairy products perpetuate disease transmission. Economic constraints, such as the high cost of vaccines, along with limited public awareness, further hinder effective control efforts.

Conclusions: Brucellosis prevention in Lorestan province requires a comprehensive, multisectoral approach. The adoption of a One Health framework can improve collaboration among stakeholders, enhance resource allocation, and address systemic barriers. Community engagement and intersectoral coordination are essential for improving public awareness and compliance with preventive measures. These findings provide a foundation for developing a National Brucellosis Control Program and inform strategies to mitigate zoonotic diseases in similar high-risk regions.

Objective: This research reports the incidence, mortality, and disability-adjusted life years (DALYs) associated with urinary tract infections (UTIs) in the Middle East and North Africa (MENA) region, stratified by sex, age, and Socio-demographic Index (SDI) from 1990 to 2021.

Methods: Data were sourced from the Global Burden of Disease 2021 study, encompassing all 21 countries in the region. Metrics such as absolute counts, age-standardised rates, and percentage changes from 1990 to 2021 are presented with 95% uncertainty intervals (UIs).

Results: In 2019, the MENA region recorded an incidence rate of 4,033.4 per 100,000 (95% UIs: 3,553.7-4,548.7) and 7,687 deaths (95% UIs: 6,663-8,969). The DALY rate was 41.3 per 100,000 (95% UIs: 36.1-47.2), which was highest among older adults, reaching a peak in the 80-89 age range, and increasing with age, particularly from the 50 + age groups. A non-linear relationship was identified between the burden of UTIs and the SDI, with higher-than-expected rates in lower SDI countries such as Syria and Lebanon.

Conclusion: Despite a substantial increase in the total number of UTI cases and DALYs in the region from 1990 to 2021, the age-standardised rates remained stable. The larger burden in lower SDI countries highlights the urgent need for targeted public health interventions. Improving healthcare access and antibiotic stewardship is crucial to mitigating the growing burden of UTIs, particularly among older populations in the region.