Tropical Medicine and Health最新文献

Background: Diarrheal diseases remain a major global public health challenge. Hand hygiene is one of the most cost-effective interventions for preventing the transmission of diarrheal diseases. However, billions of people around the world still lack access to soap and handwashing facilities.

Methods: Using the Global Burden of Disease (GBD) 2021 database, we quantified the burden of diarrhea attributable to a lack of access to handwashing facilities across 204 countries and territories from 1990 to 2021. We assessed disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), stratified by age, sex, Sociodemographic Index (SDI), and GBD region. Long-term trends were analyzed using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs). Potential non-linear associations were explored through locally weighted scatterplot smoothing (LOESS) regression.

Results: Globally, the age-standardized death rate (ASDR) from diarrhea attributable to the lack of handwashing facilities declined from 14.20 (2.10-26.04) to 3.04 (0.42-5.64) per 100,000 between 1990 and 2021, with an average annual decrease of 4.89% (4.64 to 5.14). During the same period, the DALY rate decreased by 76.6%, the YLL rate by 77.9%, and the YLD rate by 32.0%. In 2021, West and East Africa remained high-burden regions, with DALY rates exceeding 600 per 100,000. South Asia recorded the largest absolute number of deaths, with nearly 90,000 fatalities. Countries with low SDI exhibited an ASDR of 17.8 (2.51-33.44) per 100,000, approximately 60 times higher than that of high-SDI countries. Mortality risk was highest among boys under five, and the absolute number of deaths increased among adults aged ≥ 70 years. YLDs were consistently higher in females than in males. Projections suggest continued declines in burden through 2035, although at a slower pace, especially in low-SDI settings.

Conclusions: Although global diarrhea burdens tied to unavailable handwashing facilities have declined markedly since 1990, stark inequities persist across regions, age groups and development levels. Sustained expansion of WASH infrastructure, targeted hygiene promotion and strengthened surveillance are essential to accelerate progress toward zero preventable diarrheal deaths and universal health coverage.

Background: Nontuberculous mycobacteria are increasingly recognized as causes of chronic and refractory skin and soft tissue infections, even in individuals without immunodeficiency. Among them, Mycobacterium mageritense is a rare, rapidly growing species that can lead to persistent lesions requiring prolonged antimicrobial therapy. Reports of M. mageritense infections involving both the skin and regional lymph nodes are limited, and this case adds new clinical and genomic insights.

Case presentation: A 48-year-old previously healthy man presented with a slowly enlarging cutaneous lesion on his lower leg and ipsilateral inguinal lymphadenitis. Empirical antibacterial therapy with β-lactams and macrolides was ineffective. Wound cultures subsequently grew M. mageritense, confirmed by whole-genome sequencing. Several antimicrobial regimens were attempted, and the final successful therapy consisted of oral levofloxacin and minocycline for 4 months, leading to complete clinical resolution. Genomic analysis identified resistance-related genes, including erm(40), aac(2')-Ib, tet(V), and RbpA, although in vitro minimum inhibitory concentrations showed variable susceptibility. Phylogenetic comparison revealed that the isolate was closely related to previously reported M. mageritense strains from Japan.

Conclusions: This case demonstrates that M. mageritense can cause cutaneous infection with secondary lymphadenitis in an immunocompetent host. Accurate species identification using molecular or genomic methods and selection of appropriate combination antibiotic therapy based on susceptibility testing are crucial for successful management of such infections.

Background: Dengue fever (DF) is a viral disease caused by the dengue virus and is transmitted to humans by Aedes mosquitoes. It is characterized by symptoms such as high fever and severe headache, which can lead to severe complications. As there are no effective treatments or vaccines, prevention is crucial. This study aims to identify best practices from various countries for controlling Aedes populations and managing DF.

Methods: We reviewed best practices for DF and Aedes mosquito control from various countries, including Taiwan, India, Oman, Singapore, Malaysia, Sri Lanka, Indonesia, Pakistan, China, the Philippines, Japan, Brazil, Paraguay, France, Portugal, Spain, Peru, the United States, Colombia, Australia, and Iran. The PubMed database was searched until August 2024.

Results: Dengue outbreaks necessitate diverse control strategies across nations. Machine learning models incorporating climatic and entomological data improved outbreak prediction accuracy by up to 29%, while Wolbachia-based interventions reduced dengue incidence by 77% in urban trials. Community-driven programs enhanced preventive behaviors by 50-70%, and novel vaccines demonstrated > 94% efficacy against severe dengue. Challenges such as insecticide resistance and climate variability underscore the need for adaptive surveillance and cross-sector collaboration. Innovations in mobile health tools and sterile insect techniques further optimized vector control, achieving > 90% reductions in mosquito populations, compared with baseline densities before intervention.

Conclusions: Effective Aedes mosquito management against DF requires community engagement, surveillance, and innovative control methods. Successful strategies from selected countries highlight the importance of interventions, ongoing research, and public education to reduce disease risks. Continuous research, collaboration across sectors, and public awareness are necessary to reduce Aedes mosquitoes' risks and protect public health from vector-borne diseases.

Introduction: The global development discourse primarily emphasizes the vital role of international aid in post-conflict health systems and governance. Somalia's post-conflict health recovery has relied heavily on multisectoral aid that saved lives but entrenched parallel systems. While the national budget rose from ~ SOS 200 million (2015) to ~ SOS 1.3 billion (2025), the Ministry of Health's share remained ≤ 7%, leaving sustainability and local ownership at risk. Recent funding cuts have reduced food, health, and WASH services, heightening disease and malnutrition risks. This review examines the long-term impacts of multisectoral aid on Somalia's health system and governance, focusing on its effectiveness, sustainability, and unintended consequences.

Method: We conducted a narrative review (1990-2024; final search April 25, 2025) across PubMed, Scopus, Web of Science, Google Scholar, and gray literature (WHO, UNICEF, World Bank, USAID, FMoH). Using SANRA guidance, two reviewers screened 221 records plus prior evidence; 334 studies/reports were synthesized via hybrid thematic coding (NVivo) across five domains: aid-driven system development; aid-governance interactions; consequences of dependency; comparative insights; and sustainability pathways.

Results: Aid delivered tangible "fruits": expanded immunization and MCH coverage; high 2024 delivery performance (health 95% with US$69.8 M spent; nutrition 95.5% with US$73.9 M); and total donor inflows of ~ US$721.9 M fully deposited. However, most funds flowed off-budget through vertical programs and parallel supply/data chains, fragmenting governance and dampening state capacity. Despite the health share peaking at 7% (2023) and stabilizing near 6.8% (2025), cuts in 2025 curtailed essential services, leaving millions more vulnerable. Comparative cases (Liberia, Sierra Leone vs. South Sudan, Afghanistan) show sustainability improves when pooled funding, government payroll integration, and PHC-first strategies are adopted.

Conclusion: For Somalia to transition from aid dependency to sustainable health governance, a deliberate shift is needed by strengthening FMoH leadership, funding PHC, unifying systems, integrating staff into public payroll, and ensuring epidemic readiness.

Background: Diarrhea outbreaks including cholera have reached global highs this year. In the Democratic Republic of the Congo (DRC), there are estimated to be over 93 million diarrhea episodes annually. Effective and scalable water, sanitation, and hygiene (WASH) interventions are urgently needed to reduce diarrheal diseases in the DRC. Mobile health (mHealth) reminders have been shown to reduce disease morbidity and increase health-protective behaviors. Therefore, WASH mHealth programs present a promising approach to improve WASH behaviors.

Methods: The WASHmobile Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program is a targeted WASH intervention combining voice and SMS mHealth messages and quarterly in-person visits delivered to diarrhea patient households in DRC to reduce diarrheal diseases. During the randomized controlled trial of WASHmobile, 1196 participants received weekly WASHmobile program voice, Interactive Voice Response (IVR) quiz, and text messages over 12 months. Outcome indicators included % of unique voice, IVR, and text messages received (fidelity) and % of unique messages fully listened to (dose), assessed using the engageSPARK mobile message platform, and program reach to households assessed through monthly follow-up visits.

Results: Eighty-four percent of households received unique text messages and 90% of unique voice and IVR messages were answered. Households reported receiving a WASHmobile mHealth message in the past 2 weeks at 72% of surveillance visits (844/1177). Seventy-four percent (309/418) of participants reported sharing a WASHmobile mHealth message with another person at least once.

Conclusion: These findings show high fidelity, dose, and reach of mobile message delivery in the WASHmobile mHealth program. This study demonstrates the feasibility of delivering the WASHmobile PICHA7 program in eastern DRC and provides important insights for delivering WASH mHealth programing in low- and middle-income countries globally.

Trial registration: NCT05166850.

Background: Human immunodeficiency virus (HIV) testing during antenatal care (ANC) is pivotal for prevention of mother-to-child transmission (PMTCT), facilitating early initiation of antiretroviral therapy, infant prophylaxis, and retention in care. While coverage has improved globally, inequalities threaten progress towards Sustainable Development Goal (SDG) 3.3 on ending the AIDS epidemic. This study examined trends and inequalities in HIV testing uptake among pregnant women during ANC in Ghana between 2008 and 2022.

Methods: Data were drawn from the 2008, 2014, and 2022 Ghana Demographic and Health Surveys, comprising a pooled sample of 41,574 women aged 15-49 years who had given birth within two years preceding each survey. The World Health Organization's Health Equity Assessment Toolkit was applied to estimate Differences (D), Ratios (R), Absolute Concentration Indices (ACI), Population Attributable Fractions (PAF), and Population Attributable Risks (PAR) across equity stratifiers which include ge, education, marital status, residence, region, and wealth.

Results: The study found that the national coverage of HIV testing during ANC increased from 28.9% in 2008 to 61.0% in 2014 and 72.4% in 2022. Uptake improved among women with no education (18% in 2008 to 60% in 2022) and rural women (20-70%). Nonetheless, wealth quintile, uptake in 2022 ranged from 92.3% in the richest to 51.7% in the poorest; the ACI was 8.2% (95% CI 7.2-9.1) and PAF 27.5% (95% CI 27.4-27.5). Regional disparities were largest with Volta achieving 88.9% versus 32.8% in Savannah, with D rising from 39.7% in 2008 to 56.1% in 2022, while PAF fell from 70.1% (95% CI 69.8-70.3) to 22.7% (95% CI 22.7-22.8). Educational inequalities narrowed; PAF declined from 106.0% (95% CI 105.4-106.5) in 2008 to 34.8% (95% CI 34.8-34.9) in 2022. Age-related differences were negligible, with ACI 1.8% (95% CI - 0.6 to 4.2) in 2022.

Conclusion: Ghana has achieved substantial expansion of ANC-based HIV testing over the past decade. However, pronounced regional and socioeconomic inequalities remain. Targeted, equity-oriented interventions focusing on northern regions and poorest households are essential to prevent avoidable paediatric HIV infections and to sustain progress towards SDG 3.3.

Purpose: This study seeks to explore the COVID-19 vaccine coverage across various countries by delving into its connections to seven vital indicators, these include the Human Development Index (HDI), Gross National Income (GNI) per capita, health expenditure, Internet usage, political stability, absence of violence and their correlation with the vaccine coverage.

Measures: This study utilized a wealth of information from three valuable and publicly accessible data sources, such as Our World in Data, the World Bank, and the WHO database as of 20 March 2023. We then employed correlation analysis, linear regression, and structural equation modeling to examine the intricate relationships between various indicators and vaccine coverage, illuminating patterns at both national and continental levels.

Results: Our comprehensive research unveiled that on an average countries around the world achieved a 54.5 ± 24.61% of COVID-19 vaccine coverage rate. Six of the seven indicators emerged to have positive correlation with the COVID-19 vaccine coverage, and they are the HDI, individuals using the internet, current health expenditure, political stability and absence of violence/terrorism, total cases per million people, and the total deaths per million people. Among these, HDI stood out as the strongest correlated indicator, and conversely, the percentage of rural population emerged as a negatively correlated indicator in relation to the vaccine coverage.

Conclusions: These findings illuminate the formidable challenges associated with the quest for achieving universal vaccine coverage. In the future to address various pandemics globally, these insights emphasize the critical need for developing targeted strategies, fostering international collaboration and implementing comprehensive approaches to ensure that vaccines are fairly and equitably distributed and ultimately foster global immunity.

Brucellosis imposes persistent public health and economic burdens in Iran, yet multisectoral coordination remains limited. Drawing on three published studies, a stakeholder network analysis, a policy agenda-setting assessment, and a cost-of-illness evaluation, this correspondence synthesizes key evidence to identify structural, political, and financial barriers to effective control. Findings reveal fragmented stakeholder engagement, misalignment of problem-policy-politics streams, and a substantial proportion of affected households exposed to catastrophic health expenditure, highlighting major gaps in financial protection. The integrated evidence supports six priority actions, including establishing One Health governance, strengthening vaccination and veterinary capacity, enhancing community engagement, improving financial protection, increasing political prioritization, and expanding international collaboration. These measures are essential for sustainable brucellosis control in Iran.

Background: Entamoeba moshkovskii, a morphologically indistinguishable but genetically distinct species from E. histolytica, has recently emerged as a potential cause of human diarrhoeal disease. Despite its increasing global recognition, its epidemiological role, genetic diversity, and transmission dynamics remain poorly defined, particularly in the Indian subcontinent.

Methods: A prospective study was conducted among 300 hospitalised patients with acute diarrhoea in Northern India to determine the molecular prevalence and phylogenetic diversity of E. moshkovskii. Stool samples were examined microscopically and tested using a species-specific real-time polymerase chain reaction (PCR) assay targeting the 18S rRNA gene. Positive amplicons were sequenced bidirectionally and compared with global reference sequences to infer genetic relationships and lineage divergence.

Results: E. moshkovskii DNA was detected in 17 of 300 patients (5.7%; 95% confidence interval 3.3-8.9%), with higher detection among male and paediatric participants. Twelve isolates yielded high-quality sequences showing 99-100% identity with reference strains, while three exhibited a reproducible thymine-to-purine substitution at position 1655. Phylogenetic reconstruction revealed three major clusters-human, animal, and environmental-with most isolates forming a human-associated lineage and two clustering with non-human strains, suggesting cross-ecological transmission.

Conclusions: This study provides the first sequence-confirmed evidence of E. moshkovskii infection in Northern India and demonstrates emerging genetic diversity among clinical isolates. The coexistence of clonal and divergent strains highlights complex transmission pathways involving environmental and zoonotic reservoirs. These findings underscore the need to incorporate E. moshkovskii into molecular diagnostic algorithms and diarrhoeal disease surveillance within a One Health framework.

Background: Acute undifferentiated febrile illness (AUFI) represents a major health challenge in tropical regions due to its wide range of etiologies. In Villeta, Colombia, previous studies investigated common causes such as malaria, arboviral diseases, leptospirosis and rickettsiosis, as well as several neglected bacterial agents. However, some patients remained without an identified etiology, underscoring the need for broader approaches to uncover other potential causes. Therefore, the aim of the present study was to investigate into other potential bacterial causes of AUFI through advanced molecular strategies utilizing 16S rRNA sequencing.

Methods: The study analyzed AUFI patient samples previously screened for fourteen pathogens. The V3-V9 hypervariable region of the 16S rRNA gene was amplified from whole-blood DNA of unresolved cases and sequenced using the Oxford Nanopore GridION platform. Reads were filtered, quality-checked, and taxonomically classified using the SILVA database.

Results: Eight samples from individuals without evidence of infection or recent exposure to previously screened pathogens were selected for 16S rRNA sequencing. DNA quality and integrity were confirmed, and enrichment produced high-quality amplicons for all samples. Sequencing generated high-quality reads overwhelmingly dominated by Francisella, representing over 93% of classified reads, followed by Coxiella and Arcobacter.

Conclusions: This study provides the first molecular evidence of Francisella in whole-blood from febrile patients in Colombia. Findings highlight its potential role in AUFI, demonstrate the value of 16S rRNA barcoding, and underscore the need for expanded surveillance of highly neglected bacterial taxa.