Tropical Medicine and Health最新文献

We read the article "Fetal Femur Length and Risk of Diabetes in Adolescence: A Prospective Cohort Study" by Sayeed et al. with great interest. The authors present compelling evidence linking mid-trimester impaired femur growth with elevated prediabetic biomarkers in Bangladeshi adolescents. However, we believe the study would benefit from considering additional factors. Maternal gestational diabetes, a well-known risk factor for type 2 diabetes mellitus (T2DM) in offspring, and family history of diabetes, which reflects genetic predisposition, should be included. Socioeconomic factors, which influence health outcomes, also warrant attention. Including these variables would provide a more comprehensive understanding of the relationship between fetal femur length and T2DM risk in adolescents.

Background: Tungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents' treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting.

Methods: A cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants-410 adults who had experienced tungiasis-using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya.

Results: Factors significantly correlated with using non-guideline-listed treatments for tungiasis were 'not knowing the causse of tungiasis', 'not seeking treatment from healthcare facilities and traditional healers', and 'wait and see to prevent infection in non-affected members'. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was 'Someone else's idea'. The most frequently mentioned reason for choosing the best self-treatment option was 'Effectiveness'. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was 'Supply situation'.

Conclusions: Residents' socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents' tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis.

Background: Gestational diabetes mellitus (GDM) is any degree of glucose intolerance first recognized during pregnancy. GDM awareness among pregnant women translates into GDM prevention and early diagnosis.

Objective: To establish the underlying factors influencing GDM Knowledge Attitude and Practices (KAP) among pregnant women at Kinango District Hospital.

Method: An explanatory mixed-methods design was implemented by initially assessing GDM KAP quantitatively [QUAN], followed by the qualitative [qual] exploration of contextual factors behind quantitative results. In the [QUAN] strand, 354 pregnant women were interviewed from January to February 2019. Thereafter, in the [qual] strand, key informant interviews were conducted among four pregnant women and three healthcare workers; a focus group discussion was held among nine pregnant women, from May to June 2019. STATA V15 software package was used to analyze the quantitative data. Qualitative data were analyzed manually using thematic analysis.

Result: Among 354 pregnant women, 29.0% were knowledgeable, 46.98% had good attitude and 60.17% had good practice. Attending at least one antenatal clinic visit and having heard about diabetes mellitus were associated with good GDM attitude and practices. Among the knowledgeable pregnant women, one-third (33.33%) obtained GDM information from a health facility. Discussions with pregnant women and the interviews with healthcare workers highlighted that daily health talks during antenatal clinic, included GDM and diabetes mellitus information. Furthermore, attendance of at least one antenatal clinic visit was low (85.88%), among pregnant women (87.86%) who were expected to have attended at least one antenatal clinic visits.

Conclusion: Despite low GDM knowledge, pregnant women had relatively good GDM attitudes and good GDM practices. Daily health talks conducted during antenatal clinic as well as indigenous knowledge among pregnant women, influenced the latter. Hence, GDM information dissemination needs to be enhanced for the improvement of GDM KAP among pregnant women for GDM prevention.

Background: Early sexual debut is a widely recognized public health issue due to its influence on lifetime multiple sexual partners which can lead to complications such as teenage pregnancy, abortion, HIV/AIDS and other sexually transmitted infections. However, there is paucity of research evidence on sexual behaviour such as age at first sexual intercourse and the number of sexual partnerships among adolescent girls in Ghana. This study aims to examine the influence of age at first sexual intercourse and other determinants on multiple sexual partnerships among adolescent girls aged 15-19 years in Ghana.

Methods: Data for this study were obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 719 sexually active adolescent girls who reported having sexual partners was extracted from the women's data file. Data were analyzed with SPSS version 27, employing multilevel logistics regression modelling. Statistical significance was set at p < 0.05.

Results: The average age at sexual debut for adolescent girls aged 15-19 years in Ghana is 15.5 years. A little over half (51.6%) of adolescent girls reported having two or more lifetime sexual partners. Adolescent girls who initiated sex before reaching age 15 were more likely (aOR = 2.00; C.I 1.39-2.87) to have multiple partners compared to those who had their first sex before attaining age 20. After controlling for other factors, girls who had their sexual debut before age 15 had higher odds (aOR = 1.85; C.I:1.30-3.31) of engaging in multiple sexual partnerships. Girls living female headed households (aOR = 2.25; C.I:1.18-4.29] and consuming alcohol (aOR = 2.38; C.I 2.38-1.09-5.17) had higher odds of having multiple sexual partners.

Conclusion: The study findings show that early sexual debut, living in female headed household, and consuming alcohol are strong predictors of multiple sexual partnerships among adolescent girls in Ghana. It suggests the need for policies promoting delayed sexual debut and empowering adolescents to make informed decisions to improve sexual health outcomes.

Malaria remains a key health and economic problem, particularly in sub-Saharan Africa. The emergence of artemisinin drug resistance (ART-R) parasite strains poses a serious threat to the control and elimination of this scourge. This is because artemisinin-based combination therapies (ACTs) remain the first-line treatment in the majority of malaria-endemic regions in Sub-Saharan Africa. Certain single-nucleotide polymorphisms in the propeller domains of Plasmodium falciparum Kelch 13 protein (K13) have been associated with delayed parasite clearance in vivo and in vitro. These mutations serve as vital molecular markers for tracking the emergence and dispersion of resistance. Recently, there have been increasing reports of the emergence and spread of P. falciparum ART-R parasites in the Eastern Africa region. This necessitates continued surveillance to best inform mitigation efforts. This study investigated the presence of all reported mutations of K13 propeller domains in the parasite population in Busia County, Kenya, a known malaria-endemic region. Two hundred twenty-six participants with microscopically confirmed uncomplicated malaria were recruited for this study. They were treated with artemether-lumefantrine under observation for the first dose, and microscopic examination was repeated 1 day later after ensuring the participants had taken the second and third doses. P. falciparum DNA from all samples underwent targeted amplification of the K13 gene using a semi-nested PCR approach, followed by Sanger sequencing. The recently validated ART-R K13 mutation C469Y was identified in three samples. These three samples were among 63 samples with a low reduction in parasitemia on day 1, suggesting day 1 parasitemia reduction rate is a useful parameter to enrich the ART-R parasites for further analysis. Our findings highlight the need for continuous surveillance of ART-R in western Kenya and the region to determine the spread of ART-R and inform containment.

Background: Sub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.

Method: We used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.

Results: The pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28-55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07-2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51-1.60), rich women AOR = 1.26, 95% CI 1.24-1.29), women 35-49 years of age (AOR = 1.36, 95% CI 1.32-1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11-1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78-0.82), not having mass media access (AOR = 0.74, 95% CI 0.72-0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68-0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.

Conclusion: The sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.

Background: Dengue is a serious public health problem worldwide, including Panama. During the last years, the number of dengue cases has increased. This may be due to the presence of mosquito populations resistant to insecticides. The aim of this study was to characterize the resistance status, its enzymatic mechanisms and Kdr mutations in wild populations of Aedes aegypti and Aedes albopictus.

Methods: Standard WHO bioassays were performed using insecticide-treated filter papers to determine resistance in populations Ae. aegypti and Ae. albopictus to pyrethroids insecticides, organophosphates, to the carbamate propoxur and to the organochlorine DDT. Biochemical assays were conducted to detect metabolic resistance mechanisms and real-time PCR was performed to determine the frequencies of the Kdr mutations Val1016IIe and F1534C.

Results: The strains Ae. aegypti El Coco showed confirmed resistance to deltamethrin (78.5% mortality) and lambda-cyhalothrin (81%), Aguadulce to deltamethrin (79.3%), David to deltamethrin (74.8%) and lambda-cyhalothrin (87.5%) and Puerto Armuelles to permethrin (83%). Aedes aegypti El Empalme showed confirmed resistance to pirimiphos-methyl (62.3% mortality), chlorpyrifos-methyl (55.5%) and propoxur (85.3%). All strains of Ae. albopictus showed possible resistance to PYs and five strains to DDT. Only Ae. albopictus Canto del Llano showed confirmed resistance to pirimiphos-methyl (70% mortality) and malathion (62%). Esterase activity was variable across sites with the most frequent expression of α-EST compared to β-EST in Ae. aegypti populations. In Ae. Albopictus, the expressed enzymes were β-EST and MFOs. Through ANOVA, significant differences were established in the levels of enzymatic activity of α- and β-EST, MFOs and GST, with p < 0.001 in the Ae. aegypti and Ae. albopictus. The Kdr Val1016IIe mutation was detected in Ae. aegypti Aguadulce, El Coco and David. The odds ratio for the Val1016Ile mutation ranged from 0.8 to 20.8 in resistant mosquitoes, indicating the association between pyrethroid phenotypic resistance and the kdr mutation.

Conclusion: The presence of a varied and generalized resistance, enzymatic mechanisms and the Val1016IIe mutation may be associated with the intensive use and possibly misuse of the different insecticides applied to control Aedes populations. These results highlight the need to develop a program for resistance management. Also, alternative approaches to mosquito control that do not involve insecticides should be explored.

Background: Suboptimal water, sanitation, and hygiene (WASH) practices constitute a serious public health risk, affecting one-third of the world's population. Remarkable progress has been made to improve WASH; however, challenges remain, with rapid population growth adding pressure on WASH systems. This study explores the current state of WASH practices and diseases in Africa, identifies challenges, and proposes public health recommendations for sustainable implementation.

Main body: The staggering burden of WASH-related diseases in low- and middle-income countries (LMICs), particularly in Africa, threatens public health, with millions of deaths and disability-adjusted life years (DALYs) attributed to poor WASH practices annually. Notable challenges plaguing WASH practices in the region include poverty, malnutrition, poor data reporting, illiteracy, climate change, and poor healthcare financing. This results in adverse health consequences, including waterborne infections like cholera, typhoid, dysentery, and diarrheal diseases. Additionally, neglected tropical diseases (NTDs) such as intestinal worms, schistosomiasis, trachoma, lost productivity, and environmental pollution from soil and underground water contamination have been implicated. Geographical disparities, cultural norms, and inadequate funding further complicate efforts to improve WASH infrastructure and practices. Globally concerted efforts are required to address these issues and permit WASH practices to protect human health by preventing infectious diseases and contributing to economic growth. Strong financial frameworks, skills training, and tools like WASH Fit are recommended for a stronger WASH approach in Africa.

Conclusion: The consequences of poor WASH extend beyond public health, impacting economic growth, gender equality, and environmental sustainability. WaterAid's policy recommendations prioritizing government administration, institutional capacity enhancement, and more financial resources are expedient.

Background: Cytomegalovirus (CMV) is the most common congenital infection in pregnancy with potential long-term adverse effects on the fetus. There is limited data on CMV seroprevalence in pregnant women in Singapore, with last reported study dating back over two decades. We look at the latest CMV seroprevalence in antenatal population in Singapore.

Methods: Between January 2021 and August 2021, 385 pregnant women receiving antenatal care at Singapore General Hospital were randomly selected for CMV IgG test to be performed on their blood samples collected during the first trimester of their pregnancies. Positivity for CMV IgG represents past exposure prior to pregnancy.

Results: Overall CMV seroprevalence was 71.7% (276/385) (95% CI 067, 0.76, p value < 0.001). The trend of CMV IgG positivity increased with age, 68.3% (95% CI 0.60, 0.76, p value < 0.001) in those aged 20-29, 72.5% (95% CI 0.66, 0.78, p value < 0.001) in the 30-39 age group, and 79.0% (95% CI 0.67, 0.76, p value 0.012) in women over 40.

Conclusions: There is a declining trend in CMV seroprevalence among pregnant women in Singapore, which indicates that a substantial portion of this population faces the risk of primary maternal CMV infection during pregnancy. Emerging research suggests that prenatal treatment with valacyclovir effectively reduces the likelihood of vertical transmission. Considering this evidence, it is imperative to reevaluate the recommendations for universal maternal CMV screening during pregnancy.