Tropical Medicine and Health最新文献

Background: Enteric infections are a leading cause of preventable mortality in children under five, primarily driven by diarrheal diseases and invasive non-typhoidal Salmonella (iNTS). Despite global progress, substantial disparities persist in low- and middle-income countries, fueled by inadequate water, sanitation, hygiene (WASH), and malnutrition.

Methods: This study utilized data from the Global Burden of Disease (GBD) 2021 to analyze the spatiotemporal patterns of enteric infections in children under five across 204 countries from 1990 to 2021. The analysis included incidence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and socio-demographic index (SDI). Bayesian meta-regression tools, such as DisMod-MR, were employed for data harmonization. Descriptive statistics, Joinpoint regression, and Spearman's correlation were used to assess trends and associations between SDI and disease burden.

Results: In 2021, enteric infections caused 60,157.3 cases and 63.4 deaths per 100,000 children under five globally, reflecting a 68.6% and 77.7% decline since 1990, respectively. Low-SDI regions bore the highest burden, with mortality rates 166-fold higher than high-SDI regions. Diarrheal diseases accounted for 81.6% of deaths, while iNTS incidence increased in certain areas. Geographically, sub-Saharan Africa and South Asia were hotspots. Neonates had the highest incidence, with male mortality consistently exceeding females. Unsafe water, poor sanitation, and malnutrition contributed to 82.3% of attributable DALYs.

Conclusion: Enteric infections remain a critical threat to child survival. Achieving global health goals requires decisive, multisectoral interventions to address the root causes of these persistent and glaring inequities.

Background: While global estimates of SARS-CoV-2-infected mortality predominantly focus on in-hospital deaths, post-discharge mortality remains an overlooked contributor to the total disease burden, especially in low- and middle-income countries such as Bangladesh. This study aimed to estimate the 30-day post-discharge mortality rate among adult (≥ 18 years) patients with severe acute respiratory infection (SARI) who were SARS-CoV-2-infected and to identify factors associated with these deaths.

Methods: From March 2020-December 2023, we enrolled hospitalised adult meeting the World Health Organization  defiend SARI case defination across nine tertiary care hospitals in Bangladesh. We followed-up with patients or their family members 30-day post-discharge to ascertain survival status. We calculated the proportion of post-discharge deaths among SARS-CoV-2-infected patients and compared the demographic and clinical characteristics of decedents versus survivors. Data were summarised using descriptive statistics, t-test, Fisher's exact test, and Chi-square tests. We used multivariable Cox's regression models to calculate the adjusted hazard ratio (aHR) to identify factors associated with SARS-CoV-2-infected adult patient's deaths during 30-day post-discharge period.

Results: Among 7,816 patients enrolled [mean age 47 years (± 47.7), 62% male], 1,280 (16.4%) were SARS-CoV-2-infected. Of them, 126 (9.8%) died during their hospital stay. Among the 1154 patients discharged alive, 1,108 (96%) were successfully followed up, and 111 (10%) died within 30 days post-discharge. The most frequently reported symptoms among post-discharge decedents included difficulty breathing (105; 94.6%), body ache (55; 49.6%), headache (44; 39.6%), with over half (59; 53.1%) having at least one pre-existing condition. Post-discharge mortality was approximately fourfold higher among prematurely discharged patients (aHR: 4.13; 95% CI 1.52-11.23), nearly fourfold higher in those with difficulty breathing (aHR: 3.69; 95% CI 1.62-8.43), and more than threefold higher among patients with kidney disease (aHR: 3.35; 95% CI 1.34-8.38) compared with their counterparts.

Conclusions: Nearly one in five adult patients with SARS-CoV-2-infected SARI in Bangladesh died either during hospitalisation or within 30-day of post-discharge, with almost half of these deaths occurring after discharge. Study findings underscore the urgent need to strengthen discharge planning, such as developing and implementing standardised discharge guidelines, prioritising high-risk patients such as premature discharge for targeted post-discharge follow-up, and implementing structured post-discharge care interventions to reduce preventable mortality in resource-limited settings.

Background: Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogeneous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies.

Methods: We conducted a cross-sectional study to identify factors associated with infection of individual children and adults, and a nested case-control study to identify factors for whole households (families). Infected children were identified through mass-screening of children aged 8-14 years between January and March 2022 in 25 villages. Of the 1619 children screened, 210 infected and 358 uninfected children were randomly selected, and their households were enrolled into the study. Observations were made of the homesteads, and structured interviews were conducted with the caregivers. All adults and children in the households were examined. Mixed effect logistic regression analysis was used to identify factors associated with infection of individuals or households.

Results: We found children who lived in high-density settlements (manyattas) had more than three times the odds of being infected than those in more open, low-density settlements (adjusted odds ratio aOR 3.51, 95% CI 1.57-7.83, p = 0.002). To our knowledge, this is the first study to show an association of household infection (at least one case) with having a child with a disability (aOR 5.38, 95% CI 1.92-15.03, p = 0.001) and a caregiver who did not show affection to their child (aOR 1.79, 95% CI 1.02-3.13, p = 0.041). For individual adults, those who reported drinking alcohol had four times the odds of infection than those who did not (aOR 4.74, 95% CI 1.93-11.68, p = 0.001). Frequency of washing feet, soap use and house cleanliness were also associated with household infection.

Conclusion: Control programs should be developed together with the caregivers to enable them to reduce alcohol use, improve their childcare, hygiene and sanitation practices.

Background: The global tuberculosis (TB) epidemic imposes a substantial burden. As a high-burden country, China faces a significant gap from the World Health Organization (WHO)'s 2025-2030 TB prevention and control targets. This study analyzed the temporal trends of TB epidemiology in mainland China to provide an evidence base for the early achievement of TB control goals.

Methods: We integrated TB surveillance data (2004-2024) from the National Health Commission of the People's Republic of China and population data from the National Bureau of Statistics. Joinpoint regression was used to identify trend changes, with the average annual percent change (AAPC) quantifying trend magnitudes. Interrupted time series model was applied to assess intervention effects, and seasonal autoregressive integrated moving average models were employed to predict future incidence and mortality trends.

Results: A total of 19.4854 million cumulative TB cases and 508,000 cumulative deaths were reported during 2004-2024. The incidence rate decreased from 74.644 to 49.888 per 100,000 population (AAPC = - 2.83%, P < 0.001), showing a "winter peak and summer trough" pattern-with a 32.7% higher incidence in winter than in summer. The mortality rate first decreased and then increased: it declined immediately after the full coverage of Directly Observed Treatment, Short-course in 2010 but rose to 0.283 per 100,000 population after 2021. Projections indicate that the achievement rate of the WHO incidence target will be only 43.24% by 2025 (target: 31.708 per 100,000 population) and 39.48% by 2030 (target: 12.683 per 100,000 population). The mortality rate is projected to reach 0.333 per 100,000 population by 2030, compared with the target of 0.013 per 100,000 population.

Conclusions: Despite notable achievements in TB control in China, significant gaps remain from the WHO's targets. It is imperative to strengthen precision stratification-based prevention and control, establish a TB diagnosis and treatment guarantee mechanism, and implement remote supervision relying on informatization.

Background: Monitoring treatment response in pulmonary tuberculosis (TB) is critical, but non-invasive biomarkers are limited for patients unable to produce sputum.

Objective: To evaluate the utility of the PATHFAST TB LAM Ag assay in urine for diagnosis and treatment monitoring of pulmonary TB.

Methods: Nine patients with confirmed TB at the University Hospital of Larissa, Greece, were followed longitudinally. Urine samples were collected at treatment initiation and at weeks 2, 4, 8, 12, 16, 20, and 24. Lipoarabinomannan (LAM) concentrations were measured using the PATHFAST TB LAM Ag assay; values ≥ 10 pg/mL were considered positive.

Results: Urinary LAM positivity peaked between weeks 4 and 12. Three kinetic patterns emerged: (i) early pronounced decline in patients with high baseline LAM; (ii) modest decreases in intermediate baseline patients; and (iii) variable or rising trajectories in low-baseline patients. Patterns mirrored previously reported sputum LAM kinetics. One patient treated on clinical criteria alone showed baseline positivity, and two patients with non-tuberculous mycobacterial infection also tested positive.

Conclusions: Urinary LAM kinetics closely mirror sputum-derived patterns, supporting urine as a non-invasive specimen for serial TB monitoring. Interpretation of low-baseline results requires caution, and further studies with larger cohorts are warranted.

A reduction in U.S. foreign aid under the "America First" policy of President Donald Trump, who took office in 2025, has significantly impacted global health. As the world's largest provider of foreign aid, the U.S. has frozen development aid to evaluate its alignment with national interests. This has led to the termination of numerous international health programs, including those addressing malaria, HIV, tuberculosis, and polio, and has caused funding shortages for non-profit and international organizations like GAVI and the World Bank. Projections indicate dire consequences. According to USAID, a potential 18 million additional malaria cases and 166,000 deaths could occur annually. Paralytic polio cases are expected to increase by 200,000 per year, and new tuberculosis cases could rise by 10.7 million by 2030. Recent studies estimate that new HIV infections and between 770,000 and 2.93 million HIV-related deaths from 2025 to 2030. This crisis presents an opportunity for the global community to rethink its approach to aid. Other forms of financing, such as private sector investment, CSR activities, and innovative mechanisms like the Global Fund, could fill the gap left by reduced ODA. The article also stresses the importance of strengthening governance in recipient countries, promoting self-reliance, and fostering international collaboration through shared data platforms and multilateral programs. Ultimately, the document argues that providing foreign aid is not just a moral obligation, but is also in the national security and economic interest of donor countries, including the United States.

Somalia's recurring hunger crises are often viewed as emergencies that can be addressed by emergency food aid. In reality, chronic food insecurity now stems from structural fault lines-poverty, conflict, displacement, climate volatility, weak land tenure, under-resourced ministries, and fractured markets-that short-term food aid cannot repair. Today, 4.3 million Somalis face acute food insecurity, and more than 700,000 children are acutely malnourished, even though the country boasts a 3333-km coastline, fertile river valleys and a rich tradition of pastoralism and farming. Cycles of drought have decimated herds, forced pastoralists into urban slums, and eroded coping mechanisms, while conflict blocks access to productive land and drives up dependence on imports for over 80% of staple foods. Climate change is tightening this vise through erratic rains, scorching heat, and flash floods. To achieve sustainable food security, Somalia must shift from emergency relief to long-term investments in resilient and inclusive food systems. That means channelling at least five percent of public expenditure into irrigation, water harvesting, and extension services; securing land rights to spur on-farm investment; scaling early-warning and climate-smart technologies; and rebuilding rural infrastructure, cold chains, and digital marketplaces so smallholders can reach consumers. Nutrition gains hinge on diversifying production of fruits, vegetables, legumes, and animal proteins, linked to community health and education programs. A national Food Systems Coordination Council should align humanitarian and development actors with regional frameworks, while public-private partnerships unlock finance for Somali agribusiness innovations. Ending hunger is not only a humanitarian obligation; it is a prerequisite for stability, growth, and social justice. With political will, integrated governance, and sustained investment, Somalia can move beyond food aid, harness its land and heritage, and lay the foundation for a resilient, self-reliant future.

Background: Cutaneous leishmaniasis (CL) is a re-emerging neglected tropical disease (NTD) in Sri Lanka. The prevention and control of CL mainly rely on early detection and treatment. The WHO roadmap for NTDs highlights the importance of community-based approaches to reduce disease burden. Accordingly, our study aimed to design and evaluate the feasibility of a community-based intervention framework to improve early and appropriate health-seeking in CL in rural Sri Lanka.

Methods: We designed the intervention by integrating key principles of community engagement and involvement (CEI) with the first four steps of the Intervention Mapping approach, in a high-incidence area for CL, Anuradhapura, Sri Lanka. We followed the steps of developing a logic model of the problem (needs assessment), a logic model of change, and selecting theory-informed, pragmatic behavioural change strategies, resulting in the design of a culturally appropriate framework for the intervention. This framework was evaluated for feasibility across six domains: acceptability, implementation, practicality, adaptation, integration, and scalability. We involved community members and professional stakeholders at each step of this process.

Results: The needs assessment resulted in a logic model of problem, identifying multilevel behavioural, social, and structural determinants contributing to delayed health-seeking for CL. The logic model of change resulted in a matrix of change objectives, connecting the modifiable determinants, objectives and outcomes of the intervention. Theory-based change methods and corresponding practical strategies, including tailored health communication, participatory and entertainment-education activities, peer-led approaches, and capacity building of community members and professionals, were selected in collaboration with stakeholders. These outputs informed the development of the community-based intervention framework comprising four interdependent phases: community entry and contextual analysis, community sensitisation, community-led actions, and maintenance and sustainability. Feasibility assessment demonstrated high acceptability of the intervention across community and professional stakeholders. Implementation, practicality, adaptation, integration, and scalability were perceived to be context-dependent and influenced by local leadership, adaptive capacity, and multisectoral collaboration.

Conclusion: CEI-based, theory-informed, and evidence-driven approach offers a feasible and contextually appropriate intervention framework to improve health-seeking in CL in rural Sri Lanka. Our intervention framework can be recommended for pilot testing to inform refinement before broader implementation.

Background: Autochthonous leishmaniasis has become increasingly recognized in Thailand, with Leishmania (Mundinia) martiniquensis identified as the predominant species, particularly among immunocompromised individuals. Infected immunosuppressed patients often present with complex clinical features, which can delay diagnosis and complicate treatment. Given the limited clinical data available and emerging reports of resistant infections, improved awareness, prompt diagnosis, and optimized management strategies are urgently needed to address this underrecognized pathogen in Thailand.

Case presentation: We report two patients with advanced HIV disease (AHD) from Songkhla Province, Southern Thailand, who developed chronic diffuse cutaneous leishmaniasis characterized by widespread non-ulcerative papulonodular lesions that progressed to visceral involvement. Histopathological examination of the skin nodules showed prominent dermal fibrosis with infiltration by macrophages heavily parasitized with kinetoplast-containing amastigotes, consistent with cutaneous leishmaniasis. Molecular analyses identified L. martiniquensis as the causative agent in both cases. The parasite strains (WHO codes: MHOM/TH/2022/CULE7.1 and MHOM/TH/2022/CULE7.2) were successfully isolated from the bone marrow and cutaneous biopsy of the second patient before treatment. Furthermore, the parasite was isolated again from a cutaneous biopsy of the same patient after relapse, designated MHOM/TH/2023/CULE8. Due to the high costs of liposomal amphotericin B and the unavailability of miltefosine in Thailand, contrary to the WHO guideline recommending these as first-line therapy, patients received intravenous amphotericin B deoxycholate (AmB-D) combined with oral itraconazole. Despite repeated treatment with AmB-D and itraconazole, both patients relapsed, and Case 1 died. This raises concerns about drug resistance.

Conclusions: These cases illustrate complex cutaneous manifestations and therapeutic challenges of relapsing diffuse cutaneous and visceral leishmaniasis caused by L. martiniquensis in patients with AHD from Southern Thailand. The persistence and relapse despite AmB-D therapy raise concerns about emerging drug-resistant strains and underscore the need for enhanced surveillance, parasite isolation, and optimized treatment strategies for this neglected pathogen. Moreover, this report expands the understanding of the cutaneous spectrum of L. martiniquensis in patients with AHD, emphasizing the importance of including leishmaniasis in the differential diagnosis of complex skin diseases among immunosuppressed individuals, particularly in endemic areas.

Background: High seropositivity (40-60%) to hantaviruses among patients with chronic kidney disease of unknown etiology (CKDu) and relatively lower seropositivity (15-20%) among healthy individuals in CKDu endemic areas of Sri Lanka was reported, suggesting a possible link between hantavirus exposure and CKDu. However, only a few studies have been conducted in CKDu non-endemic areas. A recent study revealed the presence of two Thailand orthohantavirus (THAIV)-related viruses, Lanka virus (LNKV) and Anjozorobe virus (ANJZV) in Sri Lanka. This study was conducted in three districts that are predominantly CKDu non-endemic (Kurunegala, Matale, and Kegalle) to assess hantavirus seropositivity in the community.

Methods: A total of 760 human sera were collected from 2021 to 2022. Of the 760 samples, 486 were from community controls and 274 were from renal patients. Serum samples were tested using an indirect immunofluorescent antibody assay (IFA) based on both THAIV authentic antigens and recombinant N antigen. Positive sera were further tested with LNKV recombinant glycoprotein (rGP) and serotyped with LNKV and ANJZV recombinant Gn antigens.

Results: Seropositivity among the community participants of Kegalle, Kurunegala, and Matale districts was 8.6%, 10.5%, and 6.4%, respectively, while among renal patients, the rates were 4.3%, 17.2%, and 10%, respectively. Although no significant difference was observed between the community controls and renal patients, significantly higher seroprevalence in males (12.4%) than in females (5.9%) was observed. Of the 45 seropositive sera to rGP, 21 were serotyped as LNKV infection, and 2 were serotyped as ANJZV infection.

Conclusions: A total seropositivity in community controls in this study (8.8%) was lower than previously reported. These observations suggest that LNKV exposure occurs in CKDu non-endemic areas, but at a lower frequency than in CKDu endemic areas.