Tropical Medicine and Health最新文献

Background: The Sto. Niño site in Benguet province, Philippines was once a mining area that has now been transformed into an agricultural land. In this area, there has been significant integration of the three indigenous people (IPs) Ibaloi, Kankanaeys and Kalanguyas with the Ilocano community. These IPs safeguard biodiversity and traditional knowledge, including medicinal plant use. However, the documentation of these plant species and their medicinal applications has not been systematic, with the resultant loss of knowledge across generations. This study aims to document the medicinal and ritual plants used by the indigenous communities at the site, in order to preserve and disseminate traditional medicinal knowledge that would otherwise be lost.

Methods: Ethnobotanical data were collected in Sto. Niño, Brgy. Ambassador, Municipality of Tublay, Benguet, Philippines, and collected through semi-structured interviews, together with focus group discussions (FGD). A total of 100 residents (39 male and 61 female) were interviewed. Among them, 12 were key interviewees, including community elders and farmers, while the rest were selected through the convenience and snowball technique. Demographic information collected from the interviewees included age, gender, and occupation. Ethnobotanical information collected focused on medicinal plants, including the specific parts of plants used, methods of preparation, modes of treatment, and the types of ailments treated. Ethnobotanical quantitative indices of the relative frequency of citations (RFC) and informant consensus factor (ICF) were calculated to evaluate the plant species that were utilized by the community.

Results: A total of 28 medicinal plants from 20 different families and 6 ritual plants from 5 different families were documented. Asteraceae, Poaceae, and Lamiaceae (10.71%) family are the most mentioned medicinal plant species, followed by Myrtaceae and Euphorbiaceae (7.14%). The most widely used growth form were herbs (46.4%), while leaves (61.5%) were the most utilized plant part, and the preparation of a decoction (62.2%) was the most preferred method of processing and application. The medicinal plants were most commonly utilized for wound-healing, cough and colds, stomachache and kidney trouble, whereas ritual plants were largely used for healing, protection, and funeral ceremonies.

Conclusion: This study marks the first report on the medicinal and ritual plants used by a group of indigenous communities in Sto. Niño, Brgy. Ambassador, Tublay, Benguet Province. The data collected show that plant species belonging to the Asteraceae, Poaceae, and Lamiaceae family were the most mentioned and should be further evaluated by pharmacological analysis to assess their wider use for medicinal treatment.

Background: Humanitarian crises increase the risk of mental health problems. Somalia has been affected by conflict, insecurity, and economic turmoil for over three decades, as well as climatic shocks. However, 80-90% of Somalis who have mental health problems do not have access to good-quality, and affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to have a holistic understanding of mental health problems and care in relation to people's perceptions, experiences, and behaviour related to mental health.

Methods: We undertook a qualitative study to explore Somalis' perceptions and experiences of mental health problems. We conducted three key informant interviews, two in-depth interviews, nine focus group discussions, 12 observations in private and public health facilities and more than 12 informal discussions. We used case vignettes translated into Somali during our discussion. We also studied three cases with experience of mental health problems to understand care-seeking behaviour and the experiences with services available.

Results: Somalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal support system exists in the community within clans or family relations. Armed conflict often among clans, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental problems is likely greater than is evident. It is perceived that about 95% of people suffering from mental illness remain outside of appropriate care. Few people seek care for mental health problems because they are not aware of it and because it is highly stigmatized and neglected. Those who do seek care usually go to traditional healers because of culture and cost. Resources for mental health care are grossly inadequate with a limited and often poorly trained workforce. At least two levels of barrier to mental health care exist, at the individual/family level (e.g. poor awareness of mental health and stigma) and service provider level (e.g. lack of staff and limited ability to diagnose, treat, or refer persons with mental health problems and stigma). No tool or evidence-based programme is available to address these barriers.

Conclusion: A qualitative data-driven mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health problems, there is also a need for a tool to raise awareness about mental health and the importance of mental health care among both the public and health workers.

Background: The current survey describes the seroprevalence, history of coronavirus disease 2019 (COVID-19), and vaccination status among predominantly aboriginal residents on a tourist island in southern Thailand. This information can be translated into COVID-19 vaccination and control plans for this population.

Methods: We implemented questionnaire interviews and collected blood samples from 249 residents of Lipe Island, Satun Province, in January 2022. We measured the anti-nucleocapsid protein and anti-spike (anti-S) receptor-binding protein levels of immunoglobulin (Ig) M and IgG. The differences in antibody levels among participants with different histories of vaccination and infection were analyzed using one-way analysis of variance with multiple comparisons.

Results: During the 2-year pandemic period, no island residents with COVID-19 required hospitalization despite the high prevalence of hypertension (33.3%) and diabetes mellitus (21.7%). Approximately 18.8% of the participants reported a history of COVID-19 diagnosis. In total, 95.1% of the participants had a history of complete vaccination, of which 93.5% were seropositive. The anti-S IgG geometric means (geometric standard deviation) were 3945.8 (2.0), 829.8 (9.7) AU/mL, 789.9 (5.3) AU/mL, and 22.7 (7.1) AU/mL, respectively, in participants with a history of both COVID-19 diagnosis and complete vaccination (group 1), incomplete vaccination and subsequent COVID-19 diagnosis (group 2), complete vaccination but no previous infection (group 3), or neither previous COVID-19 and complete vaccination (group 4). Significant pairwise differences in anti-S IgG levels were found between certain groups (1 vs 3, 1 vs 4, 2 vs 4, and 3 vs 4).

Conclusions: The high coverage of vaccination, high levels of population antibody titers, variable antibody levels among completely vaccinated non-infected residents, and high prevalence of non-communicable diseases (NCDs) suggested that the local health systems could control the pandemic. However, continuing surveillance, booster vaccinations, and NCD prevention programs were still required.

Background: Water, sanitation and hygiene (WASH) and child health interventions are proven simple and cost-effective strategies for preventing diarrhea and minimizing excess mortality. Individually, they are able to prevent diarrhea though sub-optimally, and their effectiveness when combined may be higher. This study examined the effect of integrated WASH and maternal and child health (MCH) interventions on prevalence of diarrhea, in a resource-limited setting in Kenya.

Methods: A controlled intervention was implemented in Narok County. The interventions included WASH interventions integrated with promotion of MCH. A structured questionnaire was used to collect data on targeted indicators before and after the interventions. Data were analyzed using descriptive statistics and Chi-square to establish the impact of the interventions.

Results: A total of 431and 424 households and 491 and 487 households in intervention and control sites, respectively, participated in the baseline and endline surveys. Following implementation of the interventions, prevalence of diarrhea decreased by 69.1% (95% CI: 49.6-87.1%) and 58.6% (95% CI: 26.6-82.4%) in the intervention and control site, respectively. Treatment of drinking water and animal husbandry practices were significantly associated with diarrhea post-interventions.

Conclusions: Integrating WASH interventions with other diarrhea control strategies and contextualizing them to meet site-specific needs may effectively prevent diarrhea.

Background: Actinomyces spp. are most commonly found in human commensal flora; however, they have also been shown to cause suppurative infections. We present a case of a rare Actinomyces funkei bacteraemia from an infected deep vein thrombosis in a patient who went on to develop pulmonary cavities secondary to septic emboli. Infected thrombi and septic emboli have been associated with other Actinomyces spp. in the literature, often posing a diagnostic challenge and, in some cases, causing drastic clinical deterioration in patients. The literature regarding Actinomyces funkei is scarce and to our knowledge there are no reports of a relationship between this Actinomyces subspecies and infected thrombi or septic emboli.

Case presentation: The patient was a 39-year-old known intravenous drug user who presented with a groin injecting site sinus and systemic symptoms. The bacteria was first observed by gram staining of a blood culture sample after 48 h of incubation and the species was identified using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) as Actinomyces funkei. Sputum cytology/histology with cell block revealed a branching gram-positive species suspicious of slow growing bacteria or fungus. CT imaging of his lower limb and chest revealed an extensive DVT with inflammatory changes and pulmonary cavities respectively. The patient was treated with Ceftriaxone before being discharged with a 6-month course of Linezolid. He made a good recovery with reduction in size of the cavitating lung lesions on follow-up imaging.

Conclusions: This case report presents a difficult-to-diagnose bacterial infection in an intravenous drug user, complicated by bacteraemia and secondary septic emboli. Relatively little is known about Actinomyces funkei, and therefore this report aims to increase clinician awareness of diagnosis, management, and complications.

Background: Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting.

Methods: This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.

Results: The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37-16.91% (16/157), HIV 19.1%, 95% CI 13.73-25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37-16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).

Conclusion: We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.

Background: Migrants are individuals who move to a different country from their usual place of residence. Japan's migrant population, particularly technical interns and students, has been growing. Even before the pandemic, previous studies have highlighted difficulties faced by migrants in utilizing healthcare services. This study examined the uptake of COVID-19 vaccination, testing, and medical care among Myanmar migrants in Japan; identified the factors associated with this uptake; and described the difficulties encountered when utilizing these services.

Methods: A cross-sectional study was conducted between March and April 2023 targeting Myanmar migrants over 18 years residing in Japan for more than 6 months. An online self-administered questionnaire in Myanmar language covered socioeconomic characteristics; history of COVID-19 vaccination, testing, and medical care; and difficulties encountered while utilizing these services with multiple-choice questions. Multivariate logistic regression analysis was performed separately to identify the factors associated with the uptake of COVID-19 vaccination, testing, and medical care.

Results: Among the 207 participants, 52% (n = 108) were under 30 years, 30% (n = 62) were male, and 31% (n = 65) were low-skilled workers (technical interns and students). Overall, 91% (n = 189) had received the COVID-19 vaccination, 76% (n = 157) had been tested for COVID-19, and 43% (n = 68) tested positive. However, only 77% (n = 52) of COVID-19 patients sought medical care. Participants under 30 years of age were less likely to receive the COVID-19 vaccine compared to those aged 30 and older (adjusted odds ratio [aOR] 0.10, 95% confidence interval [CI] 0.01-0.88, p = 0.038). Low-skilled workers were less likely to seek medical care compared to those holding other categories of residential status (aOR 0.12, 95% CI 0.02-0.79, p = 0.027). Among service users, 5% faced difficulties with COVID-19 vaccination, 10% with testing, and 17% with receiving medical care. Long waiting times and complex reservation processes were the main difficulties encountered.

Conclusions: The uptake of COVID-19 vaccination, testing, and medical care in this sample was reasonably good. However, individuals under 30 years of age showed lower uptake of vaccination, while low-skilled workers had lower uptake of medical care. Strengthening education and support for young migrants and low-skilled workers regarding COVID-19 and other infectious diseases is essential, especially in workplaces and educational institutions.

Background: While Plasmodium falciparum (Pf) stands out as the most lethal malaria parasite species in humans, the impact of other species should not be dismissed. Moreover, there is a notable lack of understanding of mixed-species infections and their clinical implications.

Methods: We conducted eight school-based cross-sectional malariometric surveys in the Lake Victoria region of western Kenya between January-February 2012 and September-October 2018. In each survey, a minimum of 100 children aged 3 to 15 years were randomly chosen from a school in Ungoye village on the mainland and as well as from each school selected in every catchment area on Mfangano island. Plasmodium infection was determined by microscopy and nested polymerase chain reaction (PCR). The multiple-kind lottery (MKL) model calculated the expected distribution of Plasmodium infections in the population and compared it to observed values using a chi-squared test (χ²).

Results: The Plasmodium prevalence was 25.9% (2521/9724) by microscopy and 51.1% (4969/9724) by PCR. Among all infections detected by PCR, Pf, P. malariae (Pm), and P. ovale (Po) mono-infections were 58.6%, 3.1%, and 1.8%, respectively. Pf/Pm, Pf/Po, Pm/Po, and Pf/Pm/Po co-infections were 23.5%, 4.3%, 0.1%, and 8.6%, respectively. MKL modelling revealed non-random distributions, with frequencies of Pf/Pm and Pf/Pm/Po co-infections being significantly higher than expected (χ² = 3385.60, p < 0.001). Pf co-infections with Pm and Po were associated with a decreased risk of fever (aOR 0.64, 95% CI 0.46-0.83; p = 0.01) and increased risks of splenomegaly (aOR 12.79, 95% CI 9.69-16.9; p < 0.001) and anaemia (aOR 2.57, 95% CI 2.09-3.15; p < 0.001), compared to single-species infections.

Conclusion: This study sheds light on the potential interaction between Pf and Pm and/or Po. Given the clinical significance of mixed-species infections, improved diagnostics, and case management of Pm and Po are urgently needed.

Background: Describing spatio-temporal occurrence and habitat characteristics of Aedes mosquito larvae is crucial for the control of Aedes borne viral diseases. This study assessed spatio-temporal abundance and habitat characteristics of Aedes larvae in the Southern Afar Region, Ethiopia.

Methods: Immature mosquitoes were surveyed in Awash Sebat, Awash Arba, and Werer towns of the Southern Afar Region once per month from May 2022 to April 2023. Larvae and pupae surveys were carried out along the available water-holding containers. The collected larvae/pupae were reared to adults and identified by  species/genus morphologically. The physical and chemical properties of the habitats were also characterized.

Results: A total of 9099 Aedes larvae/pupae were collected, of which 53.6% (4875) were from Awash Sebat, 29.5% (2687) from Awash Arba and 16.9% (1537) from Werer. Water-holding tyres harboured the highest number of Aedes larvae/pupae followed by water-storage drums. All the Aedes larvae/pupae reared to adults were morphologically identified as Aedes aegypti. The overall Container Index was 47.28%, House Index 18.19%, Breteau Index 59.94% and Pupal Index 171.94. Significant positive relations were observed in the occurrences of Ae. aegypti larvae/pupae with water-holding tyre (AOR = 15.89, CI = 3.55-71.09, p < 0.001), water storage drums (AOR = 19.84, CI = 4.64-84.89, p < 0.001), domestic habitat (AOR = 3.76, CI = 1.27-11.12, p = 0.017), and significant negative relations were observed with Ae. aegypti larvae/pupae occurrence and tap water source (AOR = 0.08, CI = 0.02-0.31, p = 0.001). Ae. aegypti larvae/pupae densities showed positive relations with dissolved oxygen (β = 0.523, p < 0.001) and total hardness (β = 0.475, p = 0.034) of water.

Conclusions: Diverse types of artificial water-holding containers were positive for Ae. aegypti larvae/pupae. Ae. aegypti larvae/pupae were abundant in used water-holding tyres, water storage drums, and cement tanks in Awash Sebat, Awash Arba, and Werer towns. This could  put the residents of the towns at high risk of infections with Ae. aegypti transmitted viral diseases such as chikungunya and dengue outbreaks. Thus, we recommend artificial water-holding container management as a strategy to control Ae. aegypti and hence the arboviral diseases transmission.

The number of dengue cases has increased dramatically in recent years. In Latin America, the number of cases and deaths in 2023 was the highest ever recorded. We report on a patient who had been infected with dengue virus during his stay in Costa Rica in September 2023, and developed the disease after returning to Japan. Plasma obtained from the patient was used for diagnosis and dengue virus serotyping by real-time PCR. The nucleotide sequence of the envelope region of dengue virus was then determined by the direct sequencing method, and this sequence was used for phylogenetic analyses. The patient was found to be infected with dengue virus type 3 genotype III. The sequence from the present case was more homologous with sequences registered in Florida, USA, associated with travel to Cuba in 2022 than with sequences registered in Costa Rica 10 years ago. The Pan American Health Organization reported that only dengue virus type 1 and 2 cases were reported in Costa Rica in 2019-2021, whereas dengue virus type 3 and 4 cases started being reported in 2022. In 2023, the reported numbers of cases with dengue virus types 3 and 4 exceeded those of dengue virus types 1 and 2. In addition, regional differences in endemic strains have been observed in Costa Rica. Our findings suggest that the dengue virus type 3 that infected the patient was more likely an influx of a strain that had been circulating in Caribbean countries such as Cuba in recent years, rather than a re-emergence of an indigenous virus in Costa Rica. The serotypes of dengue virus prevalent in Costa Rica have been changing since 2022. All four serotypes were prevalent in 2023, with a particularly sharp increase in the number of cases of dengue virus types 3 and 4. Future monitoring and surveillance are essential because changes in endemic serotypes can cause antibody-dependent enhancement, which can lead to severe dengue disease presentations.