Tropical Medicine and Health最新文献

Background: Despite policy commitments to equitable healthcare, the Democratic Republic of the Congo (DRC) continues to experience significant disparities in child health outcomes. While national health policies formally express support for equity in access to health services, there is limited evidence on the extent to which they incorporate the core concepts (CCs) of equity. This study assessed the extent to which equity is embedded in child health policies.

Methods: The EquiFrame framework was used to analyse five child health policy documents selected based on their recency, public availability, and strategic relevance. In this study, 16 equity-related CCs were employed to evaluate both the extent of their coverage and the quality of the commitment demonstrated across the selected policy documents. Each document was analysed and ranked as low, moderate, or high in addressing equity-related CCs.

Results: The National Strategic Plan to Combat Malaria is the only policy document that achieved a high equity rating. The remaining documents were ranked as moderate. Overall, 44% of equity concepts were consistently included across all reviewed documents. While Access, Prevention, Quality, Capacity Building, Integration, and Participation were the most frequently addressed equity-related CCs, critical concepts such as Non-discrimination, Cultural Responsiveness, and Individualized Services were completely omitted. In most cases, the policy frameworks lacked the operational detail, clearly defined measurable actions and robust monitoring mechanisms required to achieve a meaningful impact.

Conclusion: This study revealed significant gaps in addressing equity in child health policies in the DRC. Future policies should systematically incorporate all equity-related CCs, accompanied by clear, measurable actions and robust monitoring frameworks. Strengthening these components is essential to advance equitable access to child health services and ensure that all children, regardless of background or circumstance, can achieve their full health potential.

Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stages of the cestode Echinococcus granulosus sensu lato (s.l.). The spread of CE results in significant economic and health damage to endemic regions. Despite its importance, there is a paucity of information regarding CE in West Africa. However, case reports from West African immigrants and refugees suggest the potential disease risk for humans in the region. Research on the prevalence of CE in livestock is also limited, with the figures showing considerable variation by year and location. Genetic studies of parasite samples in Nigeria, Mali, Mauritania, and among immigrants in Europe have predominantly identified the G6 and G6/7 genotypes of E. canadensis, which mainly infect camels. The G1 genotype was also identified in camels in Nigeria and immigrants from West Africa. As the intermediate hosts, camels are the major factor contributing to CE in West Africa. Furthermore, the infection rate in dogs, the definitive host, is 0.5-12.3% in the study area. Notably, the life cycle of the parasite is sustained by stray dogs that interact with animal carcasses and improper slaughterhouse waste disposal. Echinococcus is present in humans and animals in West Africa. It is critically important to enhance veterinary training and public health education, as well as maintain surveillance systems, to prevent human CE cases and economic damage in West Africa.

Background: In the context of intensified malaria control efforts in Burkina Faso, this study assessed i) the insecticide resistance status of Anopheles gambiae sensu lato and ii) key entomological indicators of malaria transmission in Bobo-Dioulasso.

Methods: World Health Organization-standard susceptibility bioassays were conducted on Anopheles populations collected from six neighborhoods (Kua, Sarfalao, Sabaribougou, Dogona, Farakan and Kodeni). The bioassays tested six insecticides organochlorines (4%dichlorodiphenyltrichloroethane), organophosphates (1.25% pirimiphos-methyl), pyrethroids (0.75%permethrin, 0.05% deltamethrin, 0.05% alpha-cypermethrin), and carbamates (0.1% bendiocarb). Synergist bioassays using piperonyl butoxide (PBO) were also performed to investigate metabolic resistance mechanisms, and Plasmodium infection rates were determined via Polymerase Chain Reaction.

Results: Overall, data revealed high resistance levels to dichlorodiphenyltrichloroethane and pyrethroids, which are associated with moderate or higher frequencies of knockdown resistance mutations (L995F and L995S). Fortunately, a susceptibility to bendiocarb and pirimiphos-methyl was found in the majority of localities. The restoration of pyrethroid susceptibility following piperonyl butoxide pre-exposure suggests the involvement of metabolic resistance mechanisms. Analysis of 622 specimens from the Anopheles gambiae complex revealed a predominance of An. arabiensis (90.8%), followed by An. gambiae s.s. and An. coluzzii. Sporozoite infection rates varied by species, reaching 45% in An. coluzzii, 27.4% in An. arabiensis, and 16.2% in An. gambiae s.s. The overall entomological inoculation rate (EIR) was estimated at 10.6 infectious bites per person during the study period. Anopheles arabiensis contributed most of these bites (91.2%), highlighting its central role in malaria transmission in Bobo-Dioulasso.

Conclusions: Despite insecticide resistance, Anopheles populations exhibited high Plasmodium infection rates, indicating ongoing transmission. These findings emphasize the urgent need for sustained entomological surveillance and resistance management to guide and optimize insecticide-based malaria control strategies.

The global diphtheria incidence has fallen following widespread use of the diphtheria-tetanus-pertussis (DTP) vaccine; pockets of low coverage and disrupted health services continue to fuel outbreaks. Somalia, already challenged by conflict-related displacement and fragile health infrastructure, declared a national diphtheria outbreak on 19 August 2025. We analysed weekly case-based surveillance data reported through Somalia's Integrated Disease Surveillance and Response (IDSR) system and the DHIS2 electronic platform (Epi-weeks 1-33, 2025) on the platform. Vaccination-coverage trends were extracted from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC, 2000-2024). Supplementary information was obtained from the Ministry of Health situation reports and partner briefs. By Epi-week 33 (ending 17 August 2025), 1811 suspected diphtheria cases (17 laboratory-confirmed) and 89 deaths were recorded (case-fatality rate 5%). Children < 5 years accounted for 56% of cases; 87% of patients had no documented diphtheria immunization. Weekly incidence accelerated sharply after Epi-week 20, with the largest surges in Puntland, South-West State and the Benadir Regional Administration. DTP-1 coverage increased from 40 to 60% (2000-2018) to 79% in 2022 but plateaued at 70% in 2024; DTP-3 coverage reached 71% in 2022 yet remains insufficient for herd protection. Despite targeted ring vaccination and distribution of diphtheria antitoxin (DAT), constrained vaccine and DAT supplies, insecurity, and access barriers hamper outbreak control. Somalia's diphtheria resurgence underscores how conflict, displacement, and uneven immunization can reverse hard-won gains against vaccine-preventable diseases. Closing routine-coverage gaps, guaranteeing timely DAT and antibiotic access, expanding real-time surveillance, and intensifying community engagement are urgent priorities to halt transmission and avert additional deaths. Prompt mobilization of national leadership, donors, and technical partners is essential to contain the outbreak and restore progress toward diphtheria elimination.

Introduction: Malaria remains a significant public health challenge among pregnant women in sub-Saharan Africa (SSA). Proper use of insecticide-treated nets (ITNs) is a key intervention for malaria; however, their utilisation remains low and suboptimal in high-burden countries. Investigation of correlates of use of ITNs among pregnant women in only high-burden malaria countries SSA are dearth. This study aimed to identify the pooled prevalence and factors associated with ITNs use among pregnant women in seven malaria high-burden countries in SSA.

Methods: Secondary analysis of recent (2017-2021) Malaria Indicator Survey (MIS) data from seven malaria high-burden countries in SSA was utilised. Women aged 15-49 years, who were pregnant during the survey, were included in this study, resulting in a pooled sample size of 4950 women. Pooled prevalence of ITN use was obtained through the use of proportions, with a 95% confidence interval (CI). A multilevel mixed-effect logistic regression model was run to obtain factors associated with ITNs use among pregnant women at 5% level of significance. Data analysis was done in Stata v17.0 and R 4.5.0.

Findings: The pooled prevalence of ITNs use among these countries was 63.8 [95% CI 61.8, 65.9], low in Ghana (49.2%) and high in Niger (90.5%). Having a primary level of education [aOR = 1.36, 95% CI 1.21, 1.53] compared to those with no formal education, having given birth to one to two children [aOR = 1.24, 95% CI 1.06, 1.44] compared to those with no births yet were associated with higher odds of ITN use. 14% of the total variation in ITN use was attributable to differences between countries [intra-cluster correlation (ICC) = 0.14, 95% CI 0.06, 0.20] and 32% of the variation in ITN use within countries is attributed to differences between regions [ICC = 0.32, 95% CI 0.21, 0.46].

Conclusions: The prevalence of ITN use was suboptimal, and socio-demographic and household factors are associated with ITN use among pregnant women, with substantial in-country variation underscoring the role of regional context in ITN utilization. These findings suggest that beyond individual and household determinants, local and regional contexts play a critical role in shaping ITN usage patterns. Interventions should, therefore, be tailored not only to socio-demographic profiles but also to regional and local disparities in access, awareness, and implementation effectiveness.

Introduction: Interventions to improve handwashing with soap have shown mixed effects on behaviour which may be due to contextual differences in different settings. Low-income settings have complex socio-economic conditions which requires local contextual adaptation to support intervention adoption. Detailing the development of an intervention can inform other researchers and practitioners on best practices, and it enables replicability and scalability.

Methods: This study adopted the Trials of Improved Practices (TIPs) approach and incorporated co-creation and co-design of interventions with stakeholders. A total of 56 participants were randomly selected and an initial survey was conducted. The development process entailed stakeholder engagements and educational activities. Educational activities were delivered through household-level visits and community dialogue sessions. Qualitative data were collected throughout the process using in-depth interviews. A survey was conducted after the educational activities to assess availability of handwashing facilities and handwashing with soap practices. Logistic regression was used to estimate the effect of independent variables on availability of handwashing facilities and on handwashing with soap, and McNemar's test was used to evaluate if the interventions improved handwashing practices. Qualitative data were analysed thematically, and the findings explained the process and the effect of the interventions.

Results: Initial survey results showed that 59% of handwashing facilities were not at a fixed location, and only 21% of respondents reported handwashing with soap. Households with a fixed handwashing facility had 5.3 times higher odds of handwashing with soap compared to households with mobile handwashing facilities (P = 0.02 CI 1.32-21.23). Participating households made improvements by designating handwashing facilities at the compound level and separate handwashing facilities at the household level. Access to fixed handwashing facilities increased from 10 to 77%, and reported handwashing with soap among respondents significantly increased from 21 to 64% after the education activities (McNemar's X²(1) = 12.46; P = 0.00). This improvement in handwashing was attributed to the educational visits and practical demonstrations and was motivated by improved hygiene conditions in the households.

Implications: Households can improve reported handwashing with soap if they are provided with the necessary skills for making improvements. This approach could serve as a model for future public health initiatives aimed at improving hygiene practices in similar settings.

Background: Diarrhea is a common cause of morbidity and mortality, and its incidence worldwide has changed little over the past four decades. Therefore, to estimate the disease burden of diarrhea, this study aimed to assess the prevalence, risk factor, and determinants of health-seeking behavior in people with diarrhea in Chongqing.

Methods: This cross-sectional study was conducted in Chongqing, China, between May and June 2024. An online questionnaire was used to survey respondents' demographic information, experience of diarrhea symptoms, and treatment-seeking behaviors in the past 6 months (from October 2023 to April 2024). Descriptive statistics, univariate and multivariate logistic regression analyses were used to summarize the data and identify the possible determinants of medical treatment-seeking behaviors.

Results: Among 27,150 respondents, 7.98% were young children (≤ 5 years). Diarrhea prevalence was 25.38% overall, and higher among children ≤ 5 years (29.5%) and adults ≥ 60 years (26.7%). Only 23.23% (1601/6891) of diarrhea cases sought medical care, primarily due to perceived mild severity or treatment unnecessary. Higher odds of healthcare-seeking behaviors were observed in children aged ≤ 5 years, rural residents, and those with higher household incomes (particularly ≥ 12,000 yuan). Proximity to primary healthcare facilities (< 1 km), poorer self-rated health, fewer diarrhea episodes, more severe symptoms, longer duration of illness (especially ≥ 7 days), and greater perceived impact of diarrhea were also positively associated with healthcare-seeking behaviors. The main reasons individuals with diarrhea did not seek medical care were that they felt their condition was not serious and that a visit to a medical facility was unnecessary (71.40%).

Conclusion: Diarrhea is highly prevalent in Chongqing, especially among young children and the elderly, coupled with a low rate of medical seeking. The findings underscore the influence of socioeconomic, geographic, clinical severity, and perceptual factors on healthcare-seeking behavior. Targeted interventions should focus on high-risk groups and improving accessibility and awareness to encourage appropriate care for diarrhea.

Background: The Immunization Agenda 2030 (IA2030), led by WHO and partners, targets the global challenge of zero-dose children, who face higher risks of vaccine-preventable diseases. Globally, 18 million children remain zero-dose, with over half in conflict or humanitarian settings. In Somalia, about 60% of children are zero-dose, and during the 2022-2024 drought, over 70,000 deaths occurred, with nearly 40% among children under five. This review explores the burden, determinants, and geographic distribution of zero-dose children in Somalia's conflict-affected regions.

Methods: This narrative review followed SANRA guidance. We searched PubMed, Scopus, Web of Science, Google Scholar, and key institutional sites (WHO, UNICEF, ReliefWeb, MoH Somalia, NGOs) for English-language literature (1990-July 31, 2025). From 197 records were identified, 82 new studies were included, resulting in a total of 279 studies after de-duplication and two-reviewer screening. Evidence was synthesized thematically and aligned to Immunization Agenda 2030 (IA2030) priorities.

Results: Zero-dose hotspots are concentrated in rural, nomadic, and conflict-affected zones, with Lower Juba reaching a peak of 62%. Key challenges include insecurity, limited access, disrupted supply chains, workforce shortages, and demand-side barriers like mistrust and misinformation. Humanitarian efforts are frequently hindered by checkpoints, blockades, and security concerns. From 2000 to 2024, Somalia's routine immunization program showed significant progress, with MCV-1 coverage rising from 50 to 71%, and MCV-2 from 5 to 55%, as per the WHO/UNICEF WUENIC data for the African region.

Conclusion: Zero-dose children in inaccessible Somali districts are a pressing equity and health-security challenge. Sustaining recent national gains while fulfilling Immunization Agenda 2030 (IA2030)'s "leave no one behind" requires tailored outreach to remote communities, strengthened surveillance and e-registries for defaulter tracing, resilient cold-chain and WASH linkages, empowered community health workers (especially women), negotiated humanitarian access, and a progressive domestic co-financing roadmap alongside partner support.

Chikungunya, a mosquito-borne disease, has become a global public health concern. In 2025, an imported chikungunya case was detected in Foshan, Guangdong, followed by local spread. This study analyzed the spatiotemporal evolution of this outbreak using data from official channels. Measures like enhanced mosquito control, expanded nucleic acid testing, and activation of emergency response were implemented. As a result, the epidemic was effectively controlled, with no severe cases reported. This work provided valuable insights into chikungunya prevention and control strategies, highlighting the importance of a full-chain prevention-emergency-treatment system for future global efforts.

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (ALRTIs) in infants and young children worldwide. While its epidemiology is well-characterized in temperate climates, data from subtropical regions such as Okinawa, Japan, remain limited. This study aimed to describe the clinical and demographic characteristics, risk factors, and seasonality of moderate-to-severe RSV infections in children under 5 years across Okinawa.

Methods: This retrospective, multicenter study analyzed pediatric cases of laboratoryconfirmed RSV infection requiring hospitalization between April 2017 and March 2021. Data were collected from four core hospitals across Okinawa Prefecture. Patients were categorized as having moderate or severe disease based on ICU admission status. Demographic variables, underlying diseases, household and childcare characteristics, and seasonal trends were assessed.

Results: A total of 1541 hospitalized RSV cases were included, of which 117 (7.6%) were classified as severe. Overall, 89.0% were under 24 months of age, with the highest burden in the 0-2 month group. In univariate analysis, severe cases were significantly younger, more likely to have siblings, and less likely to attend nursery school compared with moderate cases. The overall prevalence of underlying diseases did not differ between groups; however, having two or more underlying diseases was significantly associated with severity. Multivariate logistic regression confirmed younger age, the presence of siblings, and underlying diseases (both any and multiple) as independent risk factors for severe infection. Seasonal peaks occurred consistently in summer during 2017-2019. In contrast, in 2020, coinciding with the onset of the COVID-19 pandemic, the epidemic curve became broader and peak timings varied across hospitals. Overall, the total number of cases decreased by 62% compared with the pre-pandemic average.

Conclusions: This study provides a comprehensive region-wide assessment of moderate-to-severe pediatric RSV infections in a subtropical setting in Japan. Despite not including data on the use of palivizumab, nirsevimab, or maternal vaccination, the findings provide essential baseline data to guide the implementation of new preventive strategies tailored to local epidemiology.