Tropical Medicine and Health最新文献

Introduction: The International Health Regulations (2005) (IHR) mandate global health security through core capacities, yet Somalia's 48 Points of Entry (PoEs), including airports, seaports, 12 domestic airports, 6 international airports, and land borders, lack essential infrastructure, staffing, and surveillance. Somalia allocates only 1.3% of the government budget to health, far below the Abuja Declaration target of 15%, with 75% of domestic airports lacking medical staff. The study aimed to enhance Somalia's PoEs control by analyzing existing systems, identifying gaps, and comparing countries and pathway resilience strategies.

Methods: Following the Preferred Reporting Items for Narrative Reviews by SANRA guidelines, this Narrative review analyzed 118 data. The data for this study were collected from multiple sources: peer-reviewed articles, government reports, and datasets. Searches across PubMed, Scopus, and Google Scholar used terms including (International OR regulation* OR "international health regulation*") AND ("point* of entry*" OR surveillance) AND (response OR Somalia OR "horn of Africa" OR "core capacity*"). Data were coded in NVivo 12 using a hybrid approach of deductive coding mapped to WHO IHR (2005) PoE domains, and data were thematically analyzed across five domains.

Results: For health system gaps, Somalia's IHR compliance score (31 out of 100) reflects weak surveillance, workforce shortages (4.45 health workers per 1000 people), and fragmented governance. For PoEs deficiencies, 63% of sea ports lack screening measures; only 50% of international airports meet basic health security standards. For regional comparisons, Somalia trails Kenya (80% IHR capacity), Ethiopia (75% surveillance), and Rwanda (72% lab capacity) in preparedness. For key challenges, political instability disrupts coordination, CONCLUSION: Somalia's progress in meeting IHR core capacities at Points of Entry (PoEs) by 2025 is critical for enhancing national resilience, global health security, and major challenges. Addressing these challenges requires significant investments in PoEs to achieve measurable outcomes.

Background: Female Anopheles mosquitoes are the primary vectors for malaria transmission within communities, significantly contributing to the high burden of malaria in Africa overall and Uganda specifically. Many tropical plants have insect-repellent properties and have traditionally been used in their native regions to prevent mosquito bites.

Methods: A cross-sectional ethnobotanical survey was conducted between January 2025 and May 2025 in five districts of the West Nile Subregion: Adjumani, Moyo, Madi-Okollo, Pakwach, and Obongi. Semi-structured questionnaires were used to collect data on indigenous knowledge about mosquito repellents from 57 respondents, who were selected through purposive and snowball sampling techniques. The ethnobotanical data were analyzed using descriptive statistics, the informant consensus factor, and preference ranking.

Results: A total of 42 plant species from 40 genera and 25 families were documented as being used to repel mosquitoes. The plants most commonly used for this purpose were: Azadirachta indica A.Juss. (9), Boswellia papyrifera (Caill.) (7), Aeschynomene americana L. (6), Mesosphaerum suaveolens (L.) Kuntze. (6), and Ocimum gratissimum L. (5). The most common indigenous method for repelling mosquitoes involves burning either dry cow dung (32%) or dry goat droppings (20%). Most of the plant species belong to the families Fabaceae (10), Lamiaceae (4), and Asteraceae (3). The majority of the plant species used were trees (43%) and herbs (42%), with leaves (42%) and seeds (12%) being the most frequently used plant parts. Except for Cymbopogon citratus (DC.) Stapf and M. suaveolens, which are used as live plants for repelling mosquitoes, all other plant species used were prepared by burning or smoking indoors.

Conclusions: Communities in the West Nile Subregion, especially those living along the River Nile, possess rich indigenous knowledge and practices used to repel mosquitoes in their efforts to control deadly malaria.

Purpose: Accurate translation and adaptation of survey questionnaires are essential for ensuring validity and reliability in cross-cultural healthcare research. Despite the global expansion of healthcare studies, standardized guidelines for the translation process are limited.

Methods: To address this gap, we developed the Checklist for Translating and Adapting Questionnaires (CTAQ). A three-round Delphi survey was conducted to refine and validate the CTAQ. An international panel of experts in survey methodology, cross-cultural research, and healthcare participated in the study, providing iterative feedback to achieve consensus on checklist items. The development of the CTAQ involved: (i) drafting an initial checklist based on a comprehensive literature review and expert insights; (ii) rating the importance and relevance of each item using an 80% consensus threshold; and (iii) revising items through successive Delphi rounds until consensus was reached.

Results: The finalized CTAQ comprises eight stages: defining the target audience and objectives; forming a translation team; forward and backward translation; comparing versions; reconciliation; pretesting and evaluation; final review and proofreading; and post-survey evaluation. This structured approach, informed by expert consensus, integrates best practices and addresses cultural nuances, thereby enhancing the accuracy and reliability of translated survey instruments.

Conclusions: The CTAQ offers a systematic, consensus-based framework that enhances the linguistic and cultural accuracy of translated survey instruments in healthcare research.

Practice implications: Adopting the CTAQ standardizes translation workflows and promotes the production of valid, reliable, and culturally appropriate questionnaires. This contributes to greater rigor and quality in international and cross-cultural healthcare studies.

Background: Availability and access to quality laboratory diagnostics at the primary healthcare (PHC) level are critical to achieving universal health coverage. However, significant access disparities still exist. This evaluation aimed to understand the current laboratory capacity and infrastructure for communicable diseases testing at the PHC level and identify systemic challenges affecting access.

Methods: This evaluation was conducted in eight low-middle-income countries (Cambodia, China, Lao PDR, Malaysia, Mongolia, PNG, Philippines, and Solomon Islands) in the WHO Western Pacific Region. Data were collected by reviewing existing WHO and country-level policies, guidelines, and reports on laboratory services for communicable diseases at the PHC level, as well as virtual interviews with participants at various levels of healthcare.

Results: Most countries are progressing well towards improving laboratory access at all levels. Activities contributing to improved access include point-of-care testing, integrated sample transport systems to facilitate referral of samples, community engagement, and efforts towards combating stigma and discrimination. Vertical disease programs supported by development partners bridge the funding and capacity gaps for several high-priority public health problems, but these support streams are dynamic and often diminishing. The systemic challenges identified were categorized into three thematic areas: (1) weaknesses in primary healthcare systems; (2) limited community and individual engagement; and (3) persistent socio-economic barriers. Potential solutions and recommendations should include a stepwise approach customized for each country's context in collaboration with all stakeholders.

Conclusion: Despite the progress already achieved, most countries in the region still face significant challenges in improving access to essential laboratory services for communicable diseases at the PHC level.

Background: Scrub typhus is transmitted through vectors and is susceptible to meteorological factors, posing a significant threat to human life and health. Therefore, in this study, the nonlinear relationships between meteorological factors and scrub typhus (ST) and the lag effects of meteorological factors on ST were analyzed, and the explanatory power of these factors on the spatially stratified heterogeneity of ST was evaluated.

Methods: Monthly data on ST cases and meteorological factors were collected in Jiangxi from 2014 to 2023. A distributed lag nonlinear model (DLNM) was used to analyze the lag effects and nonlinear relationships between meteorological factors and ST. Geodetector was conducted using 2023 spatial data to evaluate the explanatory power of meteorological factors and their interactions on the spatially stratified heterogeneity of ST.

Results: A total of 9129 cases of newly diagnosed ST were recorded. The DLNM demonstrated nonlinear relationships between meteorological factors and ST and lag effects of meteorological factors on ST. The influence of temperature, relative humidity, and wind speed on the ST initially increased, peaking at 25.50 °C, 84.80%, and 2.00 m/s, respectively, before decreasing. Precipitation was associated with an increasing risk of ST, whereas pressure tended to decrease risk. Compared with median meteorological values, extreme conditions (such as extremely low temperature, extremely low relative humidity, extremely high pressure, and extremely high wind speed) had a protective effect on the incidence of ST. Conversely, extremely high precipitation and extremely low pressure were associated with an elevated risk of ST. Geodetector analysis revealed the following explanatory power for the spatially stratified heterogeneity of ST: temperature (0.357) > relative humidity (0.351) > pressure (0.275) > precipitation (0.225) > wind speed (0.223). Temperature and relative humidity emerged as the most critical indicators affecting ST. Furthermore, the incidence of ST was driven by the combined effects of multiple meteorological factors.

Conclusions: The incidence of ST in Jiangxi Province is significantly influenced by meteorological factors, with both lag effects and nonlinear relationships. Temperature and relative humidity are the key indicators affecting ST. The consideration of meteorological factors is essential for the prevention and control of ST.

Background: Access to essential in vitro diagnostics is limited in many low- and middle-income countries (LMICs). To address this, the World Health Organization introduced the Model List of Essential In Vitro Diagnostics (EDL) in 2018, encouraging member states to develop National Essential Diagnostics Lists (NEDLs). To date, five LMICs-Burkina Faso, Ethiopia, India, Nepal, and Nigeria-have developed NEDLs. However, gaps remain in the objectives of NEDL development, which may undermine their effective use. In this study, we aimed to analyze the objectives of NEDL development through a literature review, elicit potential pathways for achieving these objectives, and develop an assessment framework for defining NEDL objectives and pathways.

Methods: We analyzed the WHO EDL and NEDL documents and other relevant materials, aligning the objectives mentioned in these documents with a logic model. A provisional assessment framework was then designed and applied to examine stakeholder perspectives on NEDL objectives, which were obtained through key informant interviews in four Association of Southeast Asian Nations (ASEAN) countries-Cambodia, Indonesia, Lao PDR, and the Philippines-where NEDL initiatives are still in their early stages. Based on these findings, a revised assessment framework was developed.

Results: The literature review yielded a provisional assessment framework comprising six domains: procurement, supply chain, laboratory equipment maintenance, quality assurance, regulatory work, and benefit packages. An analysis of stakeholder perspectives in the four ASEAN countries identified potential pathways for achieving the NEDL objectives across these six domains and other aspects. This process resulted in a new seven-domain assessment framework, incorporating key modifications to the provisional framework: "benefit packages" was replaced with "health financing", and "service delivery platform" was added as the seventh domain.

Conclusions: The newly developed assessment framework can support high-level officials in initiating NEDL development and promoting its effective use. It can also guide health ministries in selecting NEDL leads and technical committee members and help identify intermediary outcomes for monitoring NEDL operationalization. Although empirical evidence on NEDL outcomes remains limited owing to its early global implementation stage, this study provides valuable insights to support the future development and deployment of NEDLs and strengthen diagnostic systems in LMICs.

Background: Hepatic cystic echinococcosis (HCE) remains a significant public health issue in endemic countries. Although recurrence is a recognized challenge, its independent impact on adverse clinical outcomes such as postoperative complications (POC), mortality, and length of hospital stay (LHS) remains poorly studied in Latin America. This study aimed to assess the risk of POC, mortality, and LHS in patients with recurrence of HCE.

Methods: We conducted a retrospective cohort study of patients who underwent surgery for HCE between 1993 and 2019 at two centers in southern Chile. Patients with recurrence (exposed group) were compared to those undergoing primary surgery (non-exposed group). The primary outcome was the presence of POC; secondary outcomes included mortality and LHS. Crude and adjusted relative risks (RR) with 95% confidence intervals were estimated using Poisson regression with robust errors. Linear regression models were applied to assess the effect of recurrence on LHS.

Results: A total of 154 patients with 271 cysts were included. Recurrence was identified in 43 patients (27.9%). POC occurred in 18.2% of the total cohort and were significantly more frequent in the recurrence group (41.9% vs. 9.0%, p < 0.001). Adjusted RR for POC in the presence of recurrence was 5.1 (95% CI 2.7-9.9). Mortality was higher in patients with recurrence (7.0% vs. 2.7%, RR: 2.6; 95% CI 0.5-12.3), though not statistically significant. LHS was 1 day longer in the recurrence group (7.3 ± 4.5 vs. 5.6 ± 3.4; p = 0.02), but this association lost significance in regression models.

Conclusions: Recurrence of HCE increases the risk of POC. While trends toward higher mortality and prolonged LHS were observed, these did not reach statistical significance. These findings underscore the importance of long-term follow-up and the need to identify prognostic factors for recurrence to optimize outcomes in patients with HCE in endemic regions.

Background: Treatment recommendations for malaria in infants of < 5 kg body weight (BW) are not evidence-based. Due to pharmacokinetic characteristics of this population, weight-based dose adjustments for antimalarials may be suboptimal. The 20 mg artemether:120 mg lumefantrine dispersible tablet, even with dose adjustment, may lead to artemether over-exposure and reduced lumefantrine exposure in patients < 5 kg. PBPK modelling predicted that a 1:12 artemether:lumefantrine ratio dispersible tablet should match efficacious and safe drug exposures in patients 5- < 15 kg treated with the current artemether-lumefantrine dispersible tablet: the CALINA study used an exposure-matching approach to confirm that drug exposures were comparable.

Methods: Sequential age cohorts (Cohort 1: > 28 days; Cohort 2: 1-28 days) of patients < 5 kg with Plasmodium falciparum malaria received the new artemether-lumefantrine dispersible tablet (each dose 5 mg artemether: 60 mg lumefantrine) twice daily for 3 days. Artemether C_max, and lumefantrine C_168h and C_max were compared with historical data from patients 5- < 15 kg treated with the current artemether-lumefantrine dispersible tablet. The primary endpoint was met if the 90% CI for artemether C_max contained the LS mean value from historical data (101 ng/mL). PCR-corrected and uncorrected ACPR at Days 15, 29 and 43 and parasite clearance time were evaluated. Adverse events, laboratory evaluations, and developmental assessments were performed.

Results: In Cohort 1 (N = 22), geometric mean artemether C_max was 68.0 ng/mL (90% CI 45.1,103 ng/mL); therefore, C_max was comparable to that in historical data, meeting the primary endpoint. In Cohort 2 (N = 6), there were too few patients for formal analysis, but geometric mean artemether C_max was comparable to that in Cohort 1 (62.2 ng/mL, 90% CI 33.6,115 ng/mL). In both cohorts, lumefantrine C_168h and C_max were comparable to historical data. PCR-corrected Day 29 ACPR was 95.5% and 100% in Cohorts 1 and 2, respectively. Treatment was well-tolerated. Developmental assessments at 12 months of age were within the normal range.

Conclusions: The optimized dose of artemether-lumefantrine (5 mg/60 mg) achieves the exposures required for optimal efficacy and safety in patients < 5 kg body weight with P. falciparum malaria, consistent with those in patients 5- < 15 kg treated with the current dispersible tablet (20 mg/120 mg).

Trial registry: Clinicaltrials.gov: NCT04300309.

Background: Aedes mosquitoes are primary vectors of arboviral diseases, such as dengue, chikungunya, and Zika, posing major threats to tropical public health. Understanding their spatial distribution and resistance status is vital for sustainable control. This study investigated the mapping of breeding habitats, species composition, and insecticide susceptibility in Aedes populations from Osun State, Nigeria.

Methods: Larval surveys across a rural community identified 36 potential habitats, of which 27.8% were positive for Aedes breeding. A total of 3500 larvae were collected, reared to adult stage, morphologically identified and subjected to WHO-standard insecticide bioassays.

Results: Two species were identified: Aedes aegypti (99.3%) and Aedes albopictus (0.7%), with Ae. aegypti strongly predominant (p < 0.05). Mortality rates following insecticide exposure ranged from 94 to 100%. Complete susceptibility was observed for permethrin, deltamethrin, and pirimiphos-methyl, while reduced mortality (94%) against alpha-cypermethrin indicated possible emerging resistance. The mapping of larval habitats revealed clustered breeding in rural communities, portending localized risk of arboviral transmission.

Conclusions: These findings highlight that while Aedes populations in the study area remain largely susceptible to conventional insecticides, early signals of resistance require proactive management by the state. Incorporating synergists into integrated vector control, alongside habitat surveillance and mapping, will be critical to sustaining insecticide effectiveness and reducing the burden of Aedes-borne diseases in Osun State and Nigeria at large.

Background: Global vaccine coverage improved substantially. In Afghanistan, routine immunization has been expanding since 1978 but remains inadequate, contributing to consistently high under-five mortality rates. This time-trend analysis focused on national routine childhood immunization coverage and the number of Expanded Programme on Immunization (EPI) centers in Afghanistan from 1999 to 2023.

Methods: Data were drawn from World Health Organization/United Nations Children's Fund (WHO/UNICEF) estimates and the "Gavi, the Vaccine Alliance" administrative reports (1999-2018). Seven vaccines were assessed: third dose of polio vaccine (Pol3), first and second doses of measles-containing vaccine (MCV1, MCV2), first and third doses of diphtheria-tetanus-pertussis vaccine (DTP1, DTP3), Bacillus Calmette-Guérin (BCG), and third dose of hepatitis B vaccine (HepB3). Linear spline regression, with knots in 2006 and 2018, was validated.

Results: Between 1999 and 2023, coverage of all seven vaccines increased. WHO/UNICEF data showed Pol3 rising from 27% to 68%, MCV1 from 31% to 55%, DTP1 from 15.2% to 67%, DTP3 from 27% to 60%, and BCG from 38% to 68%, with MCV2 growing from 2% to 42% and HepB3 peaking at 67%. Spline regression revealed rapid growth from 1999 to 2006, slower increases from 2007 to 2018, and declines from 2019 to 2023. Gavi data mirrored these patterns, with DTP3 rising by 7.96% annually from 1999 to 2006 and DTP1 falling by 0.30% from 2007 to 2018. EPI centers expanded by 159.78 per year (2001-2006) and 74.12 (2007-2018).

Conclusions: Afghanistan's immunization coverage increased substantially until 2006, grew more slowly from 2007 to 2018, and declined after 2019. These patterns highlight the vulnerability of routine immunization programs to contextual challenges and suggest that sustaining coverage will require continued strengthening of routine services, monitoring subnational disparities, and implementing conflict-sensitive strategies.