Tropical Medicine and Health最新文献

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.

Background: Wild edible plants (WEPs) play a vital role in ensuring food security, enhancing nutrition, and preserving cultural heritage, particularly in dryland ecosystems. In Eastern Ethiopia, the Karamara forest patches host a rich diversity of WEPs; however, comprehensive ethnobotanical documentation remains scarce. This study aimed to document the diversity, utilization patterns, seasonal availability, and indigenous knowledge of WEPs, as well as to assess associated threats and conservation practices.

Methods: A cross-sectional ethnobotanical survey was conducted from February 2023 to January 2024 involving 64 informants selected through purposive and snowball sampling techniques. Data were collected via semi-structured interviews, focus group discussions, market surveys, and guided field walks. Voucher specimens were collected and identified using the Flora of Ethiopia and Eritrea and verified with digital plant databases such as the International Plant Names Index (IPNI) and Plants of the World Online (POWO). Quantitative analyses included Relative Frequency of Citation (RFC), Preference and Direct Matrix Ranking. Statistical analyses (t-tests, ANOVA, and Pearson correlation) were used to examine variations in ethnobotanical knowledge across gender, age, literacy, and experience.

Results: A total of 42 WEP species, belonging to 32 genera and 24 families, were documented, with shrubs (50%) and trees (33.3%) as the dominant growth forms. Fruits (69%) and leaves (14%) were the most commonly consumed parts. Amaranthus caudatus L., Ficus sycomorus L., and Ziziphus mucronata Willd. were the most preferred species. Ethnobotanical knowledge showed significant variation among informant groups (P < 0.05). Seasonal availability, collection methods, and marketability patterns reflected local adaptive strategies. Major threats identified included firewood collection, charcoal production, overgrazing, and drought. Community-based management and integration of WEPs into home gardens were recognized as promising conservation approaches.

Conclusion: WEPs in the Karamara forest patches play a vital role in supporting dietary diversity, livelihoods, and cultural identity. Sustainable management, participatory conservation, and systematic documentation of indigenous knowledge are essential for safeguarding both biodiversity and food security in the region. Future studies should prioritize investigating the nutritional composition, phytochemical properties, and pharmacological potential of WEPs to ensure their safe utilization and explore broader applications.

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.