Tropical Medicine and Health最新文献

Background: Men engaged in transactional sex (METS) are a critical population for HIV transmission dynamics in Sub-Saharan Africa (SSA). The interplay between multiple sexual partnerships and condom use, two key risk determinants, is complex and not fully understood. This study aimed to assess the prevalence and determinants of these interdependent behaviors among METS across SSA.

Methods: Cross-sectional data from 26 recent Demographic and Health Surveys (DHS) in SSA were pooled. A sample of 10,128 men who reported providing or receiving money or gifts in exchange for sex was analyzed. A recursive bivariate probit model was use to jointly model the propensity for multiple sexual partnerships and condom use, accounting for their potential correlation. Adjusted coefficients, predicted joint probabilities, and average marginal effects (AME) were reported.

Results: The weighted prevalence of multiple sexual partnerships was 55.3% (95%CI: 53.8-56.9) and of condom use was 32.9% (95%CI: 31.4-34.4). The model revealed a significant, positive correlation between the two behaviors (rho = 0.447, p < 0.05). Key determinants had compensatory effects: living in a couple was associated with a higher propensity for multiple partnerships (β = 0.39, p < 0.001) but a lower propensity for condom use (β = - 0.78, p < 0.001). Higher education was associated with both more multiple partnerships and increased condom use. HIV-related knowledge and testing were strong predictors of condom use but not of multiple partnerships. AME analysis showed that marital status had the largest effect, increasing the probability of the high-risk outcome (multiple partners, no condom) by 25.85 percentage points (p < 0.001). Media exposure and comprehensive HIV knowledge significantly increased the probability of protective behaviors.

Conclusion: Among METS in SSA, there is evidence of risk compensation, wherein factors associated with multiple sexual partnerships are also associated with increased condom use. However, the alarmingly high prevalence of multiple partnerships coupled with low condom use among married METS represents a critical intervention gap.

Introduction: Bacterial antimicrobial resistance (AMR) is a major and growing public health threat in East African Community (EAC) countries, where fragile health systems, inadequate diagnostics, and inappropriate antibiotic use drive high levels of resistant infections. Despite this, robust subregional mortality estimates remain limited.

Methods: We conducted a secondary pooled analysis of modelled, publicly available, country-level mortality estimates from the Global Research on Antimicrobial Resistance (GRAM) 2019 project. Data were extracted for six EAC countries: Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. Because GRAM reports age-standardised mortality rates (ASMRs) with 95% uncertainty intervals, we derived standard errors from these intervals, assuming approximate normality, and used them in the pooled analysis. Using random-effects models with restricted maximum likelihood (REML), we pooled ASMRs per 100,000 population for deaths associated with and attributable to AMR. We calculated 95% confidence intervals and prediction intervals, assessed heterogeneity using I², and conducted leave-one-out sensitivity analyses to test robustness.

Results: Across the six EAC countries, there were an estimated 154,760 deaths associated with AMR and 36,480 deaths attributable to AMR in 2019. The pooled ASMR for AMR-associated deaths was 144.69 per 100,000 (95% CI 129.07-160.30) population, with a 95% prediction interval of 122.57-166.81. Country-specific ASMRs for AMR-associated deaths ranged from 129.5 per 100,000 population in Uganda to 167.0 per 100,000 population in Burundi. For AMR-attributable deaths, the pooled ASMR was 34.62 per 100,000 (95% CI 30.02-39.23) population, with a prediction interval of 28.10-41.14. Country-specific ASMRs for attributable deaths ranged from 30.80 per 100,000 population in Uganda to 41.90 per 100,000 population in Burundi. For both associated and attributable mortality, heterogeneity was negligible (I² = 0%), and sensitivity analyses confirmed that no country disproportionately influenced the pooled estimates.

Conclusion: This pooled secondary analysis indicates a substantial and regionally consistent mortality burden from bacterial AMR in East Africa. The findings reify the need for coordinated investment in AMR surveillance, stewardship, and overall response across the EAC.

Background: In 2022, a widespread dengue outbreak was reported in Nepal, with 4,593 cases reported by August escalating to 53,951 cases and 62 deaths by November. The caseload was significantly higher than in 2019, when the outbreak was last officially recorded with 17,999 cases and 6 fatalities.

Aims and objectives: This study aimed to identify Nepal's circulating dengue virus serotypes during the 2022 outbreak and analyze their distribution across different regions and hospitals.

Materials and methods: To better understand the circulating dengue virus serotypes, a study was conducted in collaboration with the Seven Provincial Hospital and National Public Health Laboratory (NPHL) with the Coordination of Epidemiology Diseases Control Division (Nepal). This study involved collecting and testing blood samples from various Provincial hospitals across Nepal, covering all the geographical patterns of Nepal.

Results: The results revealed a predominance of serotype 1, followed by serotypes 2 and 3, with some mixed infections. The findings underscore the diverse dengue serotype circulation and the potential for severe dengue infections in Nepal.

Conclusion: The 2022 dengue outbreak in Nepal was primarily driven by DENV-1, followed by DENV-2 and DENV-3. The detection of mixed infections and the absence of DENV-4 warrant further investigation to understand the transmission dynamics and potential for severe dengue cases.

Background: Malaria is a leading cause of morbidity and mortality among children under five in sub-Saharan Africa, especially in Ghana. Insecticide-treated nets (ITNs) are among the most effective prevention tools, yet disparities in use persist, undermining equitable malaria control. This study examined trends and inequalities in ITN use among Ghanaian children under five from 2003 to 2022.

Methods: A cross-sectional secondary analysis was conducted using six rounds of the Ghana Demographic and Health Surveys (2003-2022). The outcome variable was defined as whether a child had slept under an ITN on the night preceding the survey. Equity stratifiers were analysed using the WHO Health Inequality Toolkit. Inequalities were measured through difference (D), ratio (R), absolute concentration index (ACI), population attributable risk (PAR), and population attributable fraction (PAF), each with 95% confidence intervals (CIs).

Results: The study found that the national ITN use increased from 3.9% in 2003 to 54.1% in 2019, before declining to 49.0% in 2022. Wealth-based inequality widened substantially, with the ACI shifting from - 0.3 (95% CI - 1.4 to 0.8) in 2003 to - 7.9 (95% CI - 8.8 to - 7.1) in 2022. The difference between the poorest and richest quintiles rose from - 4.1% in 2003 to - 39.4% in 2022, while the ratio declined from 0.8 to 0.4. Regional disparities were also marked, with the difference increasing from 21.8% in 2003 to 39.5% in 2022, and ratios rising from 2.2 to 2.3. Residence-based inequalities grew, with rural-urban difference widening from - 0.2% in 2003 to - 25.1% in 2022. Sex and age contributed minimally, with ACIs fluctuating (- 2.5 in 2014 and 1.0 in 2022) for sex.

Conclusions: Although ITN use among Ghanaian children under five has increased substantially since 2003, widening inequities persist, particularly by wealth, region, and residence. Findings highlight the need for equity-focused policies to accelerate progress towards Sustainable Development Goal 3.3, ending malaria by 2030.

Background: Wild edible plants (WEPs) are vital for food security, nutrition, and cultural identity, particularly in arid and semi-arid regions. In Korahe Zone, Eastern Ethiopia, Somali communities rely heavily on natural vegetation, yet ethnobotanical documentation of WEPs remains limited. This study aimed to investigate the diversity, utilization, knowledge patterns, and conservation status of WEPs, with implications for food security and health.

Methods: Ethnobotanical data were collected from 120 purposively selected informants across five study sites using semi-structured interviews, focus group discussions, and guided field walks. Species were also screened against the IUCN Red List to identify threatened and vulnerable wild edible plants, providing insights into their conservation status and informing sustainable management strategies. Quantitative indices, including the Botanical Ethnoknowledge Index (BEI), Relative Frequency of Citation (RFC), Informant Consensus Factor (ICF), and Jaccard Similarity Index (JSI), were applied. Preference ranking, direct matrix ranking, and priority ranking were used to assess species use, multifunctionality, and perceived threats. Statistical analyses (t tests, ANOVA, and Pearson correlation) were conducted to examine variations in ethnobotanical knowledge across gender, age, literacy, and experience.

Results: A total of 57 WEP species across 22 families were documented, with shrubs and trees dominating. Fruits were the most commonly consumed part, while roots, tubers, leaves, stems, and resins were used during food scarcity. Knowledge varied significantly by age, gender, literacy, and experience, with older, male, and key informants exhibiting greater familiarity. Cordeauxia edulis Hemsl., Balanites aegyptiaca (L.) Delile, Amaranthus dubius Mart. ex Thell., and Moringa stenopetala (Baker f.) Cufod. were highly preferred and multipurpose. Overharvesting, habitat loss, climate variability, grazing, and invasive species were major threats. Three species were identified as threatened either critically endangered or vulnerable, highlighting the urgent need for their conservation and sustainable management.

Conclusions: WEPs are crucial for local nutrition, food security, and cultural heritage. Integrating indigenous knowledge with in-situ and ex-situ conservation strategies and promoting sustainable use and cultivation of high-value species is essential to safeguard these resources for future generations.

Introduction: Schistosome infections in early childhood can affect a child's growth and development, leading to lifelong consequences. Historically, monitoring and control of schistosomiasis have focused primarily on school-aged children leading to a knowledge gap on the magnitude of the prevalence of infections in younger age groups in many endemic countries. This study aimed to estimate the prevalence of schistosome infections among children under 2 years of age and describe its distribution in three regions of Madagascar endemic for Schistosoma mansoni, thereby informing public health strategies in the country.

Methods: A cross-sectional study was conducted on a sample of 2018 children under 2 years of age recruited from 42 primary health care centres in the regions of Itasy, Bongolava and Amoron'i Mania, Madagascar, from March 2020 to June 2021. Urine samples were collected to perform an up-converting reporter particle lateral flow circulating anodic antigen assay (UCP-LF-CAA) for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection, prevalence ratios with 95% CIs were estimated using mixed-effects Poisson regression.

Results: Among 2018 sampled children with an average age of 9.6 months (SD = 1.2), the prevalence of schistosome infection was 6.2% [CI95%: 5.0, 7.8]. The prevalence estimates were similar across all population subgroups. We observed no statistically significant associations of schistosome infections in children with maternal age (p-value = 0.4110), education (p-value = 0.1281), occupation (p-value = 0.3333), child sex (p-value = 0.3692), urbanisation (p-value = 0.8272) or region of residence (p-value = 0.7425).

Conclusion: Our results show that the prevalence of schistosome infection in children under 2 years of age in Madagascar is significant. Given the high burden and long-term consequences of early schistosome infection, integrated and inclusive public health interventions that combine treatment, caregiver health education, with improvements in sanitation and access to clean water, are needed for children under 2 years of age in endemic settings.

Background: Toxoplasmic encephalitis (TE) and tuberculoma are the leading causes of ring-enhancing brain lesions in patients with human immunodeficiency virus (HIV) infection. Because imaging findings of the two conditions overlap and cerebrospinal fluid (CSF) tests lack sensitivity, timely diagnosis is critical. Herein, we report the rare case of a patient with HIV infection and miliary tuberculosis who developed intracranial mass lesions after antiretroviral therapy (ART) initiation with high-dose prednisolone administration.

Case presentation: A 53-year-old Nepalese man who had been living in Japan was diagnosed with HIV infection (CD4 count, 146 cells/µL) and miliary tuberculosis. Four-drug rifabutin-based therapy was initiated. However, trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was discontinued because of a rash and replaced with monthly pentamidine. ART (dolutegravir/lamivudine) was initiated 3 weeks later. Prednisolone (60 mg/day) was administered for refractory tuberculous ascites, and the dose was tapered over 6 weeks. Eight weeks after ART, the patient developed a headache, and laboratory tests revealed a CD4 count of 384 cells/µL. Magnetic resonance imaging (MRI) revealed right frontal ring-enhancing lesions. CSF was acellular; polymerase chain reaction yielded negative results for several pathogens including Mycobacterium tuberculosis and positive results for Toxoplasma gondii. After a 5-day graded TMP-SMX desensitization, the patient received full-dose therapy for 6 weeks, followed by secondary prophylaxis. The patient's headache resolved, and repeat MRI after 2 weeks revealed marked regression of the lesions. No radiological relapse was observed 3 months after treatment completion.

Conclusions: TE can emerge during immune recovery at CD4 counts > 100 cells/µL when corticosteroid administration coincides with early ART. In patients receiving tuberculosis treatment who develop new brain lesions soon after ART, T. gondii polymerase chain reaction and prompt antiparasitic therapy should be pursued. Rifabutin permits concomitant use of dolutegravir, and TMP-SMX desensitization allows effective treatment and prophylaxis.

Diagnostic advances outpace bedside interpretation in tropical medicine. Two forces drive this gap: mimicry-infectious syndromes resembling noninfectious disease, and expansibility-epidemiology transcending geography, age, season, and host. The result is misclassification, mistargeted therapies (e.g., steroid-treated helminth infection), and wasted resources amid climate- and mobility-driven shifts. This correspondence proposes lightweight, locally led evidence circulation through structured case reviews, minimal essential data, and living, site-specific algorithms that integrate mimicry-aware red flags and calibrated pretest probabilities. Such networks transform tacit experience into auditable knowledge, improve day-to-day decision-making, and align technological advances with context, thereby strengthening equitable and sustainable care for tropical diseases.

Antimicrobial resistance (AMR) poses a severe and growing threat to public health in Africa, disproportionately affecting marginalised and vulnerable populations across communities and health systems. Current responses often prioritise technical measures, such as stewardship programmes and surveillance systems, with insufficient attention to the socioeconomic and cultural realities that drive resistance. AMR cannot be addressed in isolation, as its emergence and spread are closely linked to poverty, inadequate education, gender inequality, poor governance, limited access to healthcare, clean water, sanitation, and diagnostics, as well as weak supply chains for essential medicines. This commentary advocates for a people-centred approach to AMR that addresses the social determinants of health and fosters inclusive, community-driven solutions. Strengthening primary healthcare systems and improving access to affordable, quality-assured antimicrobials and diagnostics must be prioritised to empower both healthcare providers and patients. Local stakeholders are essential for raising awareness, promoting behaviour change, and ensuring cultural relevance through meaningful community engagement. Marginalised populations, including those in underserved regions or disproportionately exposed to infection due to displacement, disability, or comorbidities, should be central to the co-creation of AMR strategies. Embedding AMR initiatives within universal health coverage reforms, expanding preventive measures, such as vaccination, and tackling systemic challenges are also crucial for reducing antibiotic dependence and building equitable health systems. A coordinated, multisectoral response that connects human, animal, and environmental health, grounded in equity, community ownership, and interdisciplinary collaboration, is essential for sustainable AMR control efforts that leave no one behind.

Introduction: South Korea is experiencing an ageing population, coupled with a high prevalence of mental health issues among its older people. This study aimed to identify the variables that influence spiritual health (SH), seeking to provide a stronger theoretical foundation and practical guidance for designing interventions to improve purpose in life (PIL), ultimately improving spiritual health and overall quality of life in older adults.

Methods: This cross-sectional survey included 270 older adults (aged ≥ 65 years) from Wonju, Gangwon Province, and Yeoju, Gyeonggi Province, South Korea. The paper-based survey questionnaire included questions on demographic characteristics, health perceptions, and the PIL test. Descriptive statistics, Chi-square tests, and multivariate logistic regression analyses were performed using Stata 18.

Results: A total of 270 older adults (mean age = 73.8 ± 6.5 years) participated in the study, with women comprising the majority (62.6%). Among the participants, 79.6% (n = 215) reported low levels of purpose in life (PIL), while 20.4% (n = 55) reported moderate levels; no participants were classified as having high PIL. Educational attainment was significantly associated with PIL, as individuals with a university degree (p = 0.04) or graduate-level education (p = 0.01) were less likely to report moderate PIL compared to those with primary or junior high school education. In contrast, living with a care recipient was strongly and positively associated with moderate PIL (p = 0.001). Similarly, participants who reported strong religious faith demonstrated higher odds of moderate PIL (p < 0.01), whereas adherence to Shintoism was negatively associated with PIL (p = 0.03). Interestingly, engagement in volunteer activities was also inversely associated with PIL (p = 0.01).

Conclusion: The findings of this study suggest that PIL in older adults is shaped by a complex interplay between cultural, historical, and social factors. To address these issues, it is important to promote structured volunteer opportunities tailored to the preferences of older adults, strengthen caregiver support systems, and implement interventions that focus on alleviating social and economic difficulties. By doing so, it is expected that the sense of purpose in life among older adults will be enhanced, leading to an improvement in their overall well-being.