Tropical Medicine & International Health最新文献

Objectives: To characterise the recent circulation of dengue and chikungunya viruses in the Zona da Mata region of Minas Gerais, Brazil, during the major arbovirus epidemic of 2024, using publicly available RT-qPCR test results.

Methods: We analysed data from DATASUS obtained by RT-qPCR tests for dengue, Zika and chikungunya viruses reported between January and September 2024 across 41 municipalities. Demographic and epidemiological patterns were assessed, including virus-specific incidence, re-infection, sequential infection and co-infection events, and associations with testing effort.

Results: The investigation of DATASUS data showed that 5583 patients were tested by RT-qPCR, and 1663 dengue virus cases and 1756 chikungunya virus cases were detected, with most detections between March and April. Different co-infections were detected in 278 patients, and sequential and re-infections in two and five individuals, respectively. Most cases clustered temporally between March and April, coinciding with the rainy season. Dengue was more common among adolescents and young adults, while chikungunya predominated in individuals over 40. Higher detection rates were observed in females. No Zika virus cases were identified. The number of confirmed cases was strongly correlated with the number of samples tested but not with municipality population size, underscoring the limitations of passive surveillance.

Conclusions: Our findings highlight dengue and chikungunya viruses' intense transmission and co-circulation in a historically understudied region. The high frequency of co-infections, age-specific risks and testing-dependent incidence patterns reinforce the importance of expanding molecular diagnostic capacity and strengthening surveillance networks in the face of increasingly severe arbovirus epidemics.

Background: Most parents in Nigeria receive childhood vaccine education in a group clinic setting. These health talks are not standardised, and little is known about the topics addressed, how these topics are chosen, and how parents experience these talks. This study aimed to fill this knowledge gap.

Method: We conducted a qualitative study in eight immunisation clinics across rural and urban sites in Borno and Cross River State, Nigeria. We audio-recorded two health education talks at each clinic-one with the health worker unaware of being recorded. We interviewed 40 parents and 16 health workers to gather insights. Content analysis identified topics covered, while thematic analysis explored motivations for the health education content from health workers' and parents' perspectives on the talks.

Results: The content and delivery method of the recorded health talks varied considerably within and between different health workers. Of the 16 analysed talks, 6 (37.5%) contained non-vaccine-related topics such as breastfeeding and family planning. The content of health talks was based on a clinic topic schedule, prevailing interests such as ongoing disease outbreaks, or the health workers' feelings and moods. Health workers mentioned they receive little to no formal training on the content and delivery of vaccine education. Current competency was primarily based on training received during formal schooling, embedded within other health programs or media outlets aimed at the general population. Parents generally perceived the educational sessions to be informative and important. However, short health talks, long clinic sessions and a lack of courtesy were barriers to a positive clinic experience.

Conclusion: Inadequate and inconsistent health education on immunisation is prevalent at group-setting vaccine clinics in Nigeria and is driven by a lack of health worker training. Research and policy changes are critically needed to improve the quality of vaccine health education.

Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries such as the Philippines, where limited resources and regulatory challenges heighten the risk. Community-level assessments are critical for developing a context-specific evidence base that informs local decision-making. This study assessed the community AMR risk in a peri-urban community (Mandug, Davao City, Philippines) using an integrated approach that combined wastewater detection of antimicrobial resistance genes (ARGs), community survey and interviews on knowledge, practices, perceived hazards and the capacities of local government and clinical antimicrobial use (AMU). The β-lactam antibiotics, particularly cephalosporins from the nearest tertiary hospital and amoxicillin, commonly used for self-medication and livestock treatment, were identified as widely available in the area. These findings were supported by wastewater surveillance conducted at three sampling sites that represent Mandug's primary land use patterns: residential, agricultural and mixed-use areas. Quantitative polymerase chain reaction (qPCR) analysis detected multiple ARGs in both residential and agricultural wastewater samples, with blatTEM, blaSHV and aac(6')-lb-cr more prevalent in domestic use, and ermB, aac(6')-lb-cr and tet genes in agricultural areas. Multinomial regression analysis suggests that domestic ARG sources in Mandug may contribute more significantly to community wastewater ARG abundance than agricultural and commercial sources. The community survey indicated moderate knowledge of antibiotics, and existing knowledge gaps may contribute to unsafe practices like self-medication and the indiscriminate use of antimicrobials. Despite basic health infrastructure, factors such as population growth, backyard farming and insufficient implementation of national AMR policies increase vulnerability to AMR threats. Addressing AMR effectively requires a community-centered, multidimensional One Health approach. Priorities include building local capacity, executing targeted public education campaigns, strengthening surveillance systems and enforcing local policy reforms within the local government unit.

Objective: Understanding the diabetes patient journey, from awareness, screening, diagnosis, treatment, adherence and control, is crucial for improving outcomes. However, in many low- and middle-income countries, including Indonesia, data across this continuum of care remain limited due to limited health information exchange capacity. This study aimed to map and estimate the prevalence of true diabetes and key touchpoints along the patient journey to identify gaps in diabetes management in Indonesia.

Methods: We applied an evidence gap mapping approach by systematically searching relevant literature published between 1 January 2014, and 27 March 2025, in PubMed, Web of Science, Scopus and Embase, complemented by unstructured searches of government websites. Evidence was visualised using a chord diagram, bar chart and heatmaps. Random-effects meta-analyses were used to estimate pooled prevalence, stratified by study setting and sample representativeness relative to the national population.

Results: Among 94 records, none fully applied diabetes patient journey frameworks and most of the evidence was assessed as low quality. Screening was the least studied touchpoint and awareness missed nationally representative data. Pooled prevalence estimates were: true diabetes 13% (95% confidence interval (CI): 9%-17%), awareness 71% (95% CI: 54%-85%), screening 19% (95% CI: 0%-55%), diagnosis 15% (95% CI: 6%-27%), treatment 89% (95% CI: 80%-95%), adherence 59% (95% CI: 49%-69%) and control 31% (95% CI: 25%-36%). Prevalence rates were generally lower in studies conducted in the general population using nationally representative samples. Pooled prevalence across touchpoints and subgroups decreased after excluding low-quality studies, although heterogeneity within subgroups remained high.

Conclusion: Evidence gap mapping offers a practical approach to generating local patient journey data in countries with limited health information exchange capacity. Specifically for Indonesia, a comprehensive consideration of the diabetes patient journey is lacking. Barriers exist across all touchpoints, particularly in the general population.

Background: In southern Thailand, the low efficacy of albendazole contributes to the unsuccessful elimination of hookworms. Individuals infected with hookworms exhibiting low albendazole efficacy show decreased mean corpuscular volume and mean corpuscular haemoglobin and are suspected carriers of abnormal haemoglobin. This observational study aimed to compare the treatment outcomes of albendazole for hookworm infection in individuals with normal versus abnormal haemoglobin types.

Methods: 227 stool samples were examined using the Kato-Katz and agar plate culture methods. Blood samples were collected from participants with hookworm-positive stool after oral administration of 400 mg albendazole to perform complete blood counts and haemoglobin typing. Treatment outcomes were evaluated 3 weeks after albendazole administration. Participants with persistent hookworm infection received a second 400 mg dose of albendazole, and outcomes were reassessed 3 weeks later.

Results: Among 54 hookworm-positive participants, 38 were cured after the first round of treatment, and 5 were cured after the second round, all of whom had normal haemoglobin. However, 11 participants remained uncured after two treatment rounds, all with abnormal haemoglobin types: 7 with heterozygous haemoglobin E, 3 with heterozygous haemoglobin constant spring (CS) and 1 with compound heterozygous haemoglobin E/CS.

Conclusion: These findings suggest that abnormal haemoglobin may be a host factor contributing to low albendazole efficacy in treating hookworm infections.

Background: Shigellosis, a major cause of diarrhoea in low- and middle-income countries, presents a significant public health challenge due to its high morbidity and mortality, particularly among children under five. The local epidemiology and resistance patterns of Shigella species in Cameroon remain poorly characterised. This systematic review and meta-analysis aims to determine the prevalence and antibiotic resistance patterns of Shigella species in Cameroon.

Methods: This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search of databases was performed up to June 2025 to identify observational studies reporting Shigella prevalence. Data were extracted using a pre-tested standardised form, and the risk of bias was assessed with the Hoy et al. checklist. Meta-analyses were performed using a DerSimonian-Laird random-effects model in R software to estimate the pooled prevalence of Shigella. Heterogeneity was assessed using Cochran's Q test and the I² statistic.

Results: A total of 23 studies were included, surrounding 24,847 total units of analysis (including humans, animals, food and environmental samples). The overall pooled prevalence across all sources was 9% (95% CI, 5.51%-14.76%; I² = 93.3%). When restricted to human patient populations (n = 24,464 individuals), the pooled prevalence was 6% (95% CI, 3%-12%; I² = 94.0%). Prevalence rates in non-human sources were 6% in animals (n = 358), 9% in food samples (n = 1371) and 6% in environmental samples (n = 610). Among identified species, S. flexneri was most common (36.4%).

Conclusion: Our findings indicate a significant burden of shigellosis in Cameroon, coupled with a concerning level of resistance to first-line antibiotics. This high prevalence of antimicrobial resistance (AMR) suggests that current empirical treatments may be ineffective, underscoring the critical need for a continuous surveillance program to guide clinical and public health interventions.

Cystic echinococcosis (CE) is the neglected zoonotic illness caused by a parasite. Non-invasive imaging methods, most notably ultrasound, are used in clinical practice to diagnose CE. Small, non-coding RNA molecules known as microRNAs (miRNAs) function as post-transcriptional regulators in various biological processes. The identification of parasite-derived miRNAs has raised significant interest, as these molecules hold promise as potential biomarkers for CE diagnosis and subsequent monitoring. This study investigates the diagnostic potential of certain parasite-derived miRNAs namely egr-let-7-5p, egr-miR-71-5p, egr-miR-61-5p, egr-miR-10-5p, and egr-miR-9-5p, to differentiate patients with CE from healthy individuals and those with other parasitic infections. The study involved the analysis of serum samples from 83 CE patients, 95 individuals with other parasitic diseases, and 75 healthy controls. Except for egr-let-7-5p, all tested parasite-derived miRNAs effectively distinguished CE patients from healthy controls, with egr-miR-71-5p (AUC: 0.860, p < 0.001) showing the best performance, with a sensitivity of 0.810, and a specificity of 0.784. Despite the overall discriminatory power of miRNAs, only egr-miR-9-5p (AUC value: 0.649, p < 0.01) showed a significant ability to differentiate CE patients from those with other parasitic diseases, with a sensitivity of 0.580 and specificity of 0.711. Additionally, none of the parasite-derived miRNAs demonstrated significant success in distinguishing between active and inactive CE cysts. This study stands out as the most extensive evaluation to date of parasite-derived miRNA biomarkers for CE patients, representing a major step forward in diagnostic research for this zoonotic disease, which often faces diagnostic uncertainty and lacks robust laboratory methods.

Background and objectives: This systematic review and meta-analysis aimed to synthesize studies on hand hygiene practices and their determinants among healthcare workers (HCWs) in India, providing guidance for effective public health policy.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed and Scopus identified primary research studies on hand hygiene knowledge, compliance, and related practices in Indian healthcare settings published from 2009 to 2023. Out of 276 records identified, 252 were screened after removing duplicates and ineligible records. Seventy-nine full-text articles were assessed for eligibility, of which 34 were excluded for being narrative, qualitative, or otherwise non-eligible. Finally, 45 studies were included in the review and quantitative synthesis.

Results: The pooled prevalence of observed compliance with hand hygiene protocols among Indian Healthcare Workers (HCWs) was 44% (95% CI: 35%-54%), with extreme variation across studies (range: 3%-90%). Self-reported hand hygiene adequacy was similar at 45% (95% CI: 29%-62%; I2 = 99%), though adherence varied significantly across the WHO's five moments (range: 24%-68%). The pooled prevalence of adequate knowledge was 39% (95% CI: 28%-50%). Behavioural interventions demonstrated moderate to high efficacy in improving both knowledge and practice. Key reported barriers to compliance included improper protocol implementation (71.1%), inadequate training (57.8%), attitudinal issues (33.3%), resource shortages (24.4%), and high workloads (15.6%).

Conclusions: Healthcare providers in India exhibit suboptimal hand hygiene compliance with a majority (56%) observed to be non-compliant during opportunities for hand hygiene. A multifaceted approach, including comprehensive training, resource availability, regular audits, and strong leadership, is crucial to enhance hand hygiene adherence, reduce healthcare-associated infections, and improve patient safety.

Traditional medicine is increasingly promoted worldwide as a tool to achieve universal access to healthcare. Herbal medicines have formed the basis of healthcare throughout the world and are still widely used, playing a major role in the international health market. However, several factors influence the potential quality of phytotherapy. The diversity of herbal medicines, their various uses and preparation methods, the pluralism in access to these treatments, and the variability in the chemical composition of raw materials depending on their environment are all critical elements. This study compares the regulatory frameworks and quality control practices for plant-based health products in six countries: Benin, Burkina Faso, Guinea, Mali, Peru and France. It also provides an overview of the market in these countries. To do so, we compiled and highlighted key information from WHO guidelines, national legal documents, public databases on product registration and markets, and conducted interviews with health organisation experts. The main findings indicate that West African countries face challenges related to regulatory enforcement and limited industrial and research capacity. In contrast, Peru experienced an initial surge in production following regulation in 1997 and gained international recognition for Amazonian plants, but saw a decline after the 2009 U.S.-Peru Free Trade Agreement due to more stringent standards. France, while notable for its pharmacopoeia, struggles to implement quality control given the high volume of dietary supplements available. Based on these comparative insights, the paper recommends a multidimensional approach: promoting stakeholder training in good practices, developing robust pharmacopoeias, facilitating dialogue between traditional and allopathic medicines, and building shared infrastructures for research and quality control. These strategies, informed by successful practices across countries, aim to support the safe and equitable development of herbal health products worldwide.

Introduction: Insecticide resistance in malaria vectors threatens the effectiveness of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in Tanzania. Understanding the evolution of insecticide resistance is essential for guiding vector control policy in Tanzania. This review synthesises evidence on resistance patterns, surveillance and management strategies to inform programmatic decisions.

Objective: To synthesise evidence on insecticide resistance patterns, mechanisms and management strategies in Tanzanian malaria vectors (2015-2024), and to highlight research and surveillance gaps.

Methods: A scoping review was conducted using the PRISMA-ScR framework. Articles were retrieved from multiple databases based on predetermined eligibility criteria. Data on resistance patterns, mechanisms, surveillance approaches and management strategies were extracted and synthesised.

Results: Of 910 identified records, ten met inclusion criteria. All studies applied WHO susceptibility bioassays, and several incorporated molecular or biochemical assays. Pyrethroid resistance was consistently reported, largely driven by knockdown resistance (kdr) mutations and metabolic mechanisms. DDT resistance was common, while moderate resistance to carbamates appeared in about half of the studies. Organophosphates, particularly pirimiphos-methyl, remained effective and new insecticides such as clothianidin and chlorfenapyr showed high efficacy with no resistance detected. Reported management strategies included pyrethroid-PBO LLINs and integrated vector management, although surveillance coverage and mechanistic profiling were inconsistent across sites.

Conclusion: Insecticide resistance is widespread in Tanzanian malaria vectors, with pyrethroids most affected. While new insecticides and management strategies show promise, gaps in surveillance and operational evidence limit effectiveness. Strengthened research capacity, sustained funding and cross-sectoral collaboration are essential to support evidence-based resistance management and protect malaria control gains.