Tropical Medicine & International Health最新文献

Background: Tuberculosis remains a significant public health issue, particularly among children who are in close contact with tuberculosis patients. India accounts for a large proportion of global tuberculosis cases. Despite global recommendations for Isoniazid Preventive Therapy to prevent latent tuberculosis infection from progressing to active disease, the initiation and adherence to Isoniazid Preventive Therapy remain suboptimal, especially in high-burden settings. Understanding the barriers to Isoniazid Preventive Therapy implementation is crucial to improving treatment outcomes and achieving tuberculosis elimination goals.

Objectives: This study aimed to quantify the uptake of isoniazid among children under 6 years who were started on Isoniazid Preventive Therapy and to identify the challenges from the perspectives of caregivers and healthcare providers.

Methods: The study was conducted in a slum in Mumbai, India, from June to December 2023, using a mixed-methods design. The quantitative phase involved a house-to-house survey, covering all 96 contacts started on Isoniazid Preventive Therapy in 2022, using a semi-structured questionnaire. The qualitative phase included key informant interviews with healthcare providers and in-depth interviews with caregivers. Quantitative data were analysed using Fisher's exact test and chi-square test, while qualitative data were analysed thematically.

Results: Of the 96 children, 11 (11.45%) completed therapy, with an average treatment duration of 2.5 months. Quantitative findings highlighted fear of side effects and family migration as major reasons for discontinuation. Completion of chemoprophylaxis was significantly associated with factors like male gender, support from extended family, home visits by tuberculosis health staff, and shorter travel time (under 30 min) to the tuberculosis unit. Qualitative data revealed challenges across themes of supply, staff, training, services, and adherence. Key challenges included lack of awareness, unavailability of isoniazid in syrup form, inadequate training for health workers, weak program monitoring, insufficient staffing, and fears related to tuberculosis exposure during outpatient department visits.

Conclusion: Effective counselling, regular follow-ups, availability of medications in syrup form, increasing staffing based on case burden, timely training of staff, strengthening program monitoring, and ensuring infection control in tuberculosis outpatient departments are critical to achieving successful completion of isoniazid preventive therapy.

Background: The study aims to determine the host preference for blood feeding among potential hosts of Anopheles stephensi in Iran, using the Multiplex-PCR method. An. stephensi is the primary malaria vector in urban areas of South Asia and the Middle East, including southern Iran, where approximately 30.21% of malaria cases are urban. This trend has become more evident during the recent outbreaks in Iran, driven by infections of Plasmodium falciparum, Plasmodium vivax, and as well as mixed infections. Hormozgan province, one of the most endemic areas in Iran, was selected for its critical public health significance. This study builds on the validated efficiency of Multiplex-PCR for blood meal analysis by applying it to mosquitoes in southern Iran.

Methods: In 2021, mosquitoes were collected monthly from three coastal villages in Bandar Abbas county, Hormozgan province, using WHO-recommended collection methods. Blood-fed An. stephensi mosquitoes were dissected, and their stomach contents analysed via Multiplex-PCR to identify human and animal blood sources.

Results: Of 77 An. stephensi samples analysed, humans were the most common host was humans (29.9%), followed by mammals (19%), dogs (2.6%), and birds (1.3%). Mixed blood meals were detected in 34% of samples, including 23% with human and other hosts. Informal observations suggest that domestic animals such as goats, sheep, and chickens are commonly present near homes in these areas.

Conclusion: Approximately 50% of An. stephensi blood meals were sourced from humans, with 29% exclusively from humans and 23% from mixed hosts. Domestic animals such as goats, sheep, and chickens appear to attract mosquitoes, highlighting their potential role in malaria dynamics. Zooprophylaxis, alongside existing measures like insecticide residual spraying, insecticide-treated bed nets, and personal protection strategies, may strengthen urban malaria control. Further research on the ecological and behavioural drivers of mosquito host selection in urban settings is warranted.

Objective: Snakebite envenoming remains a public health threat in many tropical countries. While community knowledge of local snakes and snakebite first-aid and prevention are needed to reduce snakebite incidence and improve the outcomes for snakebite patients, it is poor in many communities. We assessed community health workers and community members regarding their knowledge on local snakes, snakebite first-aid and prevention in Neno district, Malawi.

Methods: In November 2022, we conducted a cross-sectional survey among 312 community health workers and 379 community members in the Neno District of Malawi to assess their knowledge of snake identification, snakebite first-aid, and prevention. Different questions were asked in these sections and summarised as linear scores ranging from 0% to 100%. Scores of 0%-49%, 50%-70%, and >70% were considered inadequate, fairly adequate, and adequate, respectively. Along with data collected during knowledge assessments, the socio-demographic characteristics of participants were collected. To assess knowledge differences between community health workers and community members, Pearson's chi-square or Fisher's exact tests were used, and linear regression was calculated to investigate possible predictors of knowledge.

Results: Overall, 66.6% of participants were females with a median age of 39 (IQR = 30-48) years. Of the 89% (n = 615) who agreed to view snake pictures, only 1.3% had adequate snake identification knowledge. Less than 5% (n = 33) had adequate knowledge of first aid measures, and 14.3% (n = 99) had adequate knowledge of prevention practices. Overall, less than 1% (n = 3) had adequate knowledge across the three assessment sections, with no significant difference between community health workers (n = 1, 0.3%) and community members (n = 2, 0.5%) (p > 0.949).

Conclusion: Both community health workers and community members had inadequate knowledge regarding local snake species, first aid for snakebites and prevention measures. The effect of awareness campaigns and other education initiatives could be explored to help improve these gaps.

Objective: Opisthorchis viverrini and cholangiocarcinoma have been recognised by the World Health Organisation as critical public health concerns, particularly in northeastern Thailand, where Opisthorchis viverrini is a significant cause of cholangiocarcinoma. This study examines the factors influencing Opisthorchis viverrini and cholangiocarcinoma prevention within the One Health framework in Kanthararom District, Sisaket Province, Thailand.

Methods: A cross-sectional study was conducted among 327 residents aged 20 and above, utilising a structured questionnaire to assess knowledge, attitudes, perceived self-efficacy and prevention behaviours. Data were analysed using descriptive statistics, Pearson's product-moment correlation coefficient and multiple regression analysis to identify relationships and predictors within the dataset.

Results: The results showed that 53.52% of participants had moderate knowledge and attitudes towards prevention, while perceived self-efficacy was generally high. Positive correlations were found between income, knowledge, attitudes, self-efficacy and prevention behaviours. Key predictors of Opisthorchis viverrini and cholangiocarcinoma prevention behaviours included attitudes towards human health (β = 0.212), perceived self-efficacy in human health (β = 0.211), attitudes towards animal health (β = 0.205) and knowledge about human health (β = 0.138), accounting for 24.40% of the variance in prevention behaviours. These predictors were statistically significant at 0.05 (F = 25.95; p <0.001).

Conclusion: The findings suggest that enhancing knowledge, attitudes and self-efficacy is crucial to improving Opisthorchis viverrini and cholangiocarcinoma prevention. This study underscores the need for integrated public health strategies incorporating human, animal and environmental health to reduce the prevalence of Opisthorchis viverrini and cholangiocarcinoma in high-risk regions.

Background: Rapid diagnostic tests for the serological detection of gambiense human African trypanosomiasis (gHAT) have been developed to overcome the limitations of the traditional screening method, CATT/T. b. gambiense. The Abbott Bioline human African trypanosomiasis (HAT) 2.0 rapid diagnostic test has recently been developed by Abbott using only recombinant antigens. The objective of this study was to evaluate its clinical sensitivity and specificity, in comparison with the other available rapid diagnostic tests and CATT.

Methodology/principal findings: For this study, archived plasma samples from 150 gHAT cases and 150 endemic controls originating from Chad, Guinea, the Democratic Republic of the Congo and Uganda were analysed on the following tests: CATT/T. b. gambiense, the HAT Sero K-SeT, SD BIOLINE HAT and Abbott Bioline HAT 2.0 rapid diagnostic tests, and the immune trypanolysis test. The sensitivity and specificity of Abbott Bioline HAT 2.0 were 96.7% and 78.4%, respectively, and the sensitivity and specificity of SD BIOLINE HAT were 99.3% and 74.1%. The sensitivity and specificity of CATT were 98.7% and 89.2%. The sensitivity and specificity of HAT Sero K-SeT were 99.3% and 81.3%.

Conclusions/significance: The sensitivity and specificity of the Abbott Bioline HAT 2.0 are comparable to those of its predecessors HAT Sero K-SeT and SD BIOLINE HAT. However, considering the decreasing prevalence of gHAT, a higher specificity of the tests used for screening is desirable to improve their positive predictive value.

Background: Ocular infections can harm the eye's anatomic structure on numerous levels. They are a global health issue. Endophthalmitis, a serious complication following cataract surgery, can result in substantial ocular morbidity and vision loss despite the administration of antibiotics. Bacterial ocular flora are the primary causative agents. This study aimed to assess the types of bacterial isolates on the external ocular surface and evaluate their antimicrobial susceptibility patterns in pre-operative cataract patients at Kafrelsheikh University Hospitals.

Methods: This cross-sectional study enrolled 691 patients scheduled for routine cataract surgery in the Department of Ophthalmology at Kafrelsheikh University Hospitals, Egypt. Each patient underwent a comprehensive assessment of medical history, including the use of traditional medicine, past eye trauma, and any prior eye surgeries, as well as ophthalmic clinical data such as visual acuity and ocular surface disorders. Conjunctival swabs were collected and processed using standard microbiological procedures to identify bacterial isolates and their respective antimicrobial susceptibility patterns.

Results: Among the 691 patients enrolled (median age 60 years, IQR 54-66), 59.8% were female. Conjunctival cultures yielded positive results in 38 cases (5.6%). The most frequently isolated organisms were Staphylococcus aureus, accounting for 52.6% of isolates, followed by Staphylococcus epidermidis at 15.8%. Notably, S. aureus demonstrated the highest resistance to erythromycin and vancomycin, with all 20 isolates showing resistance. In contrast, linezolid exhibited high efficacy, with 19 isolates showing sensitivity and only one displaying resistance.

Conclusion: This study indicated that ocular conditions such as dry eye syndrome, Meibomian gland dysfunction, and scaly blepharitis are strongly associated with the prevalence of culture-confirmed ocular infections. Regarding antibiotic susceptibility, most Staphylococcus species demonstrated the greatest sensitivity to linezolid and trimethoprim/sulfamethoxazole.

Background: Despite existing recommendations, there is still a scarcity of evidence on the impact of active case finding strategies versus passive case finding strategies, especially with regard to the mortality of tuberculosis patients. Therefore, our aim was to estimate the effect of case detection strategies on the prognosis of tuberculosis patients.

Methods: We conducted a retrospective cohort study of 160,384 new cases of tuberculosis patients diagnosed between 1 January 2010 and 31 August 2019 in the state of São Paulo, Brazil. We classified exposure into: passive case finding (emergency room, outpatient clinics or hospital settings) and active case finding (institutions, community or contact investigation). The primary outcome was all-cause mortality, and the secondary outcome was a composite outcome with treatment outcomes. We investigated associations using logistic regression, allowing for municipality-level random effects.

Results: Compared with outpatient passive case finding, passive case finding in the emergency room and in the hospital showed higher odds of death (adjusted odds ratio [OR] 3.69; 95% CI: 3.47-3.93 and 4.47; 95% CI: 4.22-4.74, respectively) and unfavourable treatment outcomes (1.92; 95% CI: 1.84-1.99 and 2.06; 95% CI: 1.98-2.14, respectively). By contrast, patients detected through community-based active case finding and contact investigation showed lower odds of death (0.77; 95% CI: 0.61-0.97 and 0.71; 95% CI: 0.54-0.92, respectively) and unfavourable treatment outcomes (0.85; 95% CI: 0.77-0.95 and 0.82; 95% CI: 0.74-0.91, respectively).

Conclusion: Community-based active case finding and contact investigation were associated with better prognosis than passive strategies in tuberculosis patients. Our results highlight the importance of strengthening active case finding as a fundamental part of mitigating the disease burden and controlling tuberculosis.

Objective: Extended-spectrum beta-lactamase-producing bacteria pose a significant threat to public health due to their resistance to commonly used antibiotics. This meta-analysis aims to determine the prevalence and distribution of extended-spectrum beta-lactamase-producing bacteria in Indonesia.

Methods: This systematic review and meta-analysis adhere to PRISMA guidelines to estimate the prevalence of extended-spectrum beta-lactamase-producing bacteria in Indonesia from 2008 to 2024. Systematic searches were conducted by PubMed, ScienceDirect, Google Scholar, and Index Medicus, and data were analyzed using a random-effects model to address heterogeneity.

Results: A systematic search yielded 1160 records. After duplicate removal and eligibility screening, 64 studies were included in the qualitative synthesis, and 48 were suitable for quantitative analysis. The pooled prevalence of extended-spectrum beta-lactamase-producing-producing bacteria in Indonesia was 46.38% (95% CI: 39.55%-53.21%) with significant heterogeneity (I² = 99.05%), reflecting substantial variability in methodologies, populations, and regional contexts. While Sumatra shows the highest prevalence at 63.99% (95% CI: 62.09%-65.89%) and Kalimantan the lowest at 15.24% (95% CI: 9.45%-21.02%), these findings must be interpreted with caution due to the significant heterogeneity. In hospitals, the prevalence was 47.13% (95% CI: 39.71%-54.54%), and in community was 47.26% (95% CI: 26.47%-59.95%). Adults had a higher prevalence (44.56%, 95% CI: 35.48%-53.64%) than children (32.38%, 95% CI: 20.85%-43.91%). The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli was 57.84% (95% CI: 45.97%-69.72%), and Klebsiella pneumoniae was 51.03% (95% CI: 41.19%-60.86%).

Conclusion: These findings highlight the urgent need for stringent infection control measures, tailored surveillance programmes, and effective antibiotic stewardship in Indonesia to mitigate the impact of extended-spectrum beta-lactamase-producing bacteria on public health. The substantial heterogeneity underscores the complexity of antimicrobial resistance epidemiology in Indonesia, necessitating cautious interpretation of pooled prevalence and standardised methodologies for future research to ensure accurate prevalence estimates.

Objective: Chagas disease can cause several complications, such as Chagas cardiomyopathy, the most severe clinical form of the disease. Chagas cardiomyopathy is complex and involves biological and psychosocial factors that can compromise health-related quality of life. However, it is necessary to establish interactions that significantly impact the health-related quality of life of this population. Therefore, we aimed to develop and present a theoretical model on the impact of Chagas cardiomyopathy on the health-related quality of life of patients.

Methods: This is a cross-sectional study with a multi-methodology approach. The model's development process relied on the findings of a systematic review of qualitative studies, as well as a qualitative study involving participants from original communities, conventional rural areas and urban centres. Patients diagnosed with Chagas cardiomyopathy were interviewed using a semistructured research script, and the sample size was determined by theoretical saturation. Ultimately, the model underwent evaluation and received approval from three specialists in Chagas cardiomyopathy.

Results: Patients experience many emotional conflicts, manifested by feelings of sadness, existential emptiness and anxiety. They have fears related to the course of the disease, the inability to care for the people they love, their suffering and that of the family caregivers, as well as the fear of invasive treatments and death. The model based on social determinants of health was created and presented three different levels of factors that impact patients' health-related quality of life. At the first and most external level are social, cultural and environmental conditions: absence from work, difficulties in accessing healthcare services, limited resources for specialised care and geographical barriers to accessing healthcare services. At a more internally committed level, there are social factors and community networks encompassing social isolation, family conflicts, social stigma, emotional aspects, fears and disabilities. The innermost layer of factors represents personal and behavioural complaints, such as physical ailments and poor sleep quality.

Conclusion: The factors that affect the health-related quality of life of patients with Chagas cardiomyopathy are diverse in their biopsychosocial nature.

Background: The ADAPT guidance proposes a process model for adapting evidence-informed interventions to novel contexts. Herein, we leveraged this guidance to adapt a paediatric nighttime telemedicine and medication delivery service from Haiti, a setting with low malaria prevalence, to Ghana, where malaria is a leading cause of paediatric mortality.

Methods: Core components of the intervention were defined and conserved. Discretionary components were identified and considered for adaptation. The service was defined by a workflow involving a call from a guardian of a sick child, a telemedicine assessment, referral of severe cases, and medication delivery/in-person assessments for non-severe cases. Key adaptations related to partner organisation (private to public/government), clinician type (nurse to emergency medical technician), user fees (sliding scale to none), and point-of-care testing (none to malaria rapid diagnostic testing). The adapted model was implemented in Jamestown and Usshertown, Ghana, on 16 November 2022 as part of a 12-month study to evaluate implementation outcomes and the role of the telemedicine assessment. Empiric thresholds for safety and feasibility were set a priori and served as benchmarks for this study and points of iteration for future studies.

Results: In the first year of implementation, 517 cases were enrolled; 492 were included in the analysis, 96% of which were reached at 10-day follow-up. Safety and feasibility thresholds were met. 98% of febrile cases received rapid diagnostic testing for malaria; 4% tested positive. At 10 days, 97% of cases were improving/well, and no severe adverse events were reported. The median lengths of the telemedicine assessment, time to delivery, and in-person assessments were 9, 49, and 43 min, respectively. 99% of participants expressed interest in using the service again. There was fair congruence between paired telemedicine and in-person assessments for vital sign assessments and mild/moderate triage decisions.

Conclusions: A nighttime paediatric telemedicine and medication delivery service adapted and implemented per the ADAPT Guidance met a priori-defined safety and feasibility metrics in the malaria-endemic country of Ghana. The role of telemedicine in assessing vital signs and informing mild versus moderate triage decisions may be limited.

Trial registration: This study was registered on Clinicaltrials.gov on 8/17/2022 (NCT05506683).